1 00:00:11,440 --> 00:00:13,640 Welcome to the Clinical Center Grand Rounds, 2 00:00:13,640 --> 00:00:17,440 a weekly series of educational lectures for physicians and 3 00:00:17,440 --> 00:00:20,080 health care professionals broadcast from the Clinical 4 00:00:20,080 --> 00:00:23,040 Center at the National Institutes of Health in 5 00:00:23,040 --> 00:00:24,840 Bethesda, MD. 6 00:00:24,840 --> 00:00:28,400 The NIH Clinical Center is the world's largest hospital totally 7 00:00:28,400 --> 00:00:32,080 dedicated to investigational research and leads the global 8 00:00:32,080 --> 00:00:35,040 effort in training today's investigators and discovering 9 00:00:35,040 --> 00:00:37,200 tomorrow's cures. 10 00:00:37,200 --> 00:00:46,400 Learn more by visiting us online at http://clinicalcenter.nih.gov 11 00:00:46,400 --> 00:00:49,840 WELCOME TO THIS MONTH'S CLINICAL 12 00:00:49,840 --> 00:00:50,520 CENTER GRAND ROUNDS. 13 00:00:50,520 --> 00:00:52,120 THIS IS NATIONAL NURSING MONTH 14 00:00:52,120 --> 00:00:55,600 WHERE WE TAKE THE TIME TO 15 00:00:55,600 --> 00:00:57,840 CELEBRATE NURSES AND ALL THERE 16 00:00:57,840 --> 00:00:59,120 ACHIEVEMENTS AND 17 00:00:59,120 --> 00:00:59,480 ACCOMPLISHMENTS. 18 00:00:59,480 --> 00:01:01,840 MY NAME IS SABRINA WONG, I AM 19 00:01:01,840 --> 00:01:03,920 THE SCIENTIFIC DIRECTOR OF THE 20 00:01:03,920 --> 00:01:07,600 NATIONAL INSTITUTE OF NURSING 21 00:01:07,600 --> 00:01:08,280 RESEARCH DIVISION OF INTRAMURAL 22 00:01:08,280 --> 00:01:12,360 RESEARCH AND I'M DELIGHTED TO BE 23 00:01:12,360 --> 00:01:14,560 HERE ON BEHALF OF THE NATIONAL 24 00:01:14,560 --> 00:01:15,480 INSTITUTE OF NURSING RESEARCH 25 00:01:15,480 --> 00:01:19,800 WHO IS HOSTING THIS MONTH'S 26 00:01:19,800 --> 00:01:20,280 GRAND ROUNDS. 27 00:01:20,280 --> 00:01:23,640 THE NINR AND 1 OF 27 NIH 28 00:01:23,640 --> 00:01:24,720 INSTITUTES AND CENTERS. 29 00:01:24,720 --> 00:01:29,120 SINCE ITS FOUNDING NINR HAS 30 00:01:29,120 --> 00:01:29,880 SUPPORTED RESEARCH THAT 31 00:01:29,880 --> 00:01:31,320 DEVELOPED THE SCIENTIFIC BASIS 32 00:01:31,320 --> 00:01:33,280 FOR CLINICAL PRACTICE AND 33 00:01:33,280 --> 00:01:34,120 POLICY. 34 00:01:34,120 --> 00:01:37,000 WHAT SETS NINR APART FROM OTHER 35 00:01:37,000 --> 00:01:39,960 NIH INSTITUTES IS NAOUR RESEARCH 36 00:01:39,960 --> 00:01:42,120 WITH OUR NURSING PERSPECTIVE AT 37 00:01:42,120 --> 00:01:43,960 ITS CORE IS FOCUSED ON HEALTH 38 00:01:43,960 --> 00:01:45,240 SOLUTIONS FOR PEOPLE IN THE 39 00:01:45,240 --> 00:01:47,320 CONTEXT OF THEIR LIVES AND 40 00:01:47,320 --> 00:01:49,600 LIVING CONDITIONS AND ACROSS THE 41 00:01:49,600 --> 00:01:52,240 MANY SETTINGS WHERE NURSES 42 00:01:52,240 --> 00:01:52,520 PRACTICE. 43 00:01:52,520 --> 00:01:55,200 OUR STRATEGIC PLAN WAS RELEASED 44 00:01:55,200 --> 00:01:59,080 LAST YEAR ON NATIONAL NURSES DAY 45 00:01:59,080 --> 00:01:59,280 2022. 46 00:01:59,280 --> 00:02:01,160 IT DESCRIBES HOW WE WANT TO 47 00:02:01,160 --> 00:02:02,720 LEVERAGE THE STRENGTHS AND THE 48 00:02:02,720 --> 00:02:04,160 UNIQUE KNOWLEDGE AND 49 00:02:04,160 --> 00:02:05,480 PERSPECTIVES INHERENT IN OUR 50 00:02:05,480 --> 00:02:09,720 DISCIPLINE TO THE BENEFIT OF ALL 51 00:02:09,720 --> 00:02:13,000 PEOPLE THE NINR STRATEGIC 52 00:02:13,000 --> 00:02:14,240 STRATEGY, SCIENTIFIC STRATEGY 53 00:02:14,240 --> 00:02:16,040 IDENTIFIES 5 LENSES THAT WE 54 00:02:16,040 --> 00:02:17,840 THINK BEST LEVERAGE THE 55 00:02:17,840 --> 00:02:19,280 STRENGTHS OF NURSING SCIENCE TO 56 00:02:19,280 --> 00:02:21,520 INNOVATE, THINK BIGGER AND 57 00:02:21,520 --> 00:02:22,600 GREATLY INCREASE OUR IMPACT. 58 00:02:22,600 --> 00:02:25,640 THE LENSES IN THE STRATEGIC PLAN 59 00:02:25,640 --> 00:02:27,840 ARE HEALTH EQUITY, SOCIAL 60 00:02:27,840 --> 00:02:29,000 DETERMINANTS OF HEALTH, 61 00:02:29,000 --> 00:02:32,080 POPULATION AND COMMUNITY HEALTH, 62 00:02:32,080 --> 00:02:33,120 PREVENTION AND HEALTH PROMOTION 63 00:02:33,120 --> 00:02:35,040 AND SYSTEMS AND MODELS OF CARE. 64 00:02:35,040 --> 00:02:37,320 IN ADDITION TO LEVERAGING THE 65 00:02:37,320 --> 00:02:39,960 STREAMS OF NURSING RESEARCH, THE 66 00:02:39,960 --> 00:02:42,440 LENSES PROMOTE MULTILEVEL 67 00:02:42,440 --> 00:02:44,480 APPROACHES CROSS DISCIPLINEAR 68 00:02:44,480 --> 00:02:45,600 EXPE CROSS SECTORAL 69 00:02:45,600 --> 00:02:49,600 COLLABORATION AND COMMUNITY 70 00:02:49,600 --> 00:02:50,240 ENGAGEMENT AND RESEARCH YOU CAN 71 00:02:50,240 --> 00:02:52,240 FIND MORE ABOUT THE FULL 72 00:02:52,240 --> 00:02:57,400 STRATEGIC PLAN ON OUR WEBSITE 73 00:02:57,400 --> 00:02:57,960 NINR.NIH.GOV. 74 00:02:57,960 --> 00:02:59,400 NOW, FOR WHAT YOU'VE ALL BEEN 75 00:02:59,400 --> 00:03:00,080 WAITING FOR. 76 00:03:00,080 --> 00:03:05,000 I WOULD LIKE TO INTRODUCING 77 00:03:05,000 --> 00:03:08,160 DR. HUDSON SANTOS, WHO IS AN 78 00:03:08,160 --> 00:03:09,040 INTERNATIONAL RENOWNED NURSE 79 00:03:09,040 --> 00:03:10,600 KNOWN FOR HIS WORK IN SOCIAL 80 00:03:10,600 --> 00:03:12,480 DETERMINANTS OF HEALTH AND 81 00:03:12,480 --> 00:03:13,840 ADVERSE LIFE EVENTS, 82 00:03:13,840 --> 00:03:16,560 PARTICULARLY AMONG LATIN X 83 00:03:16,560 --> 00:03:17,520 COMMUNITIES. 84 00:03:17,520 --> 00:03:20,280 DR. SANTOS, IS THE DELORES J. 85 00:03:20,280 --> 00:03:21,280 [INDISCERNIBLE] ENDOWED CHAIR 86 00:03:21,280 --> 00:03:22,280 AND ASSOCIATE DEAN FOR RESEARCH 87 00:03:22,280 --> 00:03:23,560 AT THE UNIVERSITY OF MIAMI 88 00:03:23,560 --> 00:03:25,160 SCHOOL OF NURSING AND HEALTH 89 00:03:25,160 --> 00:03:25,640 STUDIES. 90 00:03:25,640 --> 00:03:28,480 HE WAS BORN IN BRAZIL AND 91 00:03:28,480 --> 00:03:31,360 OBTAINED A BACHELOR OF SCIENCE 92 00:03:31,360 --> 00:03:34,360 AND NURSING THROUGH THE STATE 93 00:03:34,360 --> 00:03:37,040 UNIVERSITY OF PERIDOT, AND A 94 00:03:37,040 --> 00:03:39,360 Ph.D. FROM THE UNIVERSITY OF 95 00:03:39,360 --> 00:03:42,280 SALL P A OLO, AND COMPLETED A 96 00:03:42,280 --> 00:03:44,240 POST DOC AT DUKE UNIVERSITY. 97 00:03:44,240 --> 00:03:46,320 BEFORE JOINING THE UNIVERSITY OF 98 00:03:46,320 --> 00:03:48,760 MIAMI, HE WAS A TERMED 99 00:03:48,760 --> 00:03:49,440 DISTINGUISHED SCHOLAR, ASSOCIATE 100 00:03:49,440 --> 00:03:52,040 DIRECTOR AND DIRECTOR OF THE 101 00:03:52,040 --> 00:03:57,760 BIOBEHAVIORIAL LABORATORY AT THE 102 00:03:57,760 --> 00:04:00,840 UNIVERSITY OF CAR O LINEA AT 103 00:04:00,840 --> 00:04:01,320 CHAPEL HILL. 104 00:04:01,320 --> 00:04:03,040 HE WORKS ON CLINICAL 105 00:04:03,040 --> 00:04:05,840 INTERVENTIONS TO UNDERSTAND THE 106 00:04:05,840 --> 00:04:06,560 RELATIONSHIP BETWEEN BIOLODGE 107 00:04:06,560 --> 00:04:08,960 XAL AND SOCIAL FACTORS IN 108 00:04:08,960 --> 00:04:11,040 DETERMINING HEALTH AND DISEASE 109 00:04:11,040 --> 00:04:11,520 OUTCOMES. 110 00:04:11,520 --> 00:04:14,600 HIS WORK AIMS TO BRIDGE THE GAP 111 00:04:14,600 --> 00:04:16,760 BETWEEN BIOLOGICAL AND SOCIAL 112 00:04:16,760 --> 00:04:19,640 DOMAINS IN NURSING SCIENCE AND 113 00:04:19,640 --> 00:04:21,120 ADDRESS THE DEVELOPMENTAL 114 00:04:21,120 --> 00:04:23,800 ORIGINS OF HEALTH AND DISEASE. 115 00:04:23,800 --> 00:04:25,200 DR. SANTOS TODAY WILL BE 116 00:04:25,200 --> 00:04:27,080 DESCRIBING THE IMPORTANCE OF 117 00:04:27,080 --> 00:04:28,440 IDENTIFYING AND ADDRESSING 118 00:04:28,440 --> 00:04:30,280 BIOLODGE XAL EMBEDDING 119 00:04:30,280 --> 00:04:31,840 CONSEQUENCES FROM SOCIAL 120 00:04:31,840 --> 00:04:32,400 ADVERSITY SUCH AS 121 00:04:32,400 --> 00:04:36,840 DISCRIMINATION, AS A PATHWAY TO 122 00:04:36,840 --> 00:04:37,960 ACHIEVE HEALTH EQUITY. 123 00:04:37,960 --> 00:04:41,080 OVER TO YOU DR. SANTOS. 124 00:04:41,080 --> 00:04:44,600 SO I APPRECIATE THE INVITATION 125 00:04:44,600 --> 00:04:47,080 TO THIS SPEAK TOW THE NIH 126 00:04:47,080 --> 00:04:47,960 CLINICAL GRAND ROUNDS TODAY. 127 00:04:47,960 --> 00:04:53,920 IT IS A PRIVILEGE AS WE HAVE 128 00:04:53,920 --> 00:04:55,600 BENEFITED HIGHLY FROM THE 129 00:04:55,600 --> 00:04:58,360 KNOWLEDGE AS WELL AS THE FUNDING 130 00:04:58,360 --> 00:05:01,320 OPPORTUNITIES THAT COME FROM THE 131 00:05:01,320 --> 00:05:01,560 NIH. 132 00:05:01,560 --> 00:05:05,560 SO TODAY I AM GOING TO BE 133 00:05:05,560 --> 00:05:08,400 FOCUSING ON BIOLOGICAL EMBEDDING 134 00:05:08,400 --> 00:05:09,560 AND ITS IMPORTANCE TO HEALTH 135 00:05:09,560 --> 00:05:11,000 EQUITY BUT IESM NOT GOING TO BE 136 00:05:11,000 --> 00:05:14,440 PROVIDING A WHOLE LOT OF ANSWERS 137 00:05:14,440 --> 00:05:17,600 ABOUT ANY OF THOSE TOPICS. 138 00:05:17,600 --> 00:05:22,680 MY GOAL IS REALLY TRY TO HAVE A 139 00:05:22,680 --> 00:05:25,160 CONVERSATION THAT WE CAN FURTHER 140 00:05:25,160 --> 00:05:28,240 DEVELOP INTO RESEARCH IDEAS AND 141 00:05:28,240 --> 00:05:33,040 ACTIONS TO PROMOTE CHANGE. 142 00:05:33,040 --> 00:05:35,280 SO FIRST OF ALL I HAVE NO 143 00:05:35,280 --> 00:05:36,200 FINANCIAL RELATIONSHIPS FOR TO 144 00:05:36,200 --> 00:05:44,160 DISCLOSE AND WE WILL ALSO TALK 145 00:05:44,160 --> 00:05:46,160 ABOUT NO OFFLINE DRUGS DURING 146 00:05:46,160 --> 00:05:46,560 THIS PRESENTATION. 147 00:05:46,560 --> 00:05:48,120 AND THE LEARNING OBJECTIVES AND 148 00:05:48,120 --> 00:05:52,480 TO DESCRIBE THE RELEVANCE OF 149 00:05:52,480 --> 00:05:55,640 BIOLOGICAL, HEALTH NATURE, 150 00:05:55,640 --> 00:05:58,120 EQUITY AND BIOLOGICAL EMBEDDING 151 00:05:58,120 --> 00:06:04,120 AND HEALTH EQUITY AS A RESULT. 152 00:06:04,120 --> 00:06:05,680 SO BEFORE I GET TOO FAR DOWN THE 153 00:06:05,680 --> 00:06:07,320 ROAD, I WANT TO MAKE SURE WE ARE 154 00:06:07,320 --> 00:06:12,840 ALL ON THE SAME PAGE SO WE ARE 155 00:06:12,840 --> 00:06:14,400 GOING TO [INDISCERNIBLE] LET ME 156 00:06:14,400 --> 00:06:18,000 BEGIN WITH DEFINITION OF SOCIAL 157 00:06:18,000 --> 00:06:19,120 DETERMINANTS OF HEALTH AND BY 158 00:06:19,120 --> 00:06:21,880 THE WAY THESE DEFINITIONS ARE 159 00:06:21,880 --> 00:06:25,200 NOT NECESSARILY SET IN STONE. 160 00:06:25,200 --> 00:06:29,280 WE'VE HAD RESEARCHERS THAT 161 00:06:29,280 --> 00:06:30,000 BASICALLY MIGHT HAVE DIFFERENT 162 00:06:30,000 --> 00:06:30,840 DEFINITIONS BUT THOSE ARE THE 1S 163 00:06:30,840 --> 00:06:35,520 THAT I WILL BE USING FOR THE 164 00:06:35,520 --> 00:06:36,520 PRESENTATION. 165 00:06:36,520 --> 00:06:39,160 SO SOCIAL DETERMINANTS OF 166 00:06:39,160 --> 00:06:40,760 HEALTH, IT'S THE CONDITIONS IN 167 00:06:40,760 --> 00:06:42,640 THE ENVIRONMENTS AND THE 168 00:06:42,640 --> 00:06:43,720 ENVIRONMENTS WHERE PEOPLE ARE 169 00:06:43,720 --> 00:06:46,200 BORN, LIVE, LEARN, WORK, PLAY, 170 00:06:46,200 --> 00:06:48,920 WORSHIP AND AGE THAT AFFECT A 171 00:06:48,920 --> 00:06:51,120 WIDE RANGE OF HEALTH, 172 00:06:51,120 --> 00:06:52,280 FUNCTIONING AS WELL AS QUALITY 173 00:06:52,280 --> 00:06:56,400 OF LIFE OUTCOMES AND RISKS. 174 00:06:56,400 --> 00:06:57,560 SOCIAL DETERMINANTS OF HEALTH, 175 00:06:57,560 --> 00:07:01,960 HOWEVER, IS NOT NECESSARILY GOOD 176 00:07:01,960 --> 00:07:03,600 OR BAD. 177 00:07:03,600 --> 00:07:04,720 THEY'RE JUST DETERMINANTS. 178 00:07:04,720 --> 00:07:09,240 A DETERMINANT CAN HAVE A 179 00:07:09,240 --> 00:07:10,520 SPECTRUM OF BOTH GOOD SIDE AND 180 00:07:10,520 --> 00:07:12,560 NEGATIVE SIDE. 181 00:07:12,560 --> 00:07:14,920 SO REALLY AS THESE PRESENTATIONS 182 00:07:14,920 --> 00:07:17,680 WERE SPEAKING OF SOCIAL 183 00:07:17,680 --> 00:07:20,280 DETERMINANTS THAT INCLUDE 184 00:07:20,280 --> 00:07:24,240 [INDISCERNIBLE] HEALTH, IN THOSE 185 00:07:24,240 --> 00:07:25,920 DIRECTIONS, EITHER POSITIVELY OR 186 00:07:25,920 --> 00:07:26,400 NEGATIVELY. 187 00:07:26,400 --> 00:07:28,560 THE NEXT DEFINITION IS 188 00:07:28,560 --> 00:07:29,280 BIOLOGICAL EMBEDDING WHICH 189 00:07:29,280 --> 00:07:32,360 REALLY IS A PROCESS BY WHICH THE 190 00:07:32,360 --> 00:07:34,320 SOCIAL FACTORS FROM SOCIAL 191 00:07:34,320 --> 00:07:36,840 DETERMINANTS OF HEALTH AS WELL 192 00:07:36,840 --> 00:07:39,280 AS EXPERIENCES CAN BECOME 193 00:07:39,280 --> 00:07:42,120 BIOLOGICAL INTEGRATED TO 194 00:07:42,120 --> 00:07:42,680 INFLUENCE HEALTH OUTCOMES. 195 00:07:42,680 --> 00:07:45,320 REALLY WHEN WE SOCIAL LITERATURE 196 00:07:45,320 --> 00:07:50,680 YOU WILL GET THINGS LIKE GETTING 197 00:07:50,680 --> 00:07:52,400 A MESSAGE LIKE THINGS GETTING 198 00:07:52,400 --> 00:07:53,800 UNDER THEIR SKIN SO THAT'S 199 00:07:53,800 --> 00:07:58,400 BASICALLY WHAT WE MINE BY 200 00:07:58,400 --> 00:07:58,840 BIOSOCIAL EMBEDDING. 201 00:07:58,840 --> 00:08:00,240 AND HEALTH EQUITY WHICH IS A BIT 202 00:08:00,240 --> 00:08:03,000 MORE COMPLEX DEFINITION BUT FOR 203 00:08:03,000 --> 00:08:04,520 THIS PRESENTATION, IT IS REALLY 204 00:08:04,520 --> 00:08:09,680 THE PRINCIPLE ON THE LINE, A 205 00:08:09,680 --> 00:08:13,000 COMMITMENT TO REDUCE AND 206 00:08:13,000 --> 00:08:13,720 ULTIMATELY ELIMINATE DISPARITIES 207 00:08:13,720 --> 00:08:16,960 IN HEALTH AND DETERMINANTS SUCH 208 00:08:16,960 --> 00:08:20,400 AS SOCIAL, ECONOMIC AND 209 00:08:20,400 --> 00:08:20,920 ENVIRONMENTAL FACTORS. 210 00:08:20,920 --> 00:08:23,800 WITH THOSE 3 DEFINITIONS, WE ARE 211 00:08:23,800 --> 00:08:25,440 GOING TO INTEGRATE THEM IN 212 00:08:25,440 --> 00:08:26,280 DIFFERENT SESSIONS, YOU GET TO 213 00:08:26,280 --> 00:08:30,840 THE POINT OF THE PRESENTATION, 214 00:08:30,840 --> 00:08:36,520 FOR EXAMPLE, CHRONIC STRESS, IN 215 00:08:36,520 --> 00:08:39,480 THIS SITUATION WILL BE SOCIAL 216 00:08:39,480 --> 00:08:41,080 DETERMINANTS OF HEALTH CAN LEAD 217 00:08:41,080 --> 00:08:44,520 TO LONG-TERM HEALTH PROBLEMS 218 00:08:44,520 --> 00:08:45,320 LIKE HEART DISEASE. 219 00:08:45,320 --> 00:08:48,240 ANOTHER EXAMPLE, LOW LEVELS OF 220 00:08:48,240 --> 00:08:52,280 EDUCATION, ARE ASSOCIATED WITH 221 00:08:52,280 --> 00:08:53,480 POOR HEALTH OUTCOMES AND SO ON 222 00:08:53,480 --> 00:08:56,200 AND O FORTH. 223 00:08:56,200 --> 00:08:58,080 SO BIOLOGIC EMBEDDING CAN LEAD 224 00:08:58,080 --> 00:09:00,120 TO THOSE HEALTH INIQUITIES AND 225 00:09:00,120 --> 00:09:02,400 FOR INSTANCE THOSE WITH SOCIAL 226 00:09:02,400 --> 00:09:04,120 ECONOMIC GROUPS MIGHT EXPERIENCE 227 00:09:04,120 --> 00:09:06,520 SOME CHRONIC STRESS WHICH CAN 228 00:09:06,520 --> 00:09:11,200 LEAD TO POORER HEALTH OUTCOMES, 229 00:09:11,200 --> 00:09:13,880 HEALTH EQUITY, AIM TO CORRECT 230 00:09:13,880 --> 00:09:14,800 THOSE DISPARITIES, WITH THAT 231 00:09:14,800 --> 00:09:17,120 SAID, I HOPE WE ARE ALL ON THE 232 00:09:17,120 --> 00:09:18,880 SAME PAGE IN TERMS OF WHAT ARE 233 00:09:18,880 --> 00:09:21,640 WE GOING TO BE DISCUSSING AND I 234 00:09:21,640 --> 00:09:25,800 DON'T WANT TO NECESSARILY 235 00:09:25,800 --> 00:09:27,560 REINVENT THE WHEEL, OF SOCIAL 236 00:09:27,560 --> 00:09:29,160 DETERMINANTS OF HEALTH AS WELL 237 00:09:29,160 --> 00:09:31,680 AS HEALTH EQUITY, I THINK THE 238 00:09:31,680 --> 00:09:33,200 NATIONAL CENTER OF NURSING 239 00:09:33,200 --> 00:09:35,000 RESEARCH HAS DONE A TREMENDOUS 240 00:09:35,000 --> 00:09:39,280 JOB OVER THE LAST COUPLE OF 241 00:09:39,280 --> 00:09:43,760 MONTHS AND SETTING UP THE 242 00:09:43,760 --> 00:09:44,400 NINR DIRECTOR'S LECTURE SERIES, 243 00:09:44,400 --> 00:09:45,080 WITH SEVERAL TOP INCREASE IN 244 00:09:45,080 --> 00:09:47,040 BODYS BUT 2 OF THEM WERE 245 00:09:47,040 --> 00:09:52,800 DIRECTLY RELATED TO THIS 246 00:09:52,800 --> 00:09:53,120 PRESENTATION. 247 00:09:53,120 --> 00:09:55,240 SO THE FIRST TOPIC IS SOCIAL 248 00:09:55,240 --> 00:09:56,920 DETERMINANTS OF HEALTH AND I 249 00:09:56,920 --> 00:09:57,960 HAVE PROVIDED HERE A SCREEN SHOT 250 00:09:57,960 --> 00:10:01,360 SO THAT YOU CAN SEE THAT THEY 251 00:10:01,360 --> 00:10:04,080 HAVE THE TIME AS WELL AS THE 252 00:10:04,080 --> 00:10:06,400 LINK TO THE YouTUBE CHANNEL 253 00:10:06,400 --> 00:10:10,040 AND THE SECOND LECTURE IS HEALTH 254 00:10:10,040 --> 00:10:11,240 EQUITY, AGAIN, IA SCREEN SHOT IN 255 00:10:11,240 --> 00:10:15,680 TIME, AS WELL AS THE LINK TO THE 256 00:10:15,680 --> 00:10:16,640 YouTUBE CHANNEL SO YOU CAN GO 257 00:10:16,640 --> 00:10:21,000 THERE AND GET A BETTER MORE 258 00:10:21,000 --> 00:10:23,600 COMPREHENSIVE LECTURE IN THOSE 2 259 00:10:23,600 --> 00:10:32,960 TOP INCREASE IN BODYS. 260 00:10:32,960 --> 00:10:35,320 BY WAY OF SOCIAL DETERMINANTS AS 261 00:10:35,320 --> 00:10:39,920 WELL AS HEALTH EQUITY. 262 00:10:39,920 --> 00:10:47,520 SO AS A REMINDER I'M A NURSE BY 263 00:10:47,520 --> 00:10:51,080 TRAINING A LOT OF TIMES I PAY 264 00:10:51,080 --> 00:10:52,160 ATTENTION TO THE NATIONAL 265 00:10:52,160 --> 00:10:53,520 INTUITYS OF RESEARCH AND I TRY 266 00:10:53,520 --> 00:10:55,840 TO MATCH MY RESEARCH TO SUPPORT 267 00:10:55,840 --> 00:10:59,720 THAT MISSION OF THE 268 00:10:59,720 --> 00:11:00,720 EN--STRATEGIESITUTE SO THE 269 00:11:00,720 --> 00:11:04,800 INSTITUTE HAS RECENTLY COME UP 270 00:11:04,800 --> 00:11:09,480 WITH A NEW STRATEGIC PLAN AND 271 00:11:09,480 --> 00:11:15,120 THERE ARE 2 LENSES AND THESE 272 00:11:15,120 --> 00:11:17,320 COLUMNS ARE THE DIFFERENT AREAS 273 00:11:17,320 --> 00:11:20,280 OF PRIORITY, THIS 1 OF COURSE 274 00:11:20,280 --> 00:11:21,440 HEALTH EQUITY, SECOND 1 SOCIAL 275 00:11:21,440 --> 00:11:24,640 DETERMINANTS OF HEALTH AND THEN 276 00:11:24,640 --> 00:11:25,480 POPULATION HEALTH, PREVENTION 277 00:11:25,480 --> 00:11:30,800 HEALTH PROMOTION AND SYSTEMS AND 278 00:11:30,800 --> 00:11:31,560 MODELS OF CARE. 279 00:11:31,560 --> 00:11:41,400 AND HOWEVER, THOSE LAST 3 280 00:11:41,400 --> 00:11:44,280 OOLINGS REALLY A CROSS CUTTING 281 00:11:44,280 --> 00:11:45,440 THEME FOR A BASIC STRATEGIC PLAN 282 00:11:45,440 --> 00:11:47,080 AND OF COURSE I AM EXCITED FOR 283 00:11:47,080 --> 00:11:48,160 THESE BECAUSE THESE ARE 284 00:11:48,160 --> 00:11:50,440 SOMETHING THAT MY TEAM HAS 285 00:11:50,440 --> 00:11:52,480 INVESTED A LOT OF TIME AND 286 00:11:52,480 --> 00:11:55,120 EFFORT OVER THE LAST DECADE OR 287 00:11:55,120 --> 00:11:55,960 SO. 288 00:11:55,960 --> 00:11:58,320 BUT OF COURSE, I'M BIASED AND 289 00:11:58,320 --> 00:12:07,480 THIS IS WHAT I'M BIASED, SO, ALL 290 00:12:07,480 --> 00:12:08,880 WORK WILL BE IN A LOT OF 291 00:12:08,880 --> 00:12:10,520 EXAMPLES I WILL PRESENT TODAY 292 00:12:10,520 --> 00:12:12,040 WILL BE RELATED TO INFANT AND 293 00:12:12,040 --> 00:12:14,400 CHILDHOOD HEGHT AND THAT'S 294 00:12:14,400 --> 00:12:18,320 BECAUSE THIS IS AN AREA THAT MY 295 00:12:18,320 --> 00:12:22,480 TEAM CONCENTRATED EFFORT AND TRY 296 00:12:22,480 --> 00:12:24,800 TO DEVELOP KNOWLEDGE SO, FOR 297 00:12:24,800 --> 00:12:25,520 EXAMPLE, WE ARE--WEB CONNECTED 298 00:12:25,520 --> 00:12:28,960 SPEND A LOT OF TIME TRYING TO 299 00:12:28,960 --> 00:12:31,200 UNDERSTAND SOCIAL ECONOMIC 300 00:12:31,200 --> 00:12:33,080 DIVERSITY AND HOW THAT SOCIAL 301 00:12:33,080 --> 00:12:37,600 ECONOMIC ADVERSITY IS NOT 302 00:12:37,600 --> 00:12:38,520 GETTING--AFFECTING MOTHER AND 303 00:12:38,520 --> 00:12:44,560 CHILD AND FETAL CHILD HEALTH. 304 00:12:44,560 --> 00:12:46,440 EVEN BEFORE A CHILD IS BORN AND 305 00:12:46,440 --> 00:12:51,200 HOW DOES THAT AFFECT EARLY LIFE 306 00:12:51,200 --> 00:12:55,160 AND HELP DETERMINE WHO WILL HAVE 307 00:12:55,160 --> 00:12:56,560 DIFFERENT HEALTH OUTCOMES OVER 308 00:12:56,560 --> 00:12:57,120 THE LONG-TERM. 309 00:12:57,120 --> 00:13:00,080 WITH THE GOAL OF TRYING TO 310 00:13:00,080 --> 00:13:02,240 UNDERSTAND THE PROCESS, CAN WE 311 00:13:02,240 --> 00:13:05,080 HELP SOMEONE STAY HEALTHY 312 00:13:05,080 --> 00:13:08,200 DESPITE LIVING THROUGH SOCIAL 313 00:13:08,200 --> 00:13:09,360 ECONOMIC AND DIVERSITY. 314 00:13:09,360 --> 00:13:14,080 IF SO, WHAT ARE THE PROCESSES 315 00:13:14,080 --> 00:13:15,200 THAT WE HAVE [INDISCERNIBLE] TO 316 00:13:15,200 --> 00:13:18,640 HELP THAT PERSON MAINTAIN 317 00:13:18,640 --> 00:13:19,280 OPTIMUM HEALTH. 318 00:13:19,280 --> 00:13:22,160 BECAUSE ALTHOUGH IT SOUNDS IDEAL 319 00:13:22,160 --> 00:13:26,400 TO CHANGE THIS, ALL THE SOCIAL 320 00:13:26,400 --> 00:13:30,440 ECONOMIC ADVERSITY THAT WE 321 00:13:30,440 --> 00:13:31,640 ENCOUNTER, IS ACTUALLY HARD AND 322 00:13:31,640 --> 00:13:34,040 WILL TAKE YEARS, SO IN THE MEAN 323 00:13:34,040 --> 00:13:36,240 TIME, WHILE WE STILL 35 THROUGH 324 00:13:36,240 --> 00:13:38,640 SOCIAL ECONOMIC ADVERSITY, WE 325 00:13:38,640 --> 00:13:42,040 HAVE TO FIND ALTERNATIVE WAYS TO 326 00:13:42,040 --> 00:13:43,760 HELP PEOPLE TO MAINTAIN THEIR 327 00:13:43,760 --> 00:13:44,520 HEALTH. 328 00:13:44,520 --> 00:13:53,000 SO IN THAT REGARD, BIOLOGICAL 329 00:13:53,000 --> 00:13:53,840 EMBEDDING LITERATURE HAS 330 00:13:53,840 --> 00:13:54,760 FLOURISHED OVER THE LAST FEW 331 00:13:54,760 --> 00:13:56,520 YEARS AND PEOPLE HAVE COME UP 332 00:13:56,520 --> 00:14:01,000 WITH A LIKE EXCITING COMPLEX 333 00:14:01,000 --> 00:14:03,960 MODELS, SUCH AS THIS 1, FOR 334 00:14:03,960 --> 00:14:14,320 EXAMPLE, TO THE LEFT OF THE 335 00:14:14,320 --> 00:14:16,240 FIGURE TO THE LAST OF THE 336 00:14:16,240 --> 00:14:17,920 FIGURE, YOU SEE THE SOCIAL 337 00:14:17,920 --> 00:14:19,680 ENVIRONMENT WHICH AGAIN 338 00:14:19,680 --> 00:14:20,680 [INDISCERNIBLE] MATERNAL CHILD 339 00:14:20,680 --> 00:14:24,360 HEALTH BECAUSE IT'S MY AREA OF 340 00:14:24,360 --> 00:14:29,320 EXPERTISE WHERE YOU SEE CHILD 341 00:14:29,320 --> 00:14:29,800 DEPRIVATION, CAREGIVER, 342 00:14:29,800 --> 00:14:31,080 [INDISCERNIBLE] LINKED TO CARE 343 00:14:31,080 --> 00:14:37,600 GIVING ENVIRONMENT, FAMILY 344 00:14:37,600 --> 00:14:38,600 CONTEXT, COMMUNITY ENVIRONMENT, 345 00:14:38,600 --> 00:14:39,160 SOCIETAL ENVIRONMENT AND OF 346 00:14:39,160 --> 00:14:40,960 COURSE IN THIS PROCESS, THERE 347 00:14:40,960 --> 00:14:42,640 ARE SOME BUFFERING EFFECTS FOR 348 00:14:42,640 --> 00:14:47,560 EXAMPLE, THE PRESENCE OF 349 00:14:47,560 --> 00:14:48,120 [INDISCERNIBLE] CAREGIVER, 350 00:14:48,120 --> 00:14:50,680 RESILIENCE BECAUSE THIS IS 351 00:14:50,680 --> 00:14:51,520 LOOKING AT DEVELOPMENT AS YOU 352 00:14:51,520 --> 00:14:55,400 CAN SEE HERE FROM PREGNANCY TO 353 00:14:55,400 --> 00:14:56,440 CHILDHOOD, THE DIFFERENT 354 00:14:56,440 --> 00:15:00,120 SENSITIVE PERIODS, FOR EXAMPLE, 355 00:15:00,120 --> 00:15:02,120 THE NEOINATE OR CHANGE OF 356 00:15:02,120 --> 00:15:06,280 STATION ARE VERY HIGH TENSITY TO 357 00:15:06,280 --> 00:15:07,120 THOSE STRESSORS. 358 00:15:07,120 --> 00:15:09,760 AND AS IN THIS PROCESS WE'VE 359 00:15:09,760 --> 00:15:13,960 HAVE SEEN EFFECTS MUCH HIGHER, 360 00:15:13,960 --> 00:15:15,120 BABIES BEING BORN PREMATURE, 361 00:15:15,120 --> 00:15:18,000 GENETIC VARIATION THAT COULD SET 362 00:15:18,000 --> 00:15:20,080 SOMEONE AT HIGHEST 363 00:15:20,080 --> 00:15:22,160 SUSCEPTIBILITY TO THE 364 00:15:22,160 --> 00:15:24,360 ENVIRONMENT AND CONDITIONS AND 365 00:15:24,360 --> 00:15:26,320 OTHER COMPLEX DIFFERENTIAL 366 00:15:26,320 --> 00:15:31,760 EFFECTS SUCH AS SEX, GENDER, 367 00:15:31,760 --> 00:15:33,360 TEMPRAMENT AND OTHER 368 00:15:33,360 --> 00:15:33,960 CHARACTERISTICS. 369 00:15:33,960 --> 00:15:35,800 ALL THOSE FACTORS WILL BE 370 00:15:35,800 --> 00:15:37,280 INTERACTING AND CREATING 371 00:15:37,280 --> 00:15:41,440 BIOLOGICAL CHANGE THAT WILL 372 00:15:41,440 --> 00:15:43,640 EVENTUALLY TURN INTO PHENOTYPES 373 00:15:43,640 --> 00:15:44,800 OR HEALTH CHARACTERISTICS AND 374 00:15:44,800 --> 00:15:47,080 SOME OF THOSE REALLY ARE GENETIC 375 00:15:47,080 --> 00:15:49,840 CHANGE THAT WE WILL AFFAIRS TEAM 376 00:15:49,840 --> 00:15:50,840 LEADERRER PHENOTYPES, AND IN 377 00:15:50,840 --> 00:15:54,280 THIS CASE, DRIVING THE 378 00:15:54,280 --> 00:15:55,640 BIOLOGICAL EMBEDDING AND THERE 379 00:15:55,640 --> 00:15:57,040 ARE DIFFERENT GENETIC MECH 380 00:15:57,040 --> 00:16:00,120 INFORMS WE TRY NOT--WHEN I GET 381 00:16:00,120 --> 00:16:04,960 INTO AT THIS POINT, AS WELL AS 382 00:16:04,960 --> 00:16:07,600 ALTER NARROWER STROKE 383 00:16:07,600 --> 00:16:10,160 [INDISCERNIBLE] FUNCTION, ULTRA 384 00:16:10,160 --> 00:16:12,920 HPA AND THIS REACTIVITY ACCESS 385 00:16:12,920 --> 00:16:14,400 AND ADDITIONAL SYSTEMIC EFFECT 386 00:16:14,400 --> 00:16:17,680 OF THESE IS NOT REALLY 387 00:16:17,680 --> 00:16:24,120 HAPPENINGS IN SOME SORT OF A 388 00:16:24,120 --> 00:16:26,480 SYNCHRONY AND CUMULATIVE EFFECT 389 00:16:26,480 --> 00:16:28,640 WHICH EVENTUALLY START IMPACING 390 00:16:28,640 --> 00:16:30,760 THE DEVELOPMENTAL TRAJECTORY OF 391 00:16:30,760 --> 00:16:34,840 INDIVIDUALS THAT CAN LEAD TO 392 00:16:34,840 --> 00:16:36,320 BEHAVIORIAL HEALTH RISKS, SUCH 393 00:16:36,320 --> 00:16:38,440 AS SUBSTANCE USE, DIET, STRESS 394 00:16:38,440 --> 00:16:39,760 MANAGEMENT, AND HAVING 395 00:16:39,760 --> 00:16:42,600 BEHAVIORIAL IMPACTS AS WELL AS 396 00:16:42,600 --> 00:16:48,680 ALLEVIATE SOCIAL AND ECONOMIC 397 00:16:48,680 --> 00:16:50,400 SET BACKS WHICH ULTIMATELY WILL 398 00:16:50,400 --> 00:16:55,800 INCREASE THE RISK FOR 399 00:16:55,800 --> 00:16:56,720 CARDIOVASCULAR DISEASES, 400 00:16:56,720 --> 00:16:57,280 PSYCHOPATHOLOGY, IMPAIRED 401 00:16:57,280 --> 00:16:58,920 COGNITION AND SO ON AND SO 402 00:16:58,920 --> 00:16:59,160 FORTH. 403 00:16:59,160 --> 00:17:01,040 SO AGAIN, THERE ARE MANY 404 00:17:01,040 --> 00:17:03,280 DIFFERENT MODELS LIKE THIS THAT 405 00:17:03,280 --> 00:17:04,240 HAVE BEEN DEVELOPED, THIS IS 406 00:17:04,240 --> 00:17:07,920 JUST AN EXAMPLE OF 1 AND HOW IT 407 00:17:07,920 --> 00:17:08,600 CAN GET COMPLEX. 408 00:17:08,600 --> 00:17:11,480 SO THERE'S A LOT GOING ON HERE, 409 00:17:11,480 --> 00:17:19,760 BUT IF THE MESSAGE IS ACTUALLY 1 410 00:17:19,760 --> 00:17:20,040 OF--THIS 1. 411 00:17:20,040 --> 00:17:20,400 IS INEQUALITY. 412 00:17:20,400 --> 00:17:27,200 SO THIS IS WHAT WE ACTUALLY OR 413 00:17:27,200 --> 00:17:28,600 SCAN HEALTHCARE PROFESSIONAL, I 414 00:17:28,600 --> 00:17:31,040 REALLY CARE ABOUT, RIGHT? 415 00:17:31,040 --> 00:17:32,680 SO THE BIOLOGICAL EMBEDDING 416 00:17:32,680 --> 00:17:36,160 STORY, THE SOCIAL DETERMINANTS 417 00:17:36,160 --> 00:17:37,680 OF HEALTH STORY WHEN WE LOOK 418 00:17:37,680 --> 00:17:43,120 THROUGH THE PAPERS WE PUBLISHED, 419 00:17:43,120 --> 00:17:43,840 SEEMED VERY HYPOTHETICAL BUT 420 00:17:43,840 --> 00:17:45,160 WHEN YOU LOOK AT SITUATIONS LIKE 421 00:17:45,160 --> 00:17:46,680 THIS, FOR EXAMPLE, THIS IS A 422 00:17:46,680 --> 00:17:52,520 PHOTO FROM THE GUARDIAN OF SAO 423 00:17:52,520 --> 00:17:54,760 PAULO WHICH IS WHERE I COMPLETED 424 00:17:54,760 --> 00:17:58,040 MY Ph.D. AND YOU SEE TO THE 425 00:17:58,040 --> 00:17:59,600 LEFT [INDISCERNIBLE] IS A FULL 426 00:17:59,600 --> 00:18:00,880 COMMUNITY AND IT'S SEPARATED BY 427 00:18:00,880 --> 00:18:04,080 A WALL, YOU WILL SEE THESE HIGH 428 00:18:04,080 --> 00:18:08,480 END BUILDINGS AND YOU CAN SEE 429 00:18:08,480 --> 00:18:13,000 LIKE HOW THEY ARE ON 1 SIDE, YOU 430 00:18:13,000 --> 00:18:23,120 HAVE A LOT OF PEOPLE WITH LOW 431 00:18:23,120 --> 00:18:24,160 EDUCATION, LOW ECONOMIC 432 00:18:24,160 --> 00:18:25,480 OPPORTUNITY, FRONT LINE WORKERS, 433 00:18:25,480 --> 00:18:26,280 ESSENTIAL WORKERS AND TO THE 434 00:18:26,280 --> 00:18:28,720 RIGHT YOU HAVE A LOT OF 435 00:18:28,720 --> 00:18:34,120 PRIVILEGE THAT ULTIMATELY COMES 436 00:18:34,120 --> 00:18:35,720 WITH PROTECTIVE [INDISCERNIBLE] 437 00:18:35,720 --> 00:18:37,920 IN RELATION TO HEALTH. 438 00:18:37,920 --> 00:18:40,000 BUT HEALTH DISPARITIES BY SOCIAL 439 00:18:40,000 --> 00:18:42,680 ECONOMIC STATUS AND OTHER SOCIAL 440 00:18:42,680 --> 00:18:45,160 DEPENDENTS OF HEALTH HAVE BEEN 441 00:18:45,160 --> 00:18:49,720 EXTENSIVE LIE DOCUMENTED. 442 00:18:49,720 --> 00:18:51,880 IT'S NOT NEW AND WE DON'T TRY TO 443 00:18:51,880 --> 00:18:53,960 SPEND TOO MUCH TIME AND TRY TO 444 00:18:53,960 --> 00:18:55,160 PROVE THAT BECAUSE IT HAS BEEN 445 00:18:55,160 --> 00:18:58,560 REMOVED OVER AND OVER AGAIN. 446 00:18:58,560 --> 00:19:03,200 BUT LETS US KNOW ACTUALLY ABOUT 447 00:19:03,200 --> 00:19:04,720 THE [INDISCERNIBLE] HEALTH 448 00:19:04,720 --> 00:19:09,760 IMPLICATIONS FOR EXAMPLE, 449 00:19:09,760 --> 00:19:11,120 ACHIEVING UPWARD MOBILITY. 450 00:19:11,120 --> 00:19:11,320 RIGHT? 451 00:19:11,320 --> 00:19:12,240 SO IF YOU THINK ABOUT WHEN WE 452 00:19:12,240 --> 00:19:13,680 TRY TO DO, IS WE TRY TO TAKE 453 00:19:13,680 --> 00:19:15,400 SOMEONE FROM THE LEFT SIDE OF 454 00:19:15,400 --> 00:19:16,600 THE PICTURE AND TO THE RIGHT 455 00:19:16,600 --> 00:19:23,120 SIDE OF THE PICTURE, FOR IS SO 456 00:19:23,120 --> 00:19:27,040 WE DEPEND ON THE DISCIPLINE, WE 457 00:19:27,040 --> 00:19:32,480 TRY TO HELP PEOPLE GET MORE 458 00:19:32,480 --> 00:19:33,960 EDUCATED, INCREASE INCOME, 459 00:19:33,960 --> 00:19:35,920 EATING BETTER AND ALL BASICALLY 460 00:19:35,920 --> 00:19:38,760 TRY TO MIMIC THESE HIGH RESOURCE 461 00:19:38,760 --> 00:19:42,960 AND ENVIRONMENTAL THAT WE 462 00:19:42,960 --> 00:19:45,680 BELIEVE IS PROTECTIVE. 463 00:19:45,680 --> 00:19:49,080 BUT INSTEAD, NOW, LIKE HOW DO 464 00:19:49,080 --> 00:19:50,360 WE--AND IT JUST CHANGES SOMEONE 465 00:19:50,360 --> 00:19:54,760 IN THE ENVIRONMENT AND FOR 466 00:19:54,760 --> 00:19:55,840 EXAMPLE, TO THE LEFT AND TO THE 467 00:19:55,840 --> 00:19:58,960 RIGHTED OF THE FICTURE, HAVE YOU 468 00:19:58,960 --> 00:20:01,200 2 CHILDREN, 1 OF THEM 469 00:20:01,200 --> 00:20:03,800 EXPERIENCING ADVERSE CHILDHOOD 470 00:20:03,800 --> 00:20:04,240 EXPERIENCES. 471 00:20:04,240 --> 00:20:06,520 ON THE LEFT SIDE OF THE PICTURE 472 00:20:06,520 --> 00:20:08,280 THE CHILDREN WERE EXPERIENCE 473 00:20:08,280 --> 00:20:10,120 TRAUMA, NEGLECT AND ABUSED ARE 474 00:20:10,120 --> 00:20:16,280 MORE LIKELY TO DEVELOP HEALTH 475 00:20:16,280 --> 00:20:20,480 PROBLEMS SUCH AS HEART DISEASE, 476 00:20:20,480 --> 00:20:22,440 DEPRESSION, HIGH BLOOD PRESSURE. 477 00:20:22,440 --> 00:20:24,960 THE SAME THING WITH CHRONIC 478 00:20:24,960 --> 00:20:27,600 STRESS, CHRONIC STRESS 479 00:20:27,600 --> 00:20:31,440 COMPLICATIONS SUCH AS 480 00:20:31,440 --> 00:20:32,040 NEIGHBORHOODS OR IMPOVERISHED 481 00:20:32,040 --> 00:20:34,880 AREAS ARE THINGS THAT EXIST AT 482 00:20:34,880 --> 00:20:37,200 HIGHER RATES OF STRESS-RELATED 483 00:20:37,200 --> 00:20:40,160 ISSUES LIKE HYPERTENSION, MENTAL 484 00:20:40,160 --> 00:20:40,920 HEALTH DISORDERS. 485 00:20:40,920 --> 00:20:42,200 NOW LET'S THINK OF EXAMPLE 486 00:20:42,200 --> 00:20:47,280 NUMBER 1, THIS IS THE FIRST 487 00:20:47,280 --> 00:20:49,440 CHILDHOOD EXPERIENCES THAT CHILD 488 00:20:49,440 --> 00:20:52,080 MAY BE EXPERIENCING NEGLECT, 489 00:20:52,080 --> 00:20:54,080 ABUSE AND LET'S JUST SEE, YOU 490 00:20:54,080 --> 00:20:56,880 KNOW THE EVENT THAT IS TAKING 491 00:20:56,880 --> 00:20:58,960 PLACE, OF THE ENVIRONMENT THAT 492 00:20:58,960 --> 00:21:01,160 IS THE [INDISCERNIBLE] AND IF WE 493 00:21:01,160 --> 00:21:02,320 WISH TO REMOVE THAT CHILD FROM 494 00:21:02,320 --> 00:21:04,960 THE HOUSEHOLD AND PUT IN ANOTHER 495 00:21:04,960 --> 00:21:09,640 HOUSEHOLD WHERE THERE'S NO 496 00:21:09,640 --> 00:21:11,000 NEGLECT AND ABUS THAT'S THE 497 00:21:11,000 --> 00:21:12,600 EFFECTS OF NEGLECT AND ABUSE GO 498 00:21:12,600 --> 00:21:14,800 AWAY, THAT IS A QUESTION EYE AM 499 00:21:14,800 --> 00:21:16,520 TRYING TO RAISE TODAY. 500 00:21:16,520 --> 00:21:19,760 YOU KNOW THERE IS SOME 501 00:21:19,760 --> 00:21:22,240 BIOLOGICAL CONSEQUENCES SHOULD 502 00:21:22,240 --> 00:21:24,680 THOSE STRESSORS THAT BY WHOSE 503 00:21:24,680 --> 00:21:26,120 CHANGING THE OVERALL 504 00:21:26,120 --> 00:21:27,520 INFRASTRUCTURE WITH THE OVERALL 505 00:21:27,520 --> 00:21:28,800 SOCIAL DETERMINANT OF HEALTH 506 00:21:28,800 --> 00:21:30,600 ENVIRONMENT, IT MAY NOT BE 507 00:21:30,600 --> 00:21:36,200 ENOUGH TO UNDUE THE CONSEQUENCES 508 00:21:36,200 --> 00:21:37,760 OF THE STRESSORS. 509 00:21:37,760 --> 00:21:41,840 SO GETTING A LITTLE BIT MORE 510 00:21:41,840 --> 00:21:44,040 INTO LOOK AT THE ROLE OF 511 00:21:44,040 --> 00:21:45,200 [INDISCERNIBLE] AND PROMOTING 512 00:21:45,200 --> 00:21:50,600 HEALTH EQUITY AWNCH TIME WE SEE 513 00:21:50,600 --> 00:21:52,360 POLICIES AND INTERVENTIONS THAT 514 00:21:52,360 --> 00:21:54,680 CAN ACTUALLY AND HAVE BEEN 515 00:21:54,680 --> 00:21:55,280 SUCCESSFUL ADDRESSING SOCIAL 516 00:21:55,280 --> 00:21:57,600 DETERMINANTS OF HEALTH AND USING 517 00:21:57,600 --> 00:21:59,440 THE CANNED WHAT TO PROMOTE 518 00:21:59,440 --> 00:22:06,200 HEALTH EQUITY AND HERE, I PUT 519 00:22:06,200 --> 00:22:08,480 HEALTH EQUITY IN QUOTES. 520 00:22:08,480 --> 00:22:09,680 FOR EXAMPLE, A SCHOOL DISTRICT 521 00:22:09,680 --> 00:22:12,600 IMPLEMENTS A PROGRAM TO PROVOID 522 00:22:12,600 --> 00:22:15,360 FREE, HEALTHY MEALS TO STUDENTS. 523 00:22:15,360 --> 00:22:17,680 THIS POLICY ADDRESSED SOCIAL 524 00:22:17,680 --> 00:22:20,240 DETERMINANTS OF HEALTH, FOR 525 00:22:20,240 --> 00:22:21,880 EXAMPLE, ACCESS TO NUTRITIOUS 526 00:22:21,880 --> 00:22:24,240 FOOD AND CAN HELP IMPROVE HEALTH 527 00:22:24,240 --> 00:22:25,640 OUTCOMES FOR CHILDREN 528 00:22:25,640 --> 00:22:31,360 DEMONSTRATING HOW POLICY CAN 529 00:22:31,360 --> 00:22:31,920 PROMOTE HEALTH EQUITY. 530 00:22:31,920 --> 00:22:33,440 I MYSELF HAVE AN INTERVENTION 531 00:22:33,440 --> 00:22:36,880 THAT WE JUST FINISHED--A 532 00:22:36,880 --> 00:22:40,080 CLINICAL TRIAL WHERE WE OFFER 533 00:22:40,080 --> 00:22:42,760 BEHAVIORIAL INTERVENTION TO 534 00:22:42,760 --> 00:22:44,320 MOTHERS AND CHILDREN OF LATINO 535 00:22:44,320 --> 00:22:50,040 BACKGROUND TO TRY TO PROMOTE 536 00:22:50,040 --> 00:22:53,000 HEALTHY WEIGHT AS WELL AS 537 00:22:53,000 --> 00:22:57,640 CONTROL THE ONSET OF DIABETES 538 00:22:57,640 --> 00:22:59,640 AND WE OFFER THOSE EDUCATIONS 539 00:22:59,640 --> 00:23:02,040 WHICH THE IDEA THAT THE CHANGE 540 00:23:02,040 --> 00:23:07,160 IN BEHAVIOR IS ENOUGH TO UNDUE 541 00:23:07,160 --> 00:23:09,800 THE CHRONIC CONSEQUENCE OF BEING 542 00:23:09,800 --> 00:23:12,120 EXPOSED TO THOSE STRESSES. 543 00:23:12,120 --> 00:23:17,760 JUST LIKE HERE, LIKE WE OFFERING 544 00:23:17,760 --> 00:23:19,240 NUTRITIOUS FOODS IN THE 545 00:23:19,240 --> 00:23:19,760 DISTRICT. 546 00:23:19,760 --> 00:23:21,960 AND OFTEN TIMES WE MAKE THE 547 00:23:21,960 --> 00:23:24,200 ASSUMPTION THAT ARE OFFERING 548 00:23:24,200 --> 00:23:25,800 THOSE NUTRITIONS FOOD IS ENOUGH 549 00:23:25,800 --> 00:23:28,000 TO ACTUALLY ACHIEVE HEALTH 550 00:23:28,000 --> 00:23:33,760 EQUITY, BUT IS THIS TRULY HEALTH 551 00:23:33,760 --> 00:23:40,120 EQUITY THAT IS THE QUESTION WE 552 00:23:40,120 --> 00:23:40,280 BEG. 553 00:23:40,280 --> 00:23:42,120 THERE ARE SOME REALLY 554 00:23:42,120 --> 00:23:43,080 FASCINATING RESEARCHERS THAT I 555 00:23:43,080 --> 00:23:44,920 REALLY APPRECIATE THE WORK THEY 556 00:23:44,920 --> 00:23:49,200 DO, DR. CHAN, BRODY, AND MILAR, 557 00:23:49,200 --> 00:23:53,920 ALL OF THEM AT OUR UNIVERSITY 558 00:23:53,920 --> 00:23:56,360 WHERE THEY HAVE SPENT A LOT OF 559 00:23:56,360 --> 00:23:58,200 TIME UNDERSTANDING WHAT ARE THE 560 00:23:58,200 --> 00:23:59,760 CONSEQUENCES OF FOOD MOBILITY 561 00:23:59,760 --> 00:23:59,960 RIGHT. 562 00:23:59,960 --> 00:24:01,680 SO IF YOU THINK ABOUT THOSE 563 00:24:01,680 --> 00:24:02,840 SOCIAL DETERMINANTS OF HEALTH 564 00:24:02,840 --> 00:24:04,480 CONDITIONS WHAT WE TRY TO DO AND 565 00:24:04,480 --> 00:24:06,920 TEND TO THINK OF SOCIAL 566 00:24:06,920 --> 00:24:08,520 DETERMINANTS FOR NEGATIVE LENSES 567 00:24:08,520 --> 00:24:11,280 WHERE SOCIAL DETERMINANTS OF, 568 00:24:11,280 --> 00:24:16,040 YOU KNOW PULL LOW EDOCCASION, 569 00:24:16,040 --> 00:24:18,200 LOW INCOME, HIGH LEVEL 570 00:24:18,200 --> 00:24:19,160 NEIGHBORHOOD, BIOLENS AND SO ON 571 00:24:19,160 --> 00:24:24,120 AND SO FORTH AND WE TRY TO 572 00:24:24,120 --> 00:24:24,880 ELIMINATE THOSE WITH THE IDEA 573 00:24:24,880 --> 00:24:29,960 THAT THOSE ARE NOT ENOUGH TO 574 00:24:29,960 --> 00:24:30,480 ADDRESS HEALTH INIQUITIES. 575 00:24:30,480 --> 00:24:33,880 BUT THIS GROUP OF RESEARCHERS 576 00:24:33,880 --> 00:24:35,800 FOR EXAMPLE HAVE STUDIED QUITE 577 00:24:35,800 --> 00:24:37,960 EXTENSIVELY THE CONSEQUENCE OF 578 00:24:37,960 --> 00:24:38,600 UPWARD MOBILITY. 579 00:24:38,600 --> 00:24:41,760 FOR EXAMPLE, WHAT IS THE--IT IS 580 00:24:41,760 --> 00:24:42,440 BASICALLY ASKING THE QUESTION 581 00:24:42,440 --> 00:24:45,680 WHAT IS THE CAUSE OF SOMEONE 582 00:24:45,680 --> 00:24:52,480 COMING, LEAVING FROM LIKE A LOW 583 00:24:52,480 --> 00:24:56,360 SOCIOECONOMIC STATUS TO A HIGH 584 00:24:56,360 --> 00:24:59,080 STABLE SOCIOECONOMIC STATUS? 585 00:24:59,080 --> 00:25:02,280 AND THEY HAVE SHOWS IN DIFFERENT 586 00:25:02,280 --> 00:25:03,160 STUDIES, DIFFERENT PROCESSES, 587 00:25:03,160 --> 00:25:06,080 THIS IS A PICTURE THAT I HAVE 588 00:25:06,080 --> 00:25:08,200 PUBLISHED IN THE PAPER AT THE 589 00:25:08,200 --> 00:25:09,480 ANNUAL REVIEWS OF PSYCHOLOGY AND 590 00:25:09,480 --> 00:25:12,840 YOU CAN SEE 2 PROCESSES, 2 591 00:25:12,840 --> 00:25:14,240 MECHANISMS FOR UPWARD MOBILITY 592 00:25:14,240 --> 00:25:18,720 SUCH AS HEALTH BEHAVIORS, AT THE 593 00:25:18,720 --> 00:25:21,280 TOP WHERE YOU HAVE--THEY PRESENT 594 00:25:21,280 --> 00:25:23,520 2 OF THEM, SO FOR EXAMPLE, THEY 595 00:25:23,520 --> 00:25:25,760 TRY REDUCING BEHAVIORS WHERE YOU 596 00:25:25,760 --> 00:25:29,480 CAN'T OVEREAT, TRY TO MANAGE 597 00:25:29,480 --> 00:25:31,560 YOUR STRESS AND RESTERRAATIVE 598 00:25:31,560 --> 00:25:35,320 BEHAVIORS SUCH AS SLEEPING, 599 00:25:35,320 --> 00:25:39,400 ACTIVITIES, BUT ALSO THE BOTTOM 600 00:25:39,400 --> 00:25:43,520 THE HIGHLIGHT, THAT I 601 00:25:43,520 --> 00:25:44,640 IMPLICATED, UPWARD MOBILITY. 602 00:25:44,640 --> 00:25:47,760 THIS REVELATION TRIES TO RESPOND 603 00:25:47,760 --> 00:25:52,160 TO SYSTEMS, CHANGE AND COMMON 604 00:25:52,160 --> 00:25:53,440 INFESTATIONS IN TISSUE AND TO 605 00:25:53,440 --> 00:25:57,040 THE LEFT OF THE MODEL, YOU SEE 606 00:25:57,040 --> 00:25:59,080 THE FACTORS THAT ARE IMPLICATED 607 00:25:59,080 --> 00:26:02,040 WITH THE IDEA OF FORWARD 608 00:26:02,040 --> 00:26:05,560 MOBILITY WHERE THE INDIVIDUAL 609 00:26:05,560 --> 00:26:08,760 HAS BEEN DRIVING, THEY'RE 610 00:26:08,760 --> 00:26:11,360 COMPETING, LACK OF BELONGING TO 611 00:26:11,360 --> 00:26:14,800 THE NEW SOCIAL ECONOMIC LEVEL, 612 00:26:14,800 --> 00:26:17,880 THEY HAVE ACHIEVED AND ON THIS 613 00:26:17,880 --> 00:26:25,120 MATCH OF TRADES AND HIGH SCS 614 00:26:25,120 --> 00:26:26,600 ENVIRONMENT MEANING MEANING 615 00:26:26,600 --> 00:26:29,080 REMOVING THEM IN ANOTHER 616 00:26:29,080 --> 00:26:30,560 ENVIRONMENT, IF THAT'S NOT 617 00:26:30,560 --> 00:26:32,120 COMING OUT AT COST AND OF COURSE 618 00:26:32,120 --> 00:26:34,960 IN THEIR FOCUS OF RESEARCH THEY 619 00:26:34,960 --> 00:26:37,120 LOOK AT METABOLIC HEALTH AND TO 620 00:26:37,120 --> 00:26:39,760 HAVE SHOWN THAT THESE HAVE 621 00:26:39,760 --> 00:26:43,400 CONSEQUENCE ISSUE, MORE 622 00:26:43,400 --> 00:26:44,880 METABOLIC SYNDROME DIABETES, 623 00:26:44,880 --> 00:26:50,440 STROKE AND HEART DISEASE. 624 00:26:50,440 --> 00:26:53,560 SO IN THE SO WHAT THEY HAVE GOT 625 00:26:53,560 --> 00:26:54,880 THIS SENTENCE WHICH IS REALLY 626 00:26:54,880 --> 00:26:57,040 HIGHLIGHT SOMETHING I WANT TO 627 00:26:57,040 --> 00:26:59,400 EMPHASIZE IN THIS PRESENTATION 628 00:26:59,400 --> 00:27:03,200 WHICH IS 1 OF THE PATHWAYS TO 629 00:27:03,200 --> 00:27:04,560 HEALTH IS BIOLOGICAL AND IN 630 00:27:04,560 --> 00:27:06,680 THEIR WORDS IT MEANS THE 631 00:27:06,680 --> 00:27:10,320 STRESSORS ASSOCIATED WITH UPWARD 632 00:27:10,320 --> 00:27:13,440 MOBILITY DISREGULATE THE 633 00:27:13,440 --> 00:27:15,440 ACTIVITY THE BODY'S STRAINS AND 634 00:27:15,440 --> 00:27:17,720 SYSTEMS AND PERSISTENT CHANGE IN 635 00:27:17,720 --> 00:27:18,800 THESE SYSTEMS. 636 00:27:18,800 --> 00:27:20,480 WE WILL ALTER THE BEHAVIORS OF 637 00:27:20,480 --> 00:27:25,000 THE CELLS AND TISSUES AND 638 00:27:25,000 --> 00:27:28,200 ORGANS, LEADING EVENTUALLY TO 639 00:27:28,200 --> 00:27:29,360 PRECLINICAL MANIFESTATION AND 640 00:27:29,360 --> 00:27:34,920 SUBSEQUENT RISK OF METABOLIC, 641 00:27:34,920 --> 00:27:35,480 PATTERN METABOLIC DISEASES. 642 00:27:35,480 --> 00:27:37,720 SO THIS IS REALLY THE FOUNDATION 643 00:27:37,720 --> 00:27:46,200 OF WHAT WE SPEAKING ABOUT 644 00:27:46,200 --> 00:27:46,680 BIOLOGICAL EMBEDDING. 645 00:27:46,680 --> 00:27:48,960 SO THESE ARE THE STRESSORS, EVEN 646 00:27:48,960 --> 00:27:53,400 IF THE STRESSOR IS TAKING YOU IN 647 00:27:53,400 --> 00:27:55,200 A MORE SOCIALLY OUTLOOK WAY THAT 648 00:27:55,200 --> 00:28:02,120 LOOKS PAST THERE MEANING UPWARD 649 00:28:02,120 --> 00:28:03,440 MOBILITY, SOCIOECONOMIC STATUS, 650 00:28:03,440 --> 00:28:04,320 AND [INDISCERNIBLE] CONSEQUENCE, 651 00:28:04,320 --> 00:28:10,280 THAT WILL IMPACT YOUR HEALTH. 652 00:28:10,280 --> 00:28:12,920 SO THIS TAKES ME TO THE 653 00:28:12,920 --> 00:28:17,640 FRAMEWORK THAT REALLY GUIDES OUR 654 00:28:17,640 --> 00:28:20,720 WORK HERE AT THE UNIVERSITY OF 655 00:28:20,720 --> 00:28:26,000 MIAMI SCHOOL OF MEDICINE AND 656 00:28:26,000 --> 00:28:28,520 HEALTH STUDIES WHICH IS REALLY A 657 00:28:28,520 --> 00:28:29,720 MODEL OF THE SOCIAL 658 00:28:29,720 --> 00:28:31,080 DENAMES--NAMESSICS OVER THE LEFT 659 00:28:31,080 --> 00:28:31,360 COURSE. 660 00:28:31,360 --> 00:28:32,840 MEANING IT'S NOT ENOUGH TO 661 00:28:32,840 --> 00:28:35,360 ELECTRIC AT A BIOLOGICAL SYSTEMS 662 00:28:35,360 --> 00:28:41,640 BUT ALSO NOT ENOUGH TO LOOK AT 663 00:28:41,640 --> 00:28:43,920 SOCIAL SYSTEMS WITHOUT 664 00:28:43,920 --> 00:28:44,760 UNDERSTANDING THE INTERACTION 665 00:28:44,760 --> 00:28:45,920 AND INTERPLAY THAT BOTH OF THEM 666 00:28:45,920 --> 00:28:52,160 HAVE IN THE HUMAN DEVELOPMENT 667 00:28:52,160 --> 00:28:54,400 AND THAT INTERACTION IS TAKING 668 00:28:54,400 --> 00:28:55,560 PLACE DURING GUESTATION OR EVEN 669 00:28:55,560 --> 00:28:57,240 BEFORE THAT AND IT'S CARRIED 670 00:28:57,240 --> 00:28:58,320 THROUGHOUT THE INFANCY, 671 00:28:58,320 --> 00:29:04,080 CHILDHOOD AND SO ON AND SO 672 00:29:04,080 --> 00:29:04,360 FORTH. 673 00:29:04,360 --> 00:29:06,560 BECAUSE WE ARE A CHILD MATERNAL 674 00:29:06,560 --> 00:29:08,200 HEALTH RESEARCH GROUP, WE TEND 675 00:29:08,200 --> 00:29:13,080 TO FOCUS ON GUESTATION, ALL THE 676 00:29:13,080 --> 00:29:16,920 WAY TO [INDISCERNIBLE] BUT THIS 677 00:29:16,920 --> 00:29:17,960 MODEL REALLY APPLIES THROUGHOUT 678 00:29:17,960 --> 00:29:21,720 AND INDEPENDENT OF BASIC PLANS 679 00:29:21,720 --> 00:29:26,280 FOR SUCH TOPIC, SO WITH THAT IN 680 00:29:26,280 --> 00:29:29,680 MIND, BIOSOCIAL APPROACH TO 681 00:29:29,680 --> 00:29:33,840 HEALTH IS REALLY A WAY OF 682 00:29:33,840 --> 00:29:36,000 UNDERSTANDING THE HELP OF 683 00:29:36,000 --> 00:29:38,240 INDIVIDUALS IN A WHOLISTIC 684 00:29:38,240 --> 00:29:38,640 MANNER. 685 00:29:38,640 --> 00:29:43,160 WITH THAT SAID, I AM GOING TO 686 00:29:43,160 --> 00:29:43,840 START FOCUSING ON THE PRIMER 687 00:29:43,840 --> 00:29:48,400 THAT I WANT TO HIGHLIGHT HERE 688 00:29:48,400 --> 00:29:50,520 WHICH IS DISCRIMINATION AND 689 00:29:50,520 --> 00:29:53,080 DISCRIMINATION TO BE SPECIFIC. 690 00:29:53,080 --> 00:29:55,320 OVER THE LAST--WE'VE HEARD MANY, 691 00:29:55,320 --> 00:29:58,000 MANY TIMES ABOUT DISCRIMINATION 692 00:29:58,000 --> 00:30:01,520 IN THE NEWS, IN THE 693 00:30:01,520 --> 00:30:05,000 [INDISCERNIBLE] ISSUES HERE 694 00:30:05,000 --> 00:30:06,040 ABOUT IT. 695 00:30:06,040 --> 00:30:08,680 AND NIH ACTUALLY HAVE STARTED 696 00:30:08,680 --> 00:30:09,520 PLAYING INTEREST AND 697 00:30:09,520 --> 00:30:13,360 UNDERSTANDING THE EFFECTS OF 698 00:30:13,360 --> 00:30:15,080 DISCRIMINATION, IN HEALTH 699 00:30:15,080 --> 00:30:15,440 OUTCOMES. 700 00:30:15,440 --> 00:30:17,880 FOR EXAMPLE, COUPLE YEARS AGO, 701 00:30:17,880 --> 00:30:18,840 THEY RELEASED A SPECIAL CALL 702 00:30:18,840 --> 00:30:20,040 TRYING TO FIND THE STUDIES IN 703 00:30:20,040 --> 00:30:26,040 THIS AREA OF STUDY, IN THIS 704 00:30:26,040 --> 00:30:26,480 CONCENTRATED AREA. 705 00:30:26,480 --> 00:30:29,760 THEY REISSUE THE CALL RECENTLY 706 00:30:29,760 --> 00:30:38,080 AND TRY TO MAKE SOME HEAD WAY IN 707 00:30:38,080 --> 00:30:38,400 THAT REGARD. 708 00:30:38,400 --> 00:30:41,640 BUT THERE ARE DIFFERENT FORMS OF 709 00:30:41,640 --> 00:30:42,400 DISCRIMINATION AND 710 00:30:42,400 --> 00:30:43,600 DISCRIMINATION IS REALLY JUST A 711 00:30:43,600 --> 00:30:44,640 PREJUDICE AND INDIVIDUAL 712 00:30:44,640 --> 00:30:46,160 TREATMENT OF INDIVIDUALS BASED 713 00:30:46,160 --> 00:30:49,320 ON SPECIFIC CHARACTERISTICS AND 714 00:30:49,320 --> 00:30:52,840 THOSE CAN BE NOT LIMITED TO BUT 715 00:30:52,840 --> 00:30:56,720 THEY CAN BE RACE AND ETHNICITY, 716 00:30:56,720 --> 00:31:00,840 GENDER, AGE, SEXUAL ORIENTATION, 717 00:31:00,840 --> 00:31:03,760 ABILITY, BUT THERE'S REALLY 3 718 00:31:03,760 --> 00:31:04,320 MAJOR CATEGORIES OF 719 00:31:04,320 --> 00:31:06,520 DISCRIMINATION WHICH IS THE 720 00:31:06,520 --> 00:31:08,560 STRUCTURAL, INDIVIDUAL AND 721 00:31:08,560 --> 00:31:09,440 CARRIERS, THE STRUCTURAL IS 722 00:31:09,440 --> 00:31:13,000 REALLY WITH WE ARE TRYING TO 723 00:31:13,000 --> 00:31:16,320 THINK OF FOR EXAMPLE, 724 00:31:16,320 --> 00:31:17,360 RESIDENTIAL SEGREGATION AND 725 00:31:17,360 --> 00:31:20,040 OFTEN TIMES WHEN WE THINK OF 726 00:31:20,040 --> 00:31:21,040 RESIDENTIAL SEGREGATION, WE 727 00:31:21,040 --> 00:31:22,080 THINK THAT THERE IS SOMETHING 728 00:31:22,080 --> 00:31:26,080 FROM THE PAST, FROM THE 729 00:31:26,080 --> 00:31:28,440 [INDISCERNIBLE] AREA BUT IT'S 730 00:31:28,440 --> 00:31:30,320 REALLY NOT, IF WE WERE TO COME 731 00:31:30,320 --> 00:31:32,440 TO MIAMI WHERE WE ARE LOCATED, 732 00:31:32,440 --> 00:31:34,840 AND YOU DRIVE AROUND THE CITY, 733 00:31:34,840 --> 00:31:39,920 YOU ACTUALLY SEE THAT THE 734 00:31:39,920 --> 00:31:40,400 NEIGHBORHOODS ARE FAIRLY 735 00:31:40,400 --> 00:31:40,920 SEGREGATED. 736 00:31:40,920 --> 00:31:41,960 FOR EXAMPLE, WE HAVE LITTLE 737 00:31:41,960 --> 00:31:43,600 HAVANA AND WE HAVE OTHER 738 00:31:43,600 --> 00:31:46,320 NEIGHBORHOODS THAT ARE VERY 739 00:31:46,320 --> 00:31:48,280 SPECIFIC TO DIFFERENT 740 00:31:48,280 --> 00:31:50,840 ETHNICITIES AND RACE AND THEY 741 00:31:50,840 --> 00:31:51,840 CLEARLY DON'T INTERACT MUCH. 742 00:31:51,840 --> 00:31:56,640 THERE'S NOT A WHOLE LOT OF 743 00:31:56,640 --> 00:31:59,160 INTERACTION BETWEEN DIFFERENT 744 00:31:59,160 --> 00:32:01,120 NEIGHBORHOODS SO THIS WOULD 745 00:32:01,120 --> 00:32:03,080 EVENTUALLY LEAD TO STRUCTURAL 746 00:32:03,080 --> 00:32:07,520 CHANGE AND OPPORTUNITIES THAT 747 00:32:07,520 --> 00:32:08,920 WILL AFFECT THE HEALTH OF 748 00:32:08,920 --> 00:32:09,200 INDIVIDUALS. 749 00:32:09,200 --> 00:32:11,440 THE SECOND 1 IS THE INDIVIDUAL 750 00:32:11,440 --> 00:32:13,480 FOR PROFESSIONAL DISCRIMINATION 751 00:32:13,480 --> 00:32:15,360 AND THAT IS REALLY THAT YOU 752 00:32:15,360 --> 00:32:18,040 RECEIVED UNDERSTANDING THAT 753 00:32:18,040 --> 00:32:21,680 SOMEONE IS TREATING YOU AND JUST 754 00:32:21,680 --> 00:32:25,640 BEING INJUST TO YOU OR PREJUDICE 755 00:32:25,640 --> 00:32:30,400 TO YOU, SO THE INDIVIDUAL HAS TO 756 00:32:30,400 --> 00:32:31,200 PERCEIVE THAT EVENT TO 757 00:32:31,200 --> 00:32:35,200 UNDERSTAND THAT THEY HAVE BEEN 758 00:32:35,200 --> 00:32:38,800 DISCRIMINATED AGAINST AND THEN 759 00:32:38,800 --> 00:32:40,840 [INDISCERNIBLE] IS THE 760 00:32:40,840 --> 00:32:41,520 [INDISCERNIBLE] EFFECT MEANING 761 00:32:41,520 --> 00:32:44,400 THE PERSON THAT EXPERIENCED THIS 762 00:32:44,400 --> 00:32:47,360 DISCRIMINATION, THE EFFECT OF 763 00:32:47,360 --> 00:32:49,520 DISCRIMINATION DOESN'T STOP AT 764 00:32:49,520 --> 00:32:49,760 THEM. 765 00:32:49,760 --> 00:32:53,400 IT CAN GET CARRIED ON TO THE 766 00:32:53,400 --> 00:32:55,800 CLOSE FAMILY MEMBERS AND 767 00:32:55,800 --> 00:33:00,120 PARTNERS SUCH AS A MOTHER THAT 768 00:33:00,120 --> 00:33:01,600 HAS BEEN DISCRIMINATED AGAIN, 769 00:33:01,600 --> 00:33:03,440 THE STRESSES OF THE PARENT IN 770 00:33:03,440 --> 00:33:06,120 SOME FASHION, BEING TRANSFERRED 771 00:33:06,120 --> 00:33:11,240 INTO THE HER CHILDREN. 772 00:33:11,240 --> 00:33:12,960 AND THAT IS 1 AREA WHERE WE HAVE 773 00:33:12,960 --> 00:33:17,720 BEEN SPENDING A LOST EFFORTS. 774 00:33:17,720 --> 00:33:20,760 JUST GETTING MORE INTO THE 775 00:33:20,760 --> 00:33:22,840 REASONS WHY I'M HOSTING FOR 776 00:33:22,840 --> 00:33:24,360 DISCRIMINATION ON THIS TALK IS 777 00:33:24,360 --> 00:33:28,240 CHRIS NIM NATION IS A SOURCE 778 00:33:28,240 --> 00:33:29,640 WAS--DISCRIMINATION IS A SOURCE 779 00:33:29,640 --> 00:33:30,440 OF CHRONIC STRESS. 780 00:33:30,440 --> 00:33:33,160 AND CHRONIC STRESS IS PROBABLY 781 00:33:33,160 --> 00:33:34,680 THE SINGLE MOST IMPORTANT 782 00:33:34,680 --> 00:33:40,040 PATHWAY FOR BIOLOGICAL 783 00:33:40,040 --> 00:33:40,280 EMBEDDING. 784 00:33:40,280 --> 00:33:41,280 DISCRIMINATION CAN LEAD TO 785 00:33:41,280 --> 00:33:45,760 STRESS THROUGH FEELINGS OF 786 00:33:45,760 --> 00:33:46,760 SOCIAL IEBSOLATION, EXCLUSION, 787 00:33:46,760 --> 00:33:50,480 REDUCING STRESSES AS WELL AS 788 00:33:50,480 --> 00:33:51,160 CREATING HOSTILE ENVIRONMENT. 789 00:33:51,160 --> 00:33:54,680 FOR EXAMPLE, WE SEE THE SOCIAL 790 00:33:54,680 --> 00:33:58,640 MEDIA AND OFTEN THE NEWS AND 791 00:33:58,640 --> 00:34:00,040 SOMEONE, THE NEWS PORTRAYING 792 00:34:00,040 --> 00:34:01,480 THINGS LIKE SOMEONE IS WALKING 793 00:34:01,480 --> 00:34:03,760 TO THE GROCERY STORE AND WERE 794 00:34:03,760 --> 00:34:05,480 PICKING OUT A DIFFERENT LANGUAGE 795 00:34:05,480 --> 00:34:11,360 OTHER THAN ENGLISH AND SOMEONE 796 00:34:11,360 --> 00:34:12,200 [INDISCERNIBLE] SPEAK AMERICAN, 797 00:34:12,200 --> 00:34:13,440 DON'T BELONG TO THIS COUNTRY, 798 00:34:13,440 --> 00:34:16,240 AND SO ON AND SO FORTH. 799 00:34:16,240 --> 00:34:18,280 THOSE THINGS CAN CREATE A 800 00:34:18,280 --> 00:34:19,440 SERIOUS SOURCE OF STRESS TO 801 00:34:19,440 --> 00:34:22,720 THOSE INDIVIDUALS AND STOP THEM 802 00:34:22,720 --> 00:34:26,360 FROM NOT GETTING SOCIETY AS THEY 803 00:34:26,360 --> 00:34:26,640 SHOULD. 804 00:34:26,640 --> 00:34:28,000 SO THIS STRESS CAN CONTRIBUTE TO 805 00:34:28,000 --> 00:34:29,640 THE DEVELOPMENT OF HEALTH 806 00:34:29,640 --> 00:34:35,600 DISPARITIES AND OF COURSE, 807 00:34:35,600 --> 00:34:37,560 NEGATIVELY IMPACT OVERALL WELL 808 00:34:37,560 --> 00:34:37,800 BEING. 809 00:34:37,800 --> 00:34:40,520 DISCRIMINATION EFFECTS ON 810 00:34:40,520 --> 00:34:41,840 HEALTH, HOWEVER, AGAIN, IS NOT A 811 00:34:41,840 --> 00:34:43,640 NEW THING BUT WE KNOW IT'S BAD 812 00:34:43,640 --> 00:34:47,000 AND WE KNOW IT HAS A LOT OF 813 00:34:47,000 --> 00:34:48,680 EFFECTS SUCH AS DISCRIMINATION 814 00:34:48,680 --> 00:34:52,280 HAS BEEN ASSOCIATED WITH REDUCED 815 00:34:52,280 --> 00:34:53,800 PHYSICAL ACTIVITY, THIS HAS BEEN 816 00:34:53,800 --> 00:34:56,960 ASSOCIATED WITH INCREASED RISK 817 00:34:56,960 --> 00:34:59,280 OF DEPRESSION, ANXIETY, HIGHER 818 00:34:59,280 --> 00:35:00,960 LEVELS OF PSYCHOLOGICAL STRESS, 819 00:35:00,960 --> 00:35:04,600 NEGATIVE IMPACT ON SELF-ESTEEM 820 00:35:04,600 --> 00:35:05,800 AND SELF-WORTH, BEING ASSOCIATED 821 00:35:05,800 --> 00:35:09,400 BI HIGHER RISKS OF HYPERTENSION, 822 00:35:09,400 --> 00:35:11,120 CARDIOVASCULAR DISEASE AND THIS 823 00:35:11,120 --> 00:35:12,240 WOULD FEBRUARY EXAMPLE, A LOT OF 824 00:35:12,240 --> 00:35:18,040 IT HAS BEEN DONE BY NURSE 825 00:35:18,040 --> 00:35:20,360 RESEARCHERS, DR. JACK TAYLOR. 826 00:35:20,360 --> 00:35:21,880 DISCRIMINATION HAS BEEN RELATED 827 00:35:21,880 --> 00:35:23,240 TO POOR OVERALL HEALTH OUTCOME 828 00:35:23,240 --> 00:35:30,320 AND OF COURSE INCREASE SUBSTANCE 829 00:35:30,320 --> 00:35:30,720 ABUSE. 830 00:35:30,720 --> 00:35:33,240 AND IT MAY SOUND OBVIOUS BUT 831 00:35:33,240 --> 00:35:37,240 SOMETIMES WE TAKE THOSE FACTORS 832 00:35:37,240 --> 00:35:38,320 SUCH AS DISCRIMINATION AND IT'S 833 00:35:38,320 --> 00:35:40,680 NOT TREATING THEM AS IF THERE 834 00:35:40,680 --> 00:35:45,360 ARE SOME THING IN ISOLATION FROM 835 00:35:45,360 --> 00:35:46,400 SOCIAL DETERMINANTS OF HEALTH 836 00:35:46,400 --> 00:35:48,800 BUT THIS IS A SOCIAL DETERMINANT 837 00:35:48,800 --> 00:35:51,240 OF HEALTH IN THIS SITUATION AND 838 00:35:51,240 --> 00:35:53,120 THERE'S INTERPLAY BETWEEN 839 00:35:53,120 --> 00:35:55,000 DISCRIMINATION AND OTHER SOCIAL 840 00:35:55,000 --> 00:35:57,440 DETERMINANTS OF HEALTH. 841 00:35:57,440 --> 00:35:58,120 FOR EXAMPLE, DISCRIMINATION, 842 00:35:58,120 --> 00:36:00,640 INTERACTS WITH SOCIAL 843 00:36:00,640 --> 00:36:01,680 DETERMINANTS, OTHER SOCIAL 844 00:36:01,680 --> 00:36:03,920 DETERMINANTS SUCH AS INCOME, 845 00:36:03,920 --> 00:36:05,200 EDUCATION, NEIGHBORHOOD, 846 00:36:05,200 --> 00:36:09,120 CONDITIONS, THAT CAN EXACERBATE 847 00:36:09,120 --> 00:36:11,640 HEALTH DISPARITIES. 848 00:36:11,640 --> 00:36:14,520 FOR EXAMPLE, WE SEE CASES WHERE 849 00:36:14,520 --> 00:36:17,680 SOMEONE AFFECTS SKIN COLOR IN 850 00:36:17,680 --> 00:36:19,880 BROWSING THROUGH A STORE AND OUR 851 00:36:19,880 --> 00:36:20,960 SECURITY GUARD STARTING 852 00:36:20,960 --> 00:36:21,840 FOLLOWING THEM BECAUSE THEY 853 00:36:21,840 --> 00:36:23,240 DON'T THINK THEY BELONG IN THAT 854 00:36:23,240 --> 00:36:25,760 ENVIRONMENT OR THEY DON'T HAVE 855 00:36:25,760 --> 00:36:28,120 THE ECONOMIC ABILITY TO BE A 856 00:36:28,120 --> 00:36:31,160 CLIENT OF THAT ENVIRONMENT AND 857 00:36:31,160 --> 00:36:34,080 SO, THOSE ARE INTERACTIONS OF 858 00:36:34,080 --> 00:36:39,560 SOCIAL DETERMINANTS OF HEALTH, 859 00:36:39,560 --> 00:36:42,080 PERCEIVED BEDDING, SKIN COLOR, 860 00:36:42,080 --> 00:36:43,040 BELONGING TO DIFFERENT INCOME 861 00:36:43,040 --> 00:36:44,560 GROUPS OR EDUCATION GROUPS AND 862 00:36:44,560 --> 00:36:46,480 THE THACT THAT YOU ARE 863 00:36:46,480 --> 00:36:49,680 DISCRIMINATED ON BASED ON THOSE 864 00:36:49,680 --> 00:36:50,480 CHARACTERISTICS. 865 00:36:50,480 --> 00:36:51,120 ADDRESSING SOCIAL DETERMINANTS 866 00:36:51,120 --> 00:36:56,280 OF HEALTH OF COURSE IS CRUCIAL 867 00:36:56,280 --> 00:36:56,960 TO REDUCING THEIR DISCRIMINATION 868 00:36:56,960 --> 00:36:58,920 BECAUSE IF YOU WERE ABLE TO 869 00:36:58,920 --> 00:37:01,440 ERASE FROM SOCIETY THE IDEA THAT 870 00:37:01,440 --> 00:37:04,400 SKIN COLOR IS ASSOCIATED WITH 871 00:37:04,400 --> 00:37:09,120 LEVELS OF INCOME AND EDUCATION 872 00:37:09,120 --> 00:37:14,840 AND AND SENSE OF BELONGING, 873 00:37:14,840 --> 00:37:16,880 THOSE INTERACT WITH THE 874 00:37:16,880 --> 00:37:18,760 DISCRIMINATION ITSELF AND THE 875 00:37:18,760 --> 00:37:20,800 DISCRIMINATION WILL BE REDUCED. 876 00:37:20,800 --> 00:37:22,080 OF COURSE, I HAVEN'T SAID MUCH 877 00:37:22,080 --> 00:37:24,720 ABOUT WHAT ARE THE OTHER SOCIAL 878 00:37:24,720 --> 00:37:25,560 DETERMINANTS OF HEALTH ARE BUT 879 00:37:25,560 --> 00:37:27,720 IF YOU HAVE THIS PICTURE HERE 880 00:37:27,720 --> 00:37:31,000 THAT GETS 0 GOOD HIGHLIGHT OF 881 00:37:31,000 --> 00:37:32,160 DIFFERENT CATEGORIES AND YOU CAN 882 00:37:32,160 --> 00:37:33,920 GO BACK TO THE LECTURE THAT I 883 00:37:33,920 --> 00:37:41,240 POINTED OUT EARLIER TOGETHER, 884 00:37:41,240 --> 00:37:43,200 VERY GOOD UNDERSTANDING OF THE 885 00:37:43,200 --> 00:37:43,920 SOCIAL DETERMINANTS OF HEALTH 886 00:37:43,920 --> 00:37:47,680 BUT GOING BACK TO THE EMBEDDING 887 00:37:47,680 --> 00:37:50,960 RESEARCH AGAIN, 888 00:37:50,960 --> 00:37:51,440 DR. [INDISCERNIBLE] AND 889 00:37:51,440 --> 00:37:53,640 [INDISCERNIBLE] WERE MONTH THE 890 00:37:53,640 --> 00:37:56,200 FIRST TO REALLY PUT IN THESE 891 00:37:56,200 --> 00:37:57,680 BIOLOGICAL MECHANISMS IN PLACE, 892 00:37:57,680 --> 00:38:05,560 TRY UNDERSTAND THE EFFECTS OF 893 00:38:05,560 --> 00:38:08,080 PROFESSIONALS AND HOW THEY 894 00:38:08,080 --> 00:38:08,760 AFFECT BIOLOGICAL SYSTEMS AND 895 00:38:08,760 --> 00:38:10,800 YOU CAN SEE HERE THEY GO FROM 896 00:38:10,800 --> 00:38:12,520 DISCRIMINATION TO THE HYPOTHAT 897 00:38:12,520 --> 00:38:14,800 WILLUS, TO THE PITUE TARY GLANT, 898 00:38:14,800 --> 00:38:20,360 SO ON AND SO FORTH AND BASICALLY 899 00:38:20,360 --> 00:38:22,880 ALL TRAINING AND LEAVING TO BOTH 900 00:38:22,880 --> 00:38:24,520 WAY, THE HYPERTENSIONAL BASE, 901 00:38:24,520 --> 00:38:27,200 THEY END UP GENETIC PROCESSES, 902 00:38:27,200 --> 00:38:28,480 BASICALLY PROCESSES THAT REALLY 903 00:38:28,480 --> 00:38:34,000 CHANGE HOW YOUR GENOME IS ACTING 904 00:38:34,000 --> 00:38:36,840 WHICH SENDS FEEDBACK INTO THIS 905 00:38:36,840 --> 00:38:37,160 WHOLE SYSTEM. 906 00:38:37,160 --> 00:38:39,560 AND SO THOSE AGAIN, CHOOSE 1 907 00:38:39,560 --> 00:38:40,280 EXAMPLE, OF DIFFERENT MODELS 908 00:38:40,280 --> 00:38:46,440 THAT HAVE BEEN CREATED TO GET AT 909 00:38:46,440 --> 00:38:47,120 THESE. 910 00:38:47,120 --> 00:38:50,800 THE LAST SET CREATED A SERIES ON 911 00:38:50,800 --> 00:38:51,880 RACISM SHOWING PHOBIA AND 912 00:38:51,880 --> 00:38:53,160 DISCRIMINATION AND THEY HAVE 913 00:38:53,160 --> 00:38:55,360 DONE A MUCH BETTER JOB AT 914 00:38:55,360 --> 00:38:59,400 ACTUALLY CREATING THIS FIGURE 915 00:38:59,400 --> 00:39:01,680 THAT SHOWED THE WHOLE FRAMEWORK 916 00:39:01,680 --> 00:39:03,320 OF HOW THINGS MAY TAKE PLACE AND 917 00:39:03,320 --> 00:39:05,640 FOR EXAMPLE, HAD TO BREAK THE 918 00:39:05,640 --> 00:39:07,880 FIGURE INTO 2 PORTIONS HERE AND 919 00:39:07,880 --> 00:39:09,360 YOU REALLY CAN'T SEE THAT WELL 920 00:39:09,360 --> 00:39:14,400 BUT I PUT THE LINK FOR THE 921 00:39:14,400 --> 00:39:15,560 SERIES HERE. 922 00:39:15,560 --> 00:39:18,080 AND YOU BASICALLY SEE FOR 923 00:39:18,080 --> 00:39:19,840 INDIVIDUAL PERSPECTIVE AND 924 00:39:19,840 --> 00:39:21,920 DISCRIMINATION, BEHAVIOR, 925 00:39:21,920 --> 00:39:23,040 PSYCHOLOGICAL AND PHYSIOLOGICAL 926 00:39:23,040 --> 00:39:25,920 AND YOU WILL HAVE 927 00:39:25,920 --> 00:39:26,440 INTERGENERATIONAL IMPACTS 928 00:39:26,440 --> 00:39:28,720 LEADING INTO THE CHILDHOOD AND 929 00:39:28,720 --> 00:39:33,960 ADOLESCENTS, OUTCOMES AS WELL AS 930 00:39:33,960 --> 00:39:34,600 WHOLE ADULT AND [INDISCERNIBLE] 931 00:39:34,600 --> 00:39:36,280 OUTCOME BUT OF COURSE GOING 932 00:39:36,280 --> 00:39:37,320 THROUGH BIRTH AND ADULTHOOD AND 933 00:39:37,320 --> 00:39:39,320 IN THE BIG PICTURE THEY REALLY 934 00:39:39,320 --> 00:39:47,880 SHOW OW SOCIETAL FACTORS AND 935 00:39:47,880 --> 00:39:48,680 SPECIAL, THE NEIGHBORHOOD 936 00:39:48,680 --> 00:39:50,400 SEGREGATION, NAIB OAR HOOD 937 00:39:50,400 --> 00:39:55,080 ENVIRONMENT, ACCESS TO GREEN 938 00:39:55,080 --> 00:39:55,760 SPACES, ECONOMIC FACTORS REALLY 939 00:39:55,760 --> 00:39:59,760 PLAY INTO THIS SYSTEM AND HOW 940 00:39:59,760 --> 00:40:01,240 THE HEALTH SYSTEM ACTUALLY 941 00:40:01,240 --> 00:40:04,240 ENABLES OR EVEN SUSTAINS ALL 942 00:40:04,240 --> 00:40:08,880 THOSE DETRIMENTAL EFFECTS. 943 00:40:08,880 --> 00:40:10,760 WITH THAT SAID THIS IS A 944 00:40:10,760 --> 00:40:12,440 FANTASTIC BIG PICTURE OF WHAT'S 945 00:40:12,440 --> 00:40:13,240 GOING ON BEHIND THE SCENES, THAT 946 00:40:13,240 --> 00:40:15,320 GOES FROM THIS IDEA OF BIOSOCIAL 947 00:40:15,320 --> 00:40:21,960 MECHANISM THAT GOES FROM BIOLOGY 948 00:40:21,960 --> 00:40:22,280 TO SOCIETY. 949 00:40:22,280 --> 00:40:26,640 WHICH I WILL SHIFT, FOAMUS A BIT 950 00:40:26,640 --> 00:40:27,880 AMONG DISCRIMINATION, SO I CAN 951 00:40:27,880 --> 00:40:30,000 SHOW DATA POINTS FROM OTHER 952 00:40:30,000 --> 00:40:34,320 GROUP, FOR EXAMPLE, AS OF 2018, 953 00:40:34,320 --> 00:40:38,840 4 AND 10 LATIN X DISEASES 954 00:40:38,840 --> 00:40:40,600 REPORTED DISCRIMINATION IF FOR 955 00:40:40,600 --> 00:40:45,200 [INDISCERNIBLE] 68% OF THEM WERE 956 00:40:45,200 --> 00:40:48,840 MORE LIKELY THAN U.S. BORN WERE 957 00:40:48,840 --> 00:40:49,440 LIKELY TO EXPERIENCE 958 00:40:49,440 --> 00:40:50,840 DISCRIMINATION AND THEY WERE 959 00:40:50,840 --> 00:40:52,760 RELATED TO RACE ETHNICITY, 960 00:40:52,760 --> 00:40:56,280 LANGUAGE AND SKIN COLOR AND 961 00:40:56,280 --> 00:40:59,720 MIGRATION STATUS. 962 00:40:59,720 --> 00:41:01,720 SO, OUR GROUP AGAIN, STARTED 963 00:41:01,720 --> 00:41:02,760 ASKING THE QUESTIONS, YOU KNOW 964 00:41:02,760 --> 00:41:08,760 TO A DEGREE THAT DISCRIMINATION 965 00:41:08,760 --> 00:41:10,240 ACTUALLY IS ASSOCIATED WITH 966 00:41:10,240 --> 00:41:12,440 THINGS SUCH AS STRESS AND 967 00:41:12,440 --> 00:41:13,680 DEPRESSIVE SYMPTOMS BECAUSE 968 00:41:13,680 --> 00:41:17,240 THOSE MOMS OFTEN TIMES I 969 00:41:17,240 --> 00:41:19,200 EXPERIENCE IN THE PROCESS 970 00:41:19,200 --> 00:41:21,480 SYMPTOMS AT A HIGHER RATE THAN 971 00:41:21,480 --> 00:41:22,840 THE [INDISCERNIBLE]. 972 00:41:22,840 --> 00:41:27,480 SO THIS IS HOW OUR NETWORK MODEL 973 00:41:27,480 --> 00:41:30,680 OF SYMPTOMS WELL IT'S NOT REALLY 974 00:41:30,680 --> 00:41:32,160 SYMPTOMS BUT INDIVIDUAL FACTORS 975 00:41:32,160 --> 00:41:35,320 AND AT THE TOP, YOU SEE 976 00:41:35,320 --> 00:41:39,440 [INDISCERNIBLE] AT THE BOTTOM, 977 00:41:39,440 --> 00:41:41,840 YOU SEE DEPRESSIVE SYMPTOMS AND 978 00:41:41,840 --> 00:41:42,600 LOW BIRTH WEIGHT, ECONOMIC 979 00:41:42,600 --> 00:41:46,720 HARDSHIP AND WHETHER THEY WERE 980 00:41:46,720 --> 00:41:47,800 U.S. BORN, SO THE 981 00:41:47,800 --> 00:41:49,400 [INDISCERNIBLE] ARE CALLED THE 982 00:41:49,400 --> 00:41:50,200 NODES, THE LITTLE CONNECTION 983 00:41:50,200 --> 00:41:51,320 BETWEEN THEM ARE CALLED THE 984 00:41:51,320 --> 00:41:54,720 EDGES AND THE THICKNESS OF THE 985 00:41:54,720 --> 00:41:57,640 EDGE MEANS IT'S TRYING TO HELP 986 00:41:57,640 --> 00:42:01,360 THE RELATIONSHIP AND IF IT HAS 987 00:42:01,360 --> 00:42:03,080 BLUE IT'S A POSITIVE 988 00:42:03,080 --> 00:42:04,640 ASSOCIATION, AND IF IT'S RED, IT 989 00:42:04,640 --> 00:42:05,800 IS A NEGATIVE ASSOCIATION. 990 00:42:05,800 --> 00:42:07,520 SO QUICKLY HERE, YOU SEE IN THE 991 00:42:07,520 --> 00:42:09,400 FIRST FIGURE, YOU DON'T SEE DID 992 00:42:09,400 --> 00:42:11,320 CONNECTION BETWEEN DEPRESSION 993 00:42:11,320 --> 00:42:12,720 AND THE [INDISCERNIBLE] BUT IN 994 00:42:12,720 --> 00:42:15,560 THE SAME MODEL IF YOU CHOOSE THE 995 00:42:15,560 --> 00:42:17,200 ONLY THING THAT WE CHANGE AT 996 00:42:17,200 --> 00:42:20,400 DISCRIMINATION IN THE MODEL IS 997 00:42:20,400 --> 00:42:21,600 THE OTHER DISCRIMINATION 998 00:42:21,600 --> 00:42:23,280 ACTSAs A BRIDGE CONNECTING 999 00:42:23,280 --> 00:42:27,400 THOSE 2 STRESSORS WHICH THEY ARE 1000 00:42:27,400 --> 00:42:28,360 BELIEVE THEY DISCRIMINATION 1001 00:42:28,360 --> 00:42:30,440 MAJOR TRIGGER TO HEALTH OUTCOMES 1002 00:42:30,440 --> 00:42:33,360 IN THE PREGNANCY AND POST 1003 00:42:33,360 --> 00:42:33,800 ENVIRONMENT PERIOD. 1004 00:42:33,800 --> 00:42:36,440 BUT OF COURSE, I FOCUS ON HOW 1005 00:42:36,440 --> 00:42:38,360 THINGS GET UNDER THEIR SKIN SO 1006 00:42:38,360 --> 00:42:40,000 WE CAN TRY TO ADDRESS THOSE 1007 00:42:40,000 --> 00:42:42,160 THINGS BEFORE THEY GET OUT OF 1008 00:42:42,160 --> 00:42:43,600 CONTROL AND BECOME CHRONIC 1009 00:42:43,600 --> 00:42:43,920 CONDITIONS. 1010 00:42:43,920 --> 00:42:47,320 SO 1 OF THE THINGS WE FOCUS ON 1011 00:42:47,320 --> 00:42:50,040 DNA METHYLATION, AND DNA 1012 00:42:50,040 --> 00:42:51,320 METHYLATION IS REALLY 1013 00:42:51,320 --> 00:42:53,480 [INDISCERNIBLE] THE TOP OF YOUR 1014 00:42:53,480 --> 00:42:55,200 DNA, THAT CAN TURN THE FUNCTION 1015 00:42:55,200 --> 00:42:58,960 OF THE GENE ON AND OFF. 1016 00:42:58,960 --> 00:43:01,560 FOR EXAMPLE, IN THIS PICTURE, 1017 00:43:01,560 --> 00:43:03,120 YOU HAVE A [INDISCERNIBLE] 1018 00:43:03,120 --> 00:43:04,760 ISLAND, IF YOU THINK OF THIS AS 1019 00:43:04,760 --> 00:43:05,480 [INDISCERNIBLE], AND THE 1020 00:43:05,480 --> 00:43:07,880 BEGINNING OF THE STREET AND THE 1021 00:43:07,880 --> 00:43:10,360 COOL PART OF THE STREET WHERE 1022 00:43:10,360 --> 00:43:11,760 EVERYBODY CONGREGATES SO THIS 1023 00:43:11,760 --> 00:43:14,480 [INDISCERNIBLE] IS THE PART OF 1024 00:43:14,480 --> 00:43:19,400 THIS TREE AND HERE NONE OF THOSE 1025 00:43:19,400 --> 00:43:21,160 ARE TAGGED SO THERE'S FULL 1026 00:43:21,160 --> 00:43:22,080 INFORMATION HAPPENING. 1027 00:43:22,080 --> 00:43:25,920 SO THE GENE EXPRESSION TAKES 1028 00:43:25,920 --> 00:43:27,680 PLACE AND THE LYSIS FOR WHICH 1029 00:43:27,680 --> 00:43:28,880 THEY'RE METHALATED AND TAGGED IN 1030 00:43:28,880 --> 00:43:31,920 THOSE AREAS OF THE GENES, 1031 00:43:31,920 --> 00:43:33,640 THERE'S NO GENE EXPRESSION AND 1032 00:43:33,640 --> 00:43:36,760 THE GENE NOW REPRESSED MEANING 1033 00:43:36,760 --> 00:43:37,840 THEIR NOT FUNCTIONING AS THEY 1034 00:43:37,840 --> 00:43:41,240 SHOULD, SO IF YOU THINK OF THE 1035 00:43:41,240 --> 00:43:47,760 EXAM OR AN EXAMPLE, YOU THINK OF 1036 00:43:47,760 --> 00:43:49,560 A CHRISTMAS TREE THE CHRISTMAS 1037 00:43:49,560 --> 00:43:53,760 TREE IS AN INDIVIDUAL, AND THEN 1038 00:43:53,760 --> 00:43:55,680 YOU HAVE THESE LITTLE STRESSOR 1039 00:43:55,680 --> 00:43:57,560 WHICH WOULD BE THE LITTLE KITTY 1040 00:43:57,560 --> 00:43:59,760 THAT YOUR FAMILY BROUGHT HOME 1041 00:43:59,760 --> 00:44:03,200 AND THE KITTY DEFINITELY 1042 00:44:03,200 --> 00:44:06,320 DESTROYED THE TREE BUT IT CAN 1043 00:44:06,320 --> 00:44:07,240 MESS UP DIFFERENT SECTIONS OF 1044 00:44:07,240 --> 00:44:10,360 THE TREE THAT IT LIKES, IT 1045 00:44:10,360 --> 00:44:11,840 CANNOT DETECT THE SYNCHRONY OF 1046 00:44:11,840 --> 00:44:14,200 THE TREE AND TREE IN DIFFERENT 1047 00:44:14,200 --> 00:44:15,480 AREAS, SO THESE ARE A STRESSOR 1048 00:44:15,480 --> 00:44:17,440 THAT WE'RE LOOKING FOR AND TRY 1049 00:44:17,440 --> 00:44:21,280 TO IDENTIFY HOW CAN WE BRING 1050 00:44:21,280 --> 00:44:24,320 THAT CHRISTMAS TREE BACK TO FULL 1051 00:44:24,320 --> 00:44:26,000 FUNCTION. 1052 00:44:26,000 --> 00:44:28,600 SO I BIT OF DATA POINT. 1053 00:44:28,600 --> 00:44:31,760 FOR EXAMPLE, WHEN WE ELECTRIC AT 1054 00:44:31,760 --> 00:44:33,280 PRENATAL DISCRIMINATION EXPOSURE 1055 00:44:33,280 --> 00:44:37,000 AND POSTNATAL ONSET OF 1056 00:44:37,000 --> 00:44:38,680 DEPRESSION, ANXIETY, WE OBSERVE 1057 00:44:38,680 --> 00:44:43,320 THAT ONLY THE MOTHERS THAT SHOW 1058 00:44:43,320 --> 00:44:45,920 HIGH [INDISCERNIBLE] METHYLATION 1059 00:44:45,920 --> 00:44:49,080 AND TNF ALPHA METHYLATION GO ON 1060 00:44:49,080 --> 00:44:50,640 TO DEVELOP CLINICAL SIGNIFICANT 1061 00:44:50,640 --> 00:44:54,760 LEVELS OF DEPRESSION AND ANXIETY 1062 00:44:54,760 --> 00:44:56,720 HOWEVER, THE MOTHERS THAT HAVE 1063 00:44:56,720 --> 00:44:57,600 BEEN EXPOSED TO DISCRIMINATION 1064 00:44:57,600 --> 00:45:00,000 DOES NOT HAVE THAT METHYLATION 1065 00:45:00,000 --> 00:45:00,240 PROFILE. 1066 00:45:00,240 --> 00:45:07,640 THEY DO NOT GO ON TO DEVELOP 1067 00:45:07,640 --> 00:45:08,120 THAT CLINICAL OUTPUT. 1068 00:45:08,120 --> 00:45:10,320 SO WE HAVE THE IDEA THAT THE 1069 00:45:10,320 --> 00:45:12,720 METHYLATION HERE WITH THE 1070 00:45:12,720 --> 00:45:14,040 BIOLOGICAL IMPACT HERE IS NOT 1071 00:45:14,040 --> 00:45:14,960 NECESSARILY ALL NEGATIVE SO THE 1072 00:45:14,960 --> 00:45:16,240 BODY IS TRYING TO AX DATA 1073 00:45:16,240 --> 00:45:20,080 PROTECTION AND THE BIOLOGICAL 1074 00:45:20,080 --> 00:45:21,880 EMBEDDING COULD ACTUALLY BE 1075 00:45:21,880 --> 00:45:22,880 SERVING AS A PROTECTIVE 1076 00:45:22,880 --> 00:45:25,920 MECHANISM FOR SOME INDIVIDUALS. 1077 00:45:25,920 --> 00:45:28,080 THE QUESTION IS WHEN DOES IT 1078 00:45:28,080 --> 00:45:30,040 HAPPEN AND IN WHAT CONDITION 1079 00:45:30,040 --> 00:45:31,200 DOES IT HAPPEN IN AND THAT IS 1080 00:45:31,200 --> 00:45:33,920 WHAT WE ARE TRYING TO UNDERSTAND 1081 00:45:33,920 --> 00:45:35,440 AND CAN WE MANIPULATE THOSE 1082 00:45:35,440 --> 00:45:40,640 CONDITIONS TO ALLOW PEOPLE TO 1083 00:45:40,640 --> 00:45:41,400 LIVE HEALTHIER LIVES. 1084 00:45:41,400 --> 00:45:43,760 SO WE HAVE PUBLISHED EXTENSIVELY 1085 00:45:43,760 --> 00:45:47,400 IN THIS AREA OF CONCEPT AND WE 1086 00:45:47,400 --> 00:45:48,960 LOOKED AT TELOMERE LEPGHT AND 1087 00:45:48,960 --> 00:45:51,480 OTHER MECHANISMS BUT BASICALLY 1088 00:45:51,480 --> 00:45:54,480 THE BOTTOM LINE HERE IS THAT 1089 00:45:54,480 --> 00:45:56,480 TIMING MAKES A DIFFERENCE. 1090 00:45:56,480 --> 00:45:58,280 FOR EXAMPLE, SOME PEOPLE THIS IS 1091 00:45:58,280 --> 00:46:00,280 A PATH MODEL, LOOK AT CHILDHOOD 1092 00:46:00,280 --> 00:46:07,160 IN THE U.S., CHILDHOOD RACISM, 1093 00:46:07,160 --> 00:46:07,840 RACISM AND THEN SEROREACTIVE 1094 00:46:07,840 --> 00:46:10,040 PROTEIN WHICH IS A CHRONIC 1095 00:46:10,040 --> 00:46:12,880 STRESS MARKER AT 6 MONTHS 1096 00:46:12,880 --> 00:46:14,200 POSTPARTUM AFTER PREGNANCY AS 1097 00:46:14,200 --> 00:46:15,960 WELL AS BMI AND THEN WE DO THE 1098 00:46:15,960 --> 00:46:25,120 SECOND MODEL, WE HAD 12 MONTHS 1099 00:46:25,120 --> 00:46:26,600 POSTPARTUM AND THE CHILDHOOD 1100 00:46:26,600 --> 00:46:30,080 RACES AND 6 MONTHS POSTPARTUM WE 1101 00:46:30,080 --> 00:46:32,520 SEE THE ASSOCIATION OF CRP AS 1102 00:46:32,520 --> 00:46:36,080 WELLA AS HIGH BMI BUT WE WE LOOK 1103 00:46:36,080 --> 00:46:38,160 AT 12 MONTHS POSTPARTUM, THE TSP 1104 00:46:38,160 --> 00:46:39,760 ASSOCIATION GOES AWAY SO TIME 1105 00:46:39,760 --> 00:46:41,800 MIGHT MATTER. 1106 00:46:41,800 --> 00:46:45,400 AND WE--WE DON'T YET FULLY 1107 00:46:45,400 --> 00:46:47,840 UNDERSTAND WHAT ARE THE 1108 00:46:47,840 --> 00:46:51,360 CONDITIONS THAT MAKE THOSE 1109 00:46:51,360 --> 00:46:54,080 ASSOCIATIONS BECOME STRONGER OR 1110 00:46:54,080 --> 00:46:54,760 GO AWAY. 1111 00:46:54,760 --> 00:46:57,120 BUT THE BIGGEST QUESTION HERE IS 1112 00:46:57,120 --> 00:47:01,000 WHAT ARE WE REALLY LOOKING AT? 1113 00:47:01,000 --> 00:47:01,920 ALL RIGHT? 1114 00:47:01,920 --> 00:47:03,480 SO DISCRIMINATION IS A COMPLEX 1115 00:47:03,480 --> 00:47:06,400 FACTOR THAT IS INTERACTING 1116 00:47:06,400 --> 00:47:07,400 STRONGLY WITH THE ENVIRONMENT 1117 00:47:07,400 --> 00:47:09,600 AND ALSO ALL THE SOCIAL 1118 00:47:09,600 --> 00:47:11,520 DETERMINANTS OF HEALTH AND WE 1119 00:47:11,520 --> 00:47:13,800 REALLY CANNOT GET CAUSAL EFFECT 1120 00:47:13,800 --> 00:47:16,640 BECAUSE WE DON'T REALLY KNOW 1121 00:47:16,640 --> 00:47:18,160 WHEN THINGS BEGAN AND WHEN 1122 00:47:18,160 --> 00:47:20,080 THINGS END BECAUSE THAT IS THE 1123 00:47:20,080 --> 00:47:22,160 CONDITIONS THAT PEOPLE ARE IN SO 1124 00:47:22,160 --> 00:47:25,560 THAT IS WHY WE TRY TO FOCUS ON 1125 00:47:25,560 --> 00:47:27,080 EARLY LIFE TO TRY TO GET INTO 1126 00:47:27,080 --> 00:47:30,400 THAT, BUT REALLY THE BIG PICTURE 1127 00:47:30,400 --> 00:47:35,920 HERE, IS THAT WHERE WE ARE AT, 1128 00:47:35,920 --> 00:47:37,360 AT THE ISSUES UNDER SIGNED THE 1129 00:47:37,360 --> 00:47:38,880 TIP OF THE PROBLEM A WHOLE LOT 1130 00:47:38,880 --> 00:47:41,080 MORE THAT WE ARE TRYING TO 1131 00:47:41,080 --> 00:47:48,480 UNDERSTAND, SO WE CAN TAILOR OUR 1132 00:47:48,480 --> 00:47:51,320 INTERVENTIONS TO ERASE THE 1133 00:47:51,320 --> 00:47:53,200 CONSEQUENCES THAT THESE SOCIAL 1134 00:47:53,200 --> 00:47:54,600 INSTANCES HAVE CREATED IN OUR 1135 00:47:54,600 --> 00:47:54,960 BODY. 1136 00:47:54,960 --> 00:47:58,240 SO SOME FINAL THOUGHTS, 1137 00:47:58,240 --> 00:47:59,760 BIOSOCIAL PERSPECTIVE IS 1138 00:47:59,760 --> 00:48:01,040 INTEGRAL TO HEALTH EQUITY. 1139 00:48:01,040 --> 00:48:02,760 IT'S NOT ONLY FORMED BY 1140 00:48:02,760 --> 00:48:03,600 EXPERIENCES WORKING BY PEOPLE IN 1141 00:48:03,600 --> 00:48:07,480 THE CLINIC AND THE COMMUNITY BUT 1142 00:48:07,480 --> 00:48:08,880 ALSO INCLUDES A WHOLISTIC VIEW 1143 00:48:08,880 --> 00:48:12,680 OF THE BIOLOGICAL PROCESSES AND 1144 00:48:12,680 --> 00:48:13,120 CONDITIONS. 1145 00:48:13,120 --> 00:48:15,520 WE REALLY SHOULD START TO TRY TO 1146 00:48:15,520 --> 00:48:17,720 UNDERSTAND THE ENVIRONMENT, 1147 00:48:17,720 --> 00:48:19,320 SOCIAL CULTURE, GENETIC AND 1148 00:48:19,320 --> 00:48:20,400 GERONTOLOGYSTS GOMMIC AND OTHER 1149 00:48:20,400 --> 00:48:22,480 FACTORS THAT DRIVE OTHERS TO 1150 00:48:22,480 --> 00:48:26,200 DEVELOP PRECISION HEALTH 1151 00:48:26,200 --> 00:48:27,120 INTERVENTIONS THROUGHOUT SUCCESS 1152 00:48:27,120 --> 00:48:29,440 HEALTH EQUITY WE NEED TO GO 1153 00:48:29,440 --> 00:48:32,400 BEYOND THE BIOAND BEYOND THE 1154 00:48:32,400 --> 00:48:34,440 SOCIAL TO INTEGRATE THE 1155 00:48:34,440 --> 00:48:35,200 APPROACHES THAT ACCOUNT FOR THE 1156 00:48:35,200 --> 00:48:37,040 WHOLE PERSON AND THE CONTEXT 1157 00:48:37,040 --> 00:48:39,880 THEY LIVE IN. 1158 00:48:39,880 --> 00:48:42,920 SO REALLY BIG QUESTIONS REMAIN. 1159 00:48:42,920 --> 00:48:44,400 FOR EXAMPLE, IS THIS ENOUGH--IS 1160 00:48:44,400 --> 00:48:48,080 IT ENOUGH TO END DISCRIMINATION 1161 00:48:48,080 --> 00:48:51,520 IS IT ENOUGH TO PROMOTE POSITIVE 1162 00:48:51,520 --> 00:48:52,480 SOCIAL DETERMINANTS OF HEALTH? 1163 00:48:52,480 --> 00:48:53,880 I DON'T KNOW THE ANSWER. 1164 00:48:53,880 --> 00:48:55,960 THAT IS WHAT I THINK THE NEXT 1165 00:48:55,960 --> 00:48:59,800 WAVE OF STUDIES SHOULD BE 1166 00:48:59,800 --> 00:49:00,600 LOOKING AT. 1167 00:49:00,600 --> 00:49:03,200 AND TO END, I REALLY WANT TO 1168 00:49:03,200 --> 00:49:07,520 BRING THE ISSUE TO THE 1169 00:49:07,520 --> 00:49:10,040 FOREFRONT, A TOLL ON THE BODY 1170 00:49:10,040 --> 00:49:12,240 CAN HAVE LONG-TERM REPERCUSSIONS 1171 00:49:12,240 --> 00:49:14,080 OF HEALTH. 1172 00:49:14,080 --> 00:49:15,880 ADDRESSING DISPARITIES MUST GO 1173 00:49:15,880 --> 00:49:16,480 AS CAN BE AND GO ON, SO I STOP 1174 00:49:16,480 --> 00:49:17,160 HERE AND TAKE ANY QUESTIONS. 1175 00:49:17,160 --> 00:49:20,400 >>THANK YOU DR. SANTOS THAT WAS 1176 00:49:20,400 --> 00:49:22,280 FANTASTIC. 1177 00:49:22,280 --> 00:49:25,880 SO YOU ASKED 2 QUESTIONS AT THE 1178 00:49:25,880 --> 00:49:26,040 END. 1179 00:49:26,040 --> 00:49:27,920 THE 2 BIG QUESTIONS. 1180 00:49:27,920 --> 00:49:31,520 SO WHAT'S GOING TO BE--WHAT ARE 1181 00:49:31,520 --> 00:49:34,760 YOU THINKING ABOUT IN TERMS OF 1182 00:49:34,760 --> 00:49:38,240 YOUR TEAM AND SORT OF NEXT STUDY 1183 00:49:38,240 --> 00:49:38,520 SET? 1184 00:49:38,520 --> 00:49:40,080 BECAUSE YOU REALLY ARE TAKING 1185 00:49:40,080 --> 00:49:42,760 ABOUT MOVING BEYOND THE BIO AND 1186 00:49:42,760 --> 00:49:43,320 BEYOND THE SOCIAL. 1187 00:49:43,320 --> 00:49:47,200 SO WHAT DO YOU THINK ARE SORT OF 1188 00:49:47,200 --> 00:49:50,840 PROMISING POTENTIAL NEXT STEPS 1189 00:49:50,840 --> 00:49:52,680 FOR STUDIES? 1190 00:49:52,680 --> 00:49:57,280 >>YEAH, YOU THINK I KNOW, I 1191 00:49:57,280 --> 00:50:01,160 THINK THE BIGGEST NEXT STEP, OF 1192 00:50:01,160 --> 00:50:01,960 COURSE LIKE ENDING 1193 00:50:01,960 --> 00:50:03,000 DISCRIMINATION WOULD BE 1194 00:50:03,000 --> 00:50:03,400 FANTASTIC RIGHT? 1195 00:50:03,400 --> 00:50:06,160 I THINK IT WOULD BE A GREAT 1196 00:50:06,160 --> 00:50:06,960 THING TO DO. 1197 00:50:06,960 --> 00:50:10,280 HOWEVER, IT MAY TAKE DECADES. 1198 00:50:10,280 --> 00:50:11,880 IT MAY NEVER HAPPEN SO WHAT I 1199 00:50:11,880 --> 00:50:14,880 WILL DO IS JUST SIT AND WAIT, 1200 00:50:14,880 --> 00:50:17,680 RIGHT, SO WEARY LIE ON 1201 00:50:17,680 --> 00:50:19,280 POLITICIANS TO MAKE--WE RELY ON 1202 00:50:19,280 --> 00:50:20,680 POLARIZED CISIONS TO MAKE CHANGE 1203 00:50:20,680 --> 00:50:22,880 AND WE RELY ON EDUCATION OF 1204 00:50:22,880 --> 00:50:24,920 SOCIETY TO CHANGE THE WAY THEY 1205 00:50:24,920 --> 00:50:26,000 PERCEIVE AND THEY BEHAVE. 1206 00:50:26,000 --> 00:50:28,440 IN THE MEAN TIME I THINK WE CAN 1207 00:50:28,440 --> 00:50:30,760 BE BETTER AT PROVIDING THE DATA 1208 00:50:30,760 --> 00:50:33,160 THAT CAN SUPPORT THOSE CHANGE. 1209 00:50:33,160 --> 00:50:35,200 FOR EXAMPLE, IS IT REALLY ENOUGH 1210 00:50:35,200 --> 00:50:39,400 FOR ME TO GO TO A POLITICIAN OR 1211 00:50:39,400 --> 00:50:42,960 A POLICY MAKER TO SAY, YOU KNOW 1212 00:50:42,960 --> 00:50:44,800 THIS PERSON IS PERCEIVING THESE 1213 00:50:44,800 --> 00:50:49,640 AS STRESSFUL WHEN WE ACTUALLY 1214 00:50:49,640 --> 00:50:53,040 CAN HAVE CONCRETE EVIDENCE THAT 1215 00:50:53,040 --> 00:50:54,080 IS DETRIMENTAL TO HEALTH. 1216 00:50:54,080 --> 00:50:58,520 BUT ALSO TO THE POINT OF IS IT 1217 00:50:58,520 --> 00:50:59,440 REALLY JUST ENOUGH TO PROVIDE 1218 00:50:59,440 --> 00:51:01,560 THEM WITH A MONTHLY STIPEND SO 1219 00:51:01,560 --> 00:51:05,160 THEY CAN HAVE A BETTER FOOD 1220 00:51:05,160 --> 00:51:05,480 SOURCE? 1221 00:51:05,480 --> 00:51:07,880 YES, THAT IS A FANTASTIC 1222 00:51:07,880 --> 00:51:10,920 RESOURCE, BUT WE CANNOT ALLOW 1223 00:51:10,920 --> 00:51:12,640 THOSE POLICIES TO END THERE. 1224 00:51:12,640 --> 00:51:14,840 WE HAVE TO CREATE INTERVENTIONS 1225 00:51:14,840 --> 00:51:18,440 THAT REALLY BRING THE PERSON 1226 00:51:18,440 --> 00:51:22,000 BACK TO ITS FULL CAPACITY. 1227 00:51:22,000 --> 00:51:24,320 SO WE PROVIDE THE STRUCTURAL 1228 00:51:24,320 --> 00:51:26,480 CHANGE, THE PERSON NOW IS LEFT 1229 00:51:26,480 --> 00:51:29,320 TO THEIR OWN DEVICES TO TRY TO 1230 00:51:29,320 --> 00:51:32,400 UNDUE THE CONSEQUENCES OF LIVING 1231 00:51:32,400 --> 00:51:34,720 AND THE ADVERSITY IN THEIR OWN 1232 00:51:34,720 --> 00:51:36,240 BODY, SO THEY'RE STILL GOING TO 1233 00:51:36,240 --> 00:51:37,840 DIE SOONER, THEY'RE STILL GOING 1234 00:51:37,840 --> 00:51:39,840 TO DEVELOP EARLY CHRONIC 1235 00:51:39,840 --> 00:51:43,520 CONDITIONS, BECAUSE WE HAVE NOT 1236 00:51:43,520 --> 00:51:45,400 GONE THE NEXT STEP WHICH IS HOW 1237 00:51:45,400 --> 00:51:49,040 DO WE ACTUALLY ENABLE THEM, NOW 1238 00:51:49,040 --> 00:51:50,720 THAT WE HAVE [INDISCERNIBLE] HOW 1239 00:51:50,720 --> 00:51:55,920 ABOUT WE ENABLE THEM TO CHANGE 1240 00:51:55,920 --> 00:51:57,440 THE ALL SYSTEMS. 1241 00:51:57,440 --> 00:51:59,040 AND I'M REALLY NOT TAKING ABOUT 1242 00:51:59,040 --> 00:52:01,160 A SPECIFIC SYSTEM LIKE GENETICS 1243 00:52:01,160 --> 00:52:02,440 OR GENOMICS OR WHATEVER IT IS. 1244 00:52:02,440 --> 00:52:04,080 YOU KNOW LIKE HOW DO WE GET 1245 00:52:04,080 --> 00:52:05,720 THERE AND HOW CAN WE QUANTIFY 1246 00:52:05,720 --> 00:52:08,560 THAT IN A WAY THAT IS 1247 00:52:08,560 --> 00:52:09,960 INFORMATIVE FOR THE PERSON. 1248 00:52:09,960 --> 00:52:14,720 AND OF COURSE FOR NURSES TO BE 1249 00:52:14,720 --> 00:52:15,160 IN OTHER HEALTHCARE 1250 00:52:15,160 --> 00:52:17,600 PROFESSIONALS TO BE ABLE TO USE 1251 00:52:17,600 --> 00:52:23,240 THOSE DATA POINTS TO BE--TO BE 1252 00:52:23,240 --> 00:52:24,200 EDUCATIONAL FOR THE CLIENTELE 1253 00:52:24,200 --> 00:52:29,960 THAT WE TRY TO SUPPORT, AND 1254 00:52:29,960 --> 00:52:30,480 PROTECT THE HEALTH. 1255 00:52:30,480 --> 00:52:35,440 >>YEAH, NO, THAT'S REALLY, 1256 00:52:35,440 --> 00:52:35,880 THAT'S REALLY GREAT. 1257 00:52:35,880 --> 00:52:37,120 SO I HAVE A FOLLOW UP QUESTION 1258 00:52:37,120 --> 00:52:39,680 TO THAT, BUT I WANTED TO ASK 1 1259 00:52:39,680 --> 00:52:41,520 THAT CAME IN FROM THE AUDIENCE 1260 00:52:41,520 --> 00:52:44,160 AND THAT IS WHICH CELL TYPE WAS 1261 00:52:44,160 --> 00:52:49,160 TESTED FOR DNA METHYLATION FAT 1262 00:52:49,160 --> 00:52:50,720 IN YOUR STUDIES? 1263 00:52:50,720 --> 00:52:56,160 >>SO FOR THAT STUDY IN ITSELF, 1264 00:52:56,160 --> 00:52:58,320 IT WASN'T FOCUSED ON A SINGLE 1265 00:52:58,320 --> 00:52:58,600 CELL TYPE. 1266 00:52:58,600 --> 00:53:04,080 WE USE BLOOD OF A BIOLOGICAL 1267 00:53:04,080 --> 00:53:07,320 SAMPLE AND THE ASSESSMENT WE 1268 00:53:07,320 --> 00:53:09,320 HAVE DONE WAS A CANDIDATE GENE 1269 00:53:09,320 --> 00:53:13,760 APPROACH ALTHOUGH WE DO HAVE 1270 00:53:13,760 --> 00:53:14,560 GENOME WIDE ANALYSIS. 1271 00:53:14,560 --> 00:53:16,200 IN THAT CASE WHAT WE WOULD DO IS 1272 00:53:16,200 --> 00:53:20,760 TRY TO CONTROL FOR THE CELL 1273 00:53:20,760 --> 00:53:22,520 COMPOSITION BECAUSE IN THIS CASE 1274 00:53:22,520 --> 00:53:25,040 DNA METHYLATION IS HIGHLY 1275 00:53:25,040 --> 00:53:26,400 DEPENDENTOT TISSUE BECAUSE AS 1276 00:53:26,400 --> 00:53:29,160 YOU THINK, YOU KNOW, YOUR HAIR 1277 00:53:29,160 --> 00:53:31,400 AND YOUR SKIN, THEY ALL HAVE THE 1278 00:53:31,400 --> 00:53:33,240 SAME GENETIC MAKEUP BUT THEY 1279 00:53:33,240 --> 00:53:34,480 LOOK VERY DIFFERENT, RIGHT? 1280 00:53:34,480 --> 00:53:38,320 THAT IS DNA METHYLATION. 1281 00:53:38,320 --> 00:53:40,560 IT'S TURNING ALL THE GENES ON 1282 00:53:40,560 --> 00:53:42,720 AND OFF SO THEY HAVE DIFFERENT 1283 00:53:42,720 --> 00:53:44,720 FUNCTIONS, SO WE TAKE BLOOD AND 1284 00:53:44,720 --> 00:53:46,120 WE TAKE SKIN, WE HAVE TO CONTROL 1285 00:53:46,120 --> 00:53:47,640 FOR THE CELL COMPOSITION SO 1286 00:53:47,640 --> 00:53:49,000 WE'RE NOT LOOKING AT THINGS THAT 1287 00:53:49,000 --> 00:53:53,960 ARE JUST DUE TO THE FUNCTION OF 1288 00:53:53,960 --> 00:53:54,400 THE TISSUE. 1289 00:53:54,400 --> 00:53:58,760 SO WE DO THOSE ADJUSTMENTS IN 1290 00:53:58,760 --> 00:53:59,080 OUR MODELS. 1291 00:53:59,080 --> 00:54:00,200 >>THAT'S GREAT. 1292 00:54:00,200 --> 00:54:00,560 THANK YOU. 1293 00:54:00,560 --> 00:54:02,240 >>OKAY, SO ANOTHER QUESTION 1294 00:54:02,240 --> 00:54:04,640 CAME IN AROUND THE PICTURE THAT 1295 00:54:04,640 --> 00:54:07,000 YOU WERE SHOWING IN BRAZIL, SO 1296 00:54:07,000 --> 00:54:08,720 YOU BEGAN BY SAYING THAT THE 1297 00:54:08,720 --> 00:54:10,680 OBJECT WAS TO MOVE PEOPLE FROM 1298 00:54:10,680 --> 00:54:13,440 THE LEFT SIDE OF THE WALL TO THE 1299 00:54:13,440 --> 00:54:17,520 RIGHT SIDE OF THE WALL IN THAT 1300 00:54:17,520 --> 00:54:21,000 PICTURE AND AN AAPARTMENT HOUSE, 1301 00:54:21,000 --> 00:54:23,360 WOULDN'T IT BE BETTER TO REWORK 1302 00:54:23,360 --> 00:54:24,720 THE RULES OF THE GAME SO THAT 1303 00:54:24,720 --> 00:54:26,440 THE SHARP DIFFERENCE COULD BE 1304 00:54:26,440 --> 00:54:27,840 ARK VOIDED? 1305 00:54:27,840 --> 00:54:29,560 >>YES, A HUNDRED PERCENT AND 1306 00:54:29,560 --> 00:54:30,600 PROBABLY WASN'T THE BEST EXAMPLE 1307 00:54:30,600 --> 00:54:32,880 I GAVE BUT YEAH, THE IDEA WOULD 1308 00:54:32,880 --> 00:54:37,680 BE THAT THERE'S NO SEPARATION, 1309 00:54:37,680 --> 00:54:37,880 RIGHT? 1310 00:54:37,880 --> 00:54:39,880 THAT EVERYBODY'S EQUAL AND HAVE 1311 00:54:39,880 --> 00:54:42,840 SIMILAR OPPORTUNITIES BUT IT'S 1312 00:54:42,840 --> 00:54:43,800 REALLY, REALLY, YOU KNOW, IS 1313 00:54:43,800 --> 00:54:47,960 THAT REAL REALLY A REALITY? 1314 00:54:47,960 --> 00:54:49,040 TO BE HONEST WITH MYSELF, I 1315 00:54:49,040 --> 00:54:50,400 DON'T THINK IT IS AND THEN 1316 00:54:50,400 --> 00:54:53,800 PEOPLE LIKE FOR EXAMPLE,--THE 1317 00:54:53,800 --> 00:54:54,720 REASON I USE THAT EXAMPLE IS 1318 00:54:54,720 --> 00:54:56,640 BECAUSE I WAS GETTING PREPARED 1319 00:54:56,640 --> 00:55:00,840 FOR THE SOCIAL MOBILITY STUDIES 1320 00:55:00,840 --> 00:55:02,000 WHICH IS REALLY PEOPLE WORKING 1321 00:55:02,000 --> 00:55:05,880 REALLY HARD TO TRY TO MOVE AWAY 1322 00:55:05,880 --> 00:55:07,480 FROM THAT ENVIRONMENT, TO YOU 1323 00:55:07,480 --> 00:55:12,120 KNOW THE BETTER ENVIRONMENT 1324 00:55:12,120 --> 00:55:13,640 MEANS, WHATEVER BETTER MEANS IN 1325 00:55:13,640 --> 00:55:14,000 THAT SITUATION. 1326 00:55:14,000 --> 00:55:15,280 BUT THE PERSON IS COMPLETELY 1327 00:55:15,280 --> 00:55:15,480 RIGHT. 1328 00:55:15,480 --> 00:55:18,600 THE IDEA IS THAT THINGS SHOULD 1329 00:55:18,600 --> 00:55:22,200 BE EQUALIZED AND NO SUCH 1330 00:55:22,200 --> 00:55:26,240 DISCREPANCIES SHOULD EXIST IN 1331 00:55:26,240 --> 00:55:26,480 SOCIETY. 1332 00:55:26,480 --> 00:55:27,200 >>YEAH IN AN IDEAL SOCIETY, 1333 00:55:27,200 --> 00:55:28,160 THAT WOULD BE GREAT. 1334 00:55:28,160 --> 00:55:34,960 >>THAT WOULD BE BEAUTIFUL. 1335 00:55:34,960 --> 00:55:39,120 >>SO I WANT TO ASK YOU A 1336 00:55:39,120 --> 00:55:42,040 QUESTION ABOUT SO IF WE CAN'T 1337 00:55:42,040 --> 00:55:43,280 END DISCRIMINATION, WE CAN TRY 1338 00:55:43,280 --> 00:55:45,920 TO DO STRUCTURAL DECREASING OF 1339 00:55:45,920 --> 00:55:48,480 INIQUITIES AND WE CAN TRY TO 1340 00:55:48,480 --> 00:55:49,640 PROMOTE POSITIVE SOCIAL 1341 00:55:49,640 --> 00:55:50,280 DETERMINANTS OF HEALTH. 1342 00:55:50,280 --> 00:55:54,080 WHAT DO YOU SEE THE ROLE OF 1343 00:55:54,080 --> 00:55:56,560 COMMUNITIES BEING BECAUSE THAT'S 1344 00:55:56,560 --> 00:55:59,520 WHERE INDIVIDUALS THAT LIVE, 1345 00:55:59,520 --> 00:56:02,320 WORK, PLAY AND AGE, IF YOU WILL? 1346 00:56:02,320 --> 00:56:05,240 >>I THINK COMMUNITY HAS A BIG 1347 00:56:05,240 --> 00:56:06,880 ROLE, YOU KNOW FOR 1 WE CAN 1348 00:56:06,880 --> 00:56:09,200 TEACH WHAT WE SHOULD REALLY BE 1349 00:56:09,200 --> 00:56:12,720 FOCUSING ON TO DO RESEARCH, ON, 1350 00:56:12,720 --> 00:56:14,000 RIGHT BECAUSE OFTEN TIMES WE 1351 00:56:14,000 --> 00:56:15,120 HAVE THIS TOP DOWN APPROACH 1352 00:56:15,120 --> 00:56:18,360 WHERE WE COME UP WITH THIS 1353 00:56:18,360 --> 00:56:19,000 BEHAVIORIAL INTERVENTION WHERE 1354 00:56:19,000 --> 00:56:25,040 WE NOW GOING TO TEACH PEOPLE NOW 1355 00:56:25,040 --> 00:56:26,240 TO BE [INDISCERNIBLE] AND WE GO 1356 00:56:26,240 --> 00:56:28,520 IN AND WE TEACH THEM BUT WHEN WE 1357 00:56:28,520 --> 00:56:31,120 GO IN, WE OFTEN LACK THAT DEEP 1358 00:56:31,120 --> 00:56:35,120 KNOWLEDGE OF HOW THE COMMUNITY'S 1359 00:56:35,120 --> 00:56:36,520 ADAPTING TO THAT SITUATION. 1360 00:56:36,520 --> 00:56:40,160 SO THERE YOU ARE SYSTEMS FOR 1361 00:56:40,160 --> 00:56:41,120 EXAMPLE, COMMENT HEALTH WORKERS 1362 00:56:41,120 --> 00:56:45,000 THAT HAVE BEEN SO SUCCESSFUL, 1363 00:56:45,000 --> 00:56:48,320 YOU KNOW IN COUNTRIES SUCH AS 1364 00:56:48,320 --> 00:56:50,040 CANADA, BRAZIL BECAUSE IT 1365 00:56:50,040 --> 00:56:50,680 INDICATES PRESENCE OF THE 1366 00:56:50,680 --> 00:56:52,200 COMMUNITY NOT JUST ON THE HEALTH 1367 00:56:52,200 --> 00:56:56,040 SYSTEM ITSELF BUT YOU KNOW IN 1368 00:56:56,040 --> 00:56:58,120 THE DEVELOPMENT OF KNOWLEDGE 1369 00:56:58,120 --> 00:57:02,040 THROUGH SCIENCE AND I THINK, YOU 1370 00:57:02,040 --> 00:57:04,560 KNOW THE SOLUTION REALLY IS AT 1371 00:57:04,560 --> 00:57:07,720 THE HEAD OF THE COMMUNITY. 1372 00:57:07,720 --> 00:57:09,000 AS RESEARCHERS I REALLY 1373 00:57:09,000 --> 00:57:14,800 SHOULD--I THINK WE SHOULD KNOW A 1374 00:57:14,800 --> 00:57:16,960 PATHWAY TO GET THAT--THE DATA 1375 00:57:16,960 --> 00:57:20,640 AND TO TEST SOME OF THE 1376 00:57:20,640 --> 00:57:21,960 POTENTIAL SOLUTIONS. 1377 00:57:21,960 --> 00:57:23,240 BUT I REALLY TRULY BELIEVE, THAT 1378 00:57:23,240 --> 00:57:26,440 YOU KNOW IT'S VERY HARD FOR A 1379 00:57:26,440 --> 00:57:27,600 SCIENTIST IF THEY'RE NOT IN THE 1380 00:57:27,600 --> 00:57:29,880 COMMUNITY TO COME UP WITH 1381 00:57:29,880 --> 00:57:31,560 EFFECTIVE SOLUTIONS TO WIN 1382 00:57:31,560 --> 00:57:33,640 PROBLEMS, ESPECIALLY COMPLEX 1S 1383 00:57:33,640 --> 00:57:35,080 LIKE DISCRIMINATION AND POVERTY. 1384 00:57:35,080 --> 00:57:37,400 >>YEAH, YEAH, NO, THAT'S GREAT. 1385 00:57:37,400 --> 00:57:38,560 THIS IS GREAT, DISCUSSION, OKAY, 1386 00:57:38,560 --> 00:57:41,360 SO I HAVE 1 MORE FOR YOU, 1387 00:57:41,360 --> 00:57:43,760 BECAUSE WE HAVE 2 MINUTES LEFT. 1388 00:57:43,760 --> 00:57:46,760 SO THIS IS FROM SOMEBODY 1389 00:57:46,760 --> 00:57:47,040 WATCHING. 1390 00:57:47,040 --> 00:57:50,800 SO DO YOU THINK IT'S POSSIBLE 1391 00:57:50,800 --> 00:57:53,040 THAT OVEREMPHASIS ON 1392 00:57:53,040 --> 00:57:55,080 DISCRIMINATION STUDIES 1393 00:57:55,080 --> 00:57:57,360 PERPETUATE MORE 1394 00:57:57,360 --> 00:57:58,960 DISCRIMINATION/FEELINGS OF 1395 00:57:58,960 --> 00:58:00,000 VICTIMIZATION VERSUS GROWING 1396 00:58:00,000 --> 00:58:08,000 RESILIENCE AND POSITIVE COPING 1397 00:58:08,000 --> 00:58:08,800 IN MARGINALIZED GROUPS? 1398 00:58:08,800 --> 00:58:10,640 >>THAT IS A TOUGH 1. 1399 00:58:10,640 --> 00:58:12,360 YOU KNOW, LIKE, I CAN SEE BOTH 1400 00:58:12,360 --> 00:58:20,600 SIDES OF THE ARGUMENT OF SAYING 1401 00:58:20,600 --> 00:58:24,240 IF WE DON'T EMPHASIZE IT, THEN 1402 00:58:24,240 --> 00:58:25,200 IT'S NOT HAPPENING, BUT POSING 1403 00:58:25,200 --> 00:58:26,600 THE EYE TO THE PROBLEM, DOESN'T 1404 00:58:26,600 --> 00:58:33,400 MAKE THE PROBLEM GO AWAY. 1405 00:58:33,400 --> 00:58:36,040 SO AGAIN, I THINK THAT IS 1406 00:58:36,040 --> 00:58:36,840 BASICALLY A PRIVILEGED POSITION 1407 00:58:36,840 --> 00:58:38,080 FOR US TO BE ABLE TO CLOSE OUR 1408 00:58:38,080 --> 00:58:40,720 EYES AND HOPE THAT CLOSING OUR 1409 00:58:40,720 --> 00:58:44,040 EYES TO IT, WILL MINIMIZE THE 1410 00:58:44,040 --> 00:58:44,280 PROBLEM. 1411 00:58:44,280 --> 00:58:46,760 BUT FOR THE PEOPLE THAT ACTUALLY 1412 00:58:46,760 --> 00:58:49,520 LIVING WITH IT, ON THE 1413 00:58:49,520 --> 00:58:50,360 DAY-TO-DAY LIFE, I DON'T KNOW 1414 00:58:50,360 --> 00:58:54,200 THAT THE PROBLEM WILL GO AWAY. 1415 00:58:54,200 --> 00:58:56,160 MY BET IS IT WON'T. 1416 00:58:56,160 --> 00:58:58,360 SO JUST BECAUSE WE NAME THE 1417 00:58:58,360 --> 00:59:00,000 PROBLEM AND WE ARE TALKING ABOUT 1418 00:59:00,000 --> 00:59:03,520 THE PROBLEM, DOESN'T NECESSARILY 1419 00:59:03,520 --> 00:59:05,240 CREATE THE PROBLEM. 1420 00:59:05,240 --> 00:59:07,720 I THINK INCREASING OUR AWARENESS 1421 00:59:07,720 --> 00:59:09,920 THAT SOMETHING IS HAPPENING CAN 1422 00:59:09,920 --> 00:59:10,880 ACTUALLY BE BENEFICIAL HOWEVER 1423 00:59:10,880 --> 00:59:18,160 WE NEED TO BE MINDFUL HOW WE 1424 00:59:18,160 --> 00:59:23,000 CREATE AWARENESS SO WE DON'T 1425 00:59:23,000 --> 00:59:26,760 MISEDUCATE THE SOCIETY INTO 1426 00:59:26,760 --> 00:59:27,800 CREATING FURTHER 1427 00:59:27,800 --> 00:59:28,600 MISUNDERSTANDINGS AND AND 1428 00:59:28,600 --> 00:59:31,120 FURTHER, YOU KNOW PERCEPTIONS 1429 00:59:31,120 --> 00:59:36,560 THERE THAT ARE DETRIMENTAL TO 1430 00:59:36,560 --> 00:59:38,000 THE PEOPLE THAT ARE VULNERABLE 1431 00:59:38,000 --> 00:59:39,240 TO MORE SITUATIONS. 1432 00:59:39,240 --> 00:59:39,840 , THAT'S GREAT. 1433 00:59:39,840 --> 00:59:40,120 THANK YOU. 1434 00:59:40,120 --> 00:59:45,200 THANK YOU SO MUCH FOR COMING AND 1435 00:59:45,200 --> 00:59:49,240 DOING CLINICAL GRAND ROUNDS AND 1436 00:59:49,240 --> 00:59:49,800 CELEBRATING NATIONAL NURSES 1437 00:59:49,800 --> 00:59:50,240 MONTH. 1438 00:59:50,240 --> 00:59:52,160 ON BEHALF OF NINR AND THE 1439 00:59:52,160 --> 00:59:52,960 CLINICAL CENTER, I WOULD REAL 1440 00:59:52,960 --> 00:59:54,960 LIE LIKE TO THANK YOU FOR COMING 1441 00:59:54,960 --> 00:59:56,880 AGAIN AND SPENDING TIME WITH US. 1442 00:59:56,880 --> 00:59:57,560 >>AND GO NURSES! 1443 00:59:57,560 --> 01:00:02,400 YOU KNOW, YOU CAN CHANGE THE 1444 01:00:02,400 --> 01:00:02,800 PLANET! 1445 01:00:02,800 --> 01:00:03,560 >>WE DEFINITELY HOPE SO. 1446 01:00:03,560 --> 00:00:00,000 >>THANK YOU.