Welcome to the Clinical Center Grand Rounds, a weekly series of educational lectures for physicians and health care professionals broadcast from the Clinical Center at the National Institutes of Health in Bethesda, MD. The NIH Clinical Center is the world's largest hospital totally dedicated to investigational research and leads the global effort in training today's investigators and discovering tomorrow's cures. Learn more by visiting us online at http://clinicalcenter.nih.gov OUR SPEAKER TODAY IS DR. TAISON BELL, WHO IS AN ASSISTANT PROFESSOR OF MEDICINE IN THE DIVISIONS OF INFECTIOUS DISEASES AND INTERNATIONAL HEALTH, AND PULMONARY AND CRITICAL CARE MEDICINE AT THE UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE. HE IS ALSO DIRECTOR OF THE MEDICAL INTENSIVE CARE UNIT AT UNIVERSITY OF VIRGINIA HEALTH, AND DIRECTOR OF THE UNIVERSITY OF VIRGINIA SUMMER MEDICAL LEADERSHIP PROGRAM, WHICH IS A MEDICAL SCHOOL PREPARATORY PROGRAM FOR UNDERREPRESENTED AND DISADVANTAGED STUDENTS. DR. BELL RECEIVED HIS MEDICAL DEGREE FROM THE COLUMBIA UNIVERSITY COLLEGE OF PHYSICIANS AND SURGEONS IN NEW YORK CITY, THEN TRAINED IN INTERNAL MEDICINE AT THE MASSACHUSETTS GENERAL HOSPITAL IN BOSTON, WAS CHIEF RESIDENT, SUBSEQUENTLY COMPLETED AN INFECTIOUS DISEASE FELLOWSHIP AT THE MASSACHUSETTS GENERAL AND BRIGHAM AND WOMEN'S HOSPITALS, AND CRITICAL CARE MEDICINE FELLOWSHIP AT THE NATIONAL INSTITUTES OF HEALTH CLINICAL CENTER. HE RECENTLY EARNED AN EXECUTIVE MASTER OF BUSINESS ADMINISTRATION DEGREE FROM DARDEN SCHOOL OF BUSINESS, UNIVERSITY OF VIRGINIA. DR. BELL IS A MEMBER OF THE INFECTIOUS DISEASE SOCIETY OF AMERICA, SOCIETY OF CRITICAL CARE MEDICINE, HEALTH CARE INFORMATION AND MANAGEMENT SYSTEMS SOCIETY, AND THE ALLIANCE FOR ACADEMIC INTERNAL MEDICINE. HE SERVES ON EDITORIAL BOARD OF THE JOURNAL ATS SCHOLAR, PUBLISHED MANUSCRIPTS ON A VARIETY OF TOPICS IN THE BIOMEDICAL LITERATURE. DR. BELL'S PROFESSIONAL INTERESTS INCLUDE IMPROVING INPATIENT HEALTH CARE DELIVERY THROUGH QUALITY IMPROVEMENT INITIATIVES AN INCREASING WORKFORCE DIVERSITY. HE IS HIGHLY INVESTIGATED IN EDUCATION RESEARCH, GRADUATE MEDICAL EDUCATION, TEACHING CRITICAL CARE MEDICINE FELLOWS AT THE UNIVERSITY OF VIRGINIA. CURRENTLY HE IS A PRINCIPAL INVESTIGATOR FOR STUDY EXAMINING MASTERY LEARNING FOR CRITICAL CARE FELLOWSHIP EDUCATION. IN 2020, HE WAS RECOGNIZED FOR HIS TEACHING ACCOMPLISHMENTS WITH THE VIRGINIA STATE COUNCIL OF HIGHER EDUCATION, OUTSTANDING FACULTY AWARD IN THE RISING STAR CATEGORY. THE TITLE OF DR. BELL'S PRESENTATION TODAY IS "TAKING STEPS, LEADING ANTI-RACISM EFFORTS IN ACADEMIC MEDICINE" AND WE'RE PLEASED TO WELCOME HIM BACK TO THE NIH TO DISCUSS THIS VERY IMPORTANT AND TIMELY TOPIC. DR. BELL? >> DR. LEMBO, THANK YOU FOR THAT VERY KIND INTRODUCTION. I REMEMBER HEARING INTRODUCTIONs FROM YOU BEFORE WHEN I WAS A TRAINEE, AND DID NOT IMAGINE MYSELF LEADING A CLINICAL CENTER GRAND ROUNDS THIS EARLY IN MY CAREER BUT THE THING ABOUT TRAINING AT THE NIH CLINICAL CENTER IS THAT YOU LEARN PRETTY QUICKLY TO MOVE OUTSIDE OF YOUR NORMAL COMFORT LIMITS. ON MY FIRST DAY AT THE CLINICAL CENTER ORDERING WHITE BLOOD CELL TRANSFUSIONS I REMEMBER THINKING TO MYSELF, IS THAT EVEN A THING? YOU REALLY LEARN HOW TO STEP BEYOND WHAT YOUR COMFORT ZONE IN IN A PLACE ON THE SPEAR OF MEDICAL CARE DELIVERY RESEARCH AND DISCOVERY AND EDUCATION. THIS IS SO NOSTALGIC FOR ME IN A WAY, IT'S COMING BACK TO AT LEAST A VIRTUAL HOME BASE. I'VE BEEN IN CONTACT WITH SO MANY PEERS BUT IT'S LIKE IN SOME WAYS I NEVER ACTUALLY LEFT. I WENT DIGGING THROUGH MY GOOGLE PHOTOS AND PHOTOS TAGGED WITH CLINICAL CENTER, BRINGING BACK SOME MEMORIES. OF COURSE THE HUMONGOUS BUILDING BUT FIRST AND FOREMOST PATIENTS AND COLLEAGUES YOU CONNECT WITH AND THE ONES WHO HAVE GOOD STORIES AND GOOD ENDINGS ARE CERTAINLY ONES YOU REMEMBER, ONES WITH BAD OUTCOMES YOU BECOME ATTACHED TO, BUT THE STORIES FROM THE PATIENTS ARE WHAT REALLY DRIVES A LOT OF WHAT YOU DO AND THAT AFFIRMATION HAPPENS EVERY SINGLE DAY. I'LL ADMIT MOST OF MY PHOTOS WERE OF THIS VARIETY, IN THE PARKING GARAGE WHEN YOUR NORMAL SPOT ISN'T AVAILABLE, SOME WAY TO REMEMBER WHERE IN THE HELL YOU PARKED, SO MOST OF MY PHOTOS WERE P-1 OR P-2, OR P-3 EVEN IF I WAS HAVING -- IF I GOT IN LATE. EVEN THE SPONTANEOUS MOMENTS LIKE TAKING A BREAK FROM ROUNDS TO GO HEAR A CONCERT, JUST TO TAKE YOUR MIND OFF OF THINGS IF YOU WERE HAVING A ROUGH DAY OR IF YOU WERE ON CALL AND KNEW IT WAS GOING TO BE LONG, WAYS TO TAKE A BREAK. YOU REALIZE THE TALENT THAT'S IN FRONT OF YOU AND AROUND YOU AND COLLEAGUES YOU WORK WITH ARE JUST PHENOMENAL AND EXTRAORDINARY. AND THE NIH HONESTLY WAS ONE OF THE MOST SUPPORTIVE ENVIRONMENTS I'VE EVER WORKED BECAUSE THE IDEAS THAT I HAD, HOW I WANTED TO PURSUE MY CAREER, THERE WAS NEVER A NO. IT WAS, WELL, LET ME THINK HOW TO DO THAT BECAUSE DOING THE UNUSUAL IS THE USUAL AT A PLACE LIKE THE CLINICAL CENTER, AND THAT'S WHAT ONE OF THE LESSONS THAT HAS CARRIED ME FORWARD, GIVEN ME THE COURAGE TO ASK WHY OR WHY NOT IN THE APPROPRIATE SETTING, QUESTION THE THINGS THAT ARE PUT OUT AS DOGMA, THOSE ARE ALL LESSONS I LEARNED HERE. A LOT OF THEM WILL ACTUALLY APPLY TO THE PANDEMIC, YOU KNOW, UNDERSTANDING THE LITERATURE, THE DATA, WHAT'S THERE, WHAT'S NOT THERE. REALLY HOLD THE PEOPLE ACCOUNTABLE. THOSE ARE ALL LESSONS I LEARNED GOING ALL THE WAY BACK TO THE CLINICAL CENTER JOURNAL CLUBS AND THINGS LIKE THAT. I ALSO KNOW MY CLINICAL CENTER COLLEAGUES, I WANT TO SHOUT THEM OUT. THEY WILL LOOK AT MY SLIDES TO MAKE SURE THEY ARE FORMATTED RIGHT, NICE AND CLEAN, A GOOD PRESENTATION, BECAUSE THEY HOLD TO YOU THE ACCOUNTABILITY STANDARD YOU SHOW UP AS YOUR BEST SELF EVERY SINGLE TIME. I LOOK FORWARD TO GETTING THEIR FEEDBACK ON THE SLIDES. I HAVE NO DISCLOSURES OF FINANCIAL RELEVANCE. I'LL BE DISCUSSING THE COVID-19 VACCINES WHICH ARE APPROVED UNDER EMERGENCY USE AUTHORIZATION, I'M NOT SURE IF THAT QUITE COUNTS AS APPROVED BUT I FIGURED I WOULD PUT IT THERE ANYWAY. THE FIRST THING I WANT TO ACKNOWLEDGE THESE ARE TOUGH CONVERSATIONS TO HAVE, WHEN WE ARE TALKING ABOUT RACISM IN HEALTH CARE AND ACADEMIC MEDICINE. I WANT TO MAKE THIS A SAFE SPACE TO HAVE THIS HARD CONVERSATION. THE FIRST TIME I GAVE THIS TALK WAS FOR A CONFERENCE, I GAVE THE CLOSING PARENTHESESRY. WHEN THEY ADVERTISED I WAS ATTACKED ON SOCIAL MEDIA WITH PEOPLE SAYING VERY NON-SUPPORTIVE THINGS, CALLING ME A MARXIST OR RUN AWAY FROM DOCTORS WHO TALK ABOUT ANTI-RACISM, RACE HUSTLING, THIS SORT OF THING. AND IT JUST REMINDS YOU THAT, YOU KNOW, THERE IS A STRONG SEGMENT OF SOCIETY THAT EITHER DOES NOT BELIEVE IN IT OR DOESN'T CARE OR THINKS IT'S ANTI-AMERICAN, AND SO THAT'S GOING TO HAPPEN. IT'S OKAY, I'M PREPARED FOR IT, BUT THAT DOESN'T MEAN WE SHY AWAY FROM THE CONVERSATION JUST BECAUSE PEOPLE ARE GOING TO BE UNCOMFORTABLE FROM IT OR NOT RESONATE WITH THE MESSAGE. IT STILL DESERVES TO BE DISCUSSED IN AN OPEN AND HONEST WAY. LET'S FIRST, YOU KNOW, RIP THE BAND-AID OFF AND JUST SAY THESE ARE TOUGH TO HAVE, BUT IT'S A CONVERSATION WE SHOULD HAVE. NOW, WHY I THINK THIS AUDIENCE IS PARTICULARLY ADEPT TO HAVE A CONVERSATION LIKE THIS, WHAT MAKES IT GOOD TO HAVE ANTI- RACISM CONVERSATIONS, SO IN ORDER TO DISCUSS THIS YOU HAVE TO BE WILLING TO FREQUENTLY QUESTION YOUR OWN BELIEFS, BECAUSE A LOT OF WHAT SOCIETY FEEDS US FROM BIRTH ARE CULTURAL NORMS AND IDEALS, AND SOMETIMES THEY AFFIRM YOU, SOMETIMES THEY DO NOT AFFIRM YOU. SO WHEN YOU'RE ABLE TO QUESTION YOUR OWN BELIEFS, THEN THAT'S REALLY A FOUNDATION FROM WHICH YOU BUILD FROM. YOU HAVE TO BE OKAY WITH MAKING OTHERS UNCOMFORTABLE. LIKE I SAID, THESE CONVERSATIONS ARE NOT PLEASANT AND CAN SOMETIMES MAKE PEOPLE FEEL UNCOMFORTABLE, AND THAT'S OKAY. YOU WANT TO LEAD WITH A RATIONALE THOUGHT WHEN OTHERS LEAD BY EMOTION. RACISM IS A CHARGED WORD THAT ELICITS VISCERAL RESPONSES. I THINK THE WORD IS APPROPRIATE TO USE, AC ACCURATE DESCRIPTOR OF WHAT HAPPENS IN SOCIETY BUT YOU HAVE TO BACK THAT UP WITH DATA AND AVOID LEADING WITH EMOTION AND ADMIT WHEN YOU'RE WRONG. EVERYONE IS ON A LEARNING JOURNEY, INCLUDING MYSELF, WHEN YOU MAKE MISTAKES ACKNOWLEDGE THEM AND MOVE ON. AT THE CLINICAL CENTER YOU FREQUENTLY HAVE TO QUESTION YOUR OWN BELIEVES. IN JOURNAL CLUBS, GRAND ROUNDS, TALKING ABOUT DATA, SOME THINGS I ASSUMED WERE JUST TRUE BEYOND SHADOW OF A DOUBT TURNED OUT NOT TO BE WHEN YOU DIG DOWN AND QUESTION THE DATA AND ASK QUESTIONS IN A PROBING WAY. SO THAT SKILL SET GETS BUILT AT A PLACE LIKE THE CLINICAL CENTER. HAVE YOU TO BE OKAY WITH MAKING OTHERS UNCOMFORTABLE. MANY TIMES WE WERE DISCUSSING SOMETHING NOT DONE BEFORE, THIS DRUG HADN'T BEEN USED FOR THAT INDICATION OR THAT DOSE, AND WE SAY THIS IS WHAT WE WANT TO DO, THIS IS WHAT WE THINK IS BEST FOR THE PATIENT, WE'RE IN A DATA-FREE ZONE AT THIS POINT. HAVING THAT COMFORT LEVEL WITH MAKING A LITTLE -- SOME PEOPLE UNCOMFORTABLE BECAUSE YOU FEEL THAT'S THE PROPER THING TO DO, AGAIN, ANOTHER SKILL SET THAT HAPPENED AT THE CLINICAL CENTER. LEADING WITH A RATIONAL THOUGHT WHEN OTHERS LEAD WITH EMOTIONS. A LOT OF INVESTIGATORS INVESTED IN THEIR CARE, THERE'S, LIKE I SAID EARLIER, YOU MAKE A STRONG EMOTIONAL BOND WITH PATIENTS AND A LOT TIMES THAT STRONG BOND CAN LEAD YOUR THOUGHT PROCESS, AND SOMETIMES THE BEST MOMENTS I HAVE WHEN I WAS ABLE TO DISENGAGE MYSELF FROM THE EMOTION I WAS FEELING IN A SITUATION AND JUST THINK OBJECTIVELY, WHAT'S THE BEST MOVE TO MAKE IN THIS SCENARIO. AGAIN, SKILLS I LEARNED AT THE CLINICAL CENTER. AND THEN BE WILLING TO ADMIT WHEN YOU'RE WRONG, WHICH HAPPENED EVERY SINGLE DAY I WAS AT THE CLINICAL CENTER, BEING WILLING TO HAVE THAT HUMBLENESS BUT ALSO THAT COMES WITH INTERNAL SENSE OF VALIDATION THAT WHEN YOU'RE WRONG, IT DOESN'T MEAN THAT YOU'RE A FAILURE OR YOU'RE NOT AN ANTI-RACIST, THAT IS JUST YOU GOT SOMETHING WRONG AND YOU'RE STILL ON YOUR LEARNING JOURNEY. SIMILARLY, WE GOT PLENTY OF THINGS WRONG TAKING CARE OF PATIENTS, WHEN WE ASSUMED THINGS WERE TRUE WHEN THEY WEREN'T. IT DIDN'T MEAN WE WERE BAD PROVIDERS, WE HAD TO COURSE ADJUST. I THINK THIS AUDIENCE IS HOPEFULLY RECEPTIVE TO THE MENTAL. IT'S A PARALLEL SKILL SET WORKING IN A PLACE LIKE THE NIH. NOW, MY ASK OF YOU, THIS CAN BE THE CLOSEST THING THAT CAN COME TO OBJECTIVES FOR THE TALK, I WANT YOU TO BE OPEN MINDED. THERE'S A TENDENCY WE HAVE TO RESIST THE URGE -- TO NAME REASONS WHY SOMETHING WON'T WORK WHEN A SOLUTION IS PRESENTED TO US. THAT'S JUST A NATURAL THING WE DO. BECAUSE WE'RE USED TO DOING WHAT WE'RE DOING. THAT'S INERTIA OF THE WORK FLOW THAT WE'RE IN. I ALSO WANT YOU TO DEFAULT TO HOW CAN WE RATHER THAN WHY WE CAN'T. THAT'S THIS CONCEPT OF LEANING FORWARD THINKING WHAT ARE THE WAYS WE CAN SOLVE THE PROBLEM RATHER THAN WHY ISN'T IT GOING TO WORK. I SAID BEFORE, A SAFE SPACE IS NOT NECESSARILY A COMFORTABLE SPACE. I MEANS YOU'RE SAFE FROM ATTACK AGAINST YOUR CHARACTER, BUT IT DOESN'T MEAN THAT YOU SHOULD HAVE A COMFORTABLE CONVERSATION WHEN YOU DISCUSS RACISM ALL THE TIME. AND THEN THE LAST ASK I HAVE OF YOU, TO HAVE A CONVERSATION WITH A COLLEAGUE OR SUPERVISOR REGARDLESS OF WHETHER YOU AGREE WITH WHAT I SAY OR YOU DON'T AGREE WITH WHAT I SAY, I THINK IT'S WORTHWHILE TO HAVE THESE CONVERSATIONS BECAUSE THE MORE WE HAVE AT THE GRASS ROOTS LEVEL, I THINK THE EASIER IT IS TO EVENTUALLY HAVE THIS CONVERSATION AT A HIGHER LEVEL AND MOVE IT FORWARD. IF WE DON'T TALK ABOUT IT, THEN IT STAYS IN THE DARK AND THEN, YOU KNOW, MOMENTUM WE BUILT TOWARDS ANTI-RACISM GOES AWAY. SO HAVE A CONVERSATION WITH SOMEONE ABOUT THIS TALK. WE SHOULD START WITH DEFINITIONS, BECAUSE I'M GOING TO BE USING THESE WORDS A LOT. WHEN I SAY RACE, I MEAN A SOCIAL CONSTRUCT, NOT A BIOLOGICAL FACT, BASED ON A BELIEF THERE ARE INHERENT DIFFERENCES, PHYSICAL AND BEHAVIORAL, BETWEEN GROUPS OF PEOPLE. RACISM TAKES THAT TO THE SYSTEMIC LEVEL, WHERE ONE GROUP HAS POWER TO USE RACIAL PREFERENCE TO DISCRIMINATE WITH POLICIES, PRACTICES, INSTITUTIONS DESIGNED TO FAVOR THEM OVER ANOTHER GROUP. SO NOTICE THAT I'M NOT DISCUSSING INTERPERSONAL RACISM, ALTHOUGH VERY IMPORTANT, I'LL GET TO THAT LATER, BUT WHAT I'M TALKING ABOUT ARE SYSTEMS BAKED INTO PLACE, SUCH THAT EVEN W ELL-MEANING PEOPLE WORKING WITHIN THE SYSTEM, THE SYSTEM WILL CONTINUE TO PRODUCE INEQUITIES IT WAS DESIGNED TO PRODUCE. FINALLY, THESE ARE RACIAL/ETHNIC POPULATIONS UNDERREPRESENTED IN THE MEDICAL PROFESSION RELATIVE TO NUMBERS IN THE GENERAL POPULATION, DEFINED BY THE AAMC, SO BLACK, LATINO, FILIPINO, OTHER UNDERREPRESENTED GROUPS, NATIVE ALASKA, HAWAIIAN, ET CETERA, FOR PURPOSES OF THIS TALK. THREE FORMS OF RACISM, STRUCTURAL, INSTITUTIONAL, INTERPERSONAL. SO STRUCTURAL IS THAT HIGH LEVEL SOCIAL ECONOMIC OR POLITICAL SYSTEMS THAT PERPETUATE INEQUITIES. THESE ARE WHAT MANIFEST IN PUBLIC POLICIES AND CULTURAL NORMS. SO THINGS LIKE RED LINING POLICIES THAT HIGHLIGHTED AREAS THAT WERE BLACKS WERE FORCED TO LIVE IN, HIGHER LOAN RATES OR DENIALS, PROPERTY VALUES ARTIFICIALLY SUPPRESSED, PUBLIC POLICIES THAT LED TO STRUCTURAL INEQUITIES. INSTITUTIONAL LEVEL, POLICIES AND PRACTICE WITHIN AND ACROSS INSTITUTIONS THAT PERPETUATE INEQUITIES, EXAMPLE WOULD BE THE PRISON INDUSTRIAL COMPLEX WHERE BLACK AND LATINO AMERICANS ARE MORE LIKELY TO BE CHARGED, TO BE FOUND GUILTY AND RECEIVE DIFFERENT SENTENCES FOR SIMILAR PENALTIES COMPARED TO WHITE COLLEAGUES, FOR INSTANCE. INTERPERSONAL WE'LL DISCUSS WHEN TOPICS COME UP, ACTION FROM ONE PERSON TO ANOTHER THAT CONVEYS RACIAL INSENSITIVITY, PREJUDICE, HATE, BIAS. THEY ARE ALL VERY IMPORTANT BUT I WILL, LIKE I SAID, FOCUS ON THE TOP TWO FORMS. NOW, I'M TRAINED IN INFECTIOUS DISEASE. ONE OF THE REASONS I CAME TO THE CLINICAL CENTER, BECAUSE THEY HAVE A TRACK RECORD OF PRODUCING CRITICAL CARE DOCTORS WHO ARE TRAINED, GROUND IN INFECTIOUS DISEASE DISEASE PRACTICE, REALLY THE ONLY PLACE I FOUND THAT HAD THAT SORT OF BACKGROUND. SO, THE THING ABOUT INFECTIOUS DISEASE ALWAYS WHAT IS THE QUESTION OR THE ISSUE UNDERNEATH WHAT YOU MAY SEE ON THE SURFACE. FOR INSTANCE, IF YOU HAVE SOMEONE WHO HAS AN INTRAABDOMINAL ABSCESS, YOU MAY SEE MAYBE A FEVER, DESPITE APPROPRIATE ANTIBIOTICS, YOU MAY SUSPECT INFECTION, YOU MAY HAVE A GRAM NEGATIVE ROD BACTEREMIA AND SEPSIS, THAT'S WHAT UNDERLIES THE SYMPTOM YOU SAW. ONCE YOU GET THE CAT SCAN YOU SEE ABSCESS THAT'S UNDERLYING ALL OF THIS. AND SIMILARLY WHEN I THINK ABOUT RACISM IN SOCIETY WE HAVE TO COUNTERACT, I FUNDAMENTALLY WANT TO GET AT THE ISSUE OF THE ROOT CAUSE AND IT GETS SOURCE CONTROL OF THAT ISSUE. THAT WAY, WE CAN CONTROL THE SYMPTOMS, WE CAN CONTROL THE AFTER-EFFECTS OF THE SYMPTOMS, WE'RE REALLY GETTING AT THE ROOT CAUSE IN DRAINING THE PUS, ESSENTIALLY. NOW, I WANT TO MOVE INTO SOME OF THE ISSUES, AND I TITLED THESE INFECTIONS. THE FIRST SEGMENT IS CALLED "SAY HER NAME." THE REASON I'M -- THIS IS BREONNA TAYLOR, FOR THOSE THAT DON'T KNOW. THE REASON I WANT TO SECTION OFF BY THE PEOPLE WHO HAVE SUFFERED UNDER RACIAL BIAS AND RACISM AND SOCIETY AND LOST THEIR LIVES TO IT, THEY RING TRUE IN A LOT OF BLACK TRAINEES MIND. ATTENDINGS YOU MEET, NOTABLE PEOPLE IN YOUR TRAINING ARE NAMES YOU REMEMBER, BUT FOR A LOT OF PEOPLE WHO SHARE MY CULTURAL BACKGROUND THE NAMES OF PEOPLE WHO WERE MURDERED AT THE HANDS OF POLICE ARE THE NAMES THAT MARK OUR MOMENTS IN TRAINING. SO FOR INSTANCE TRAYVON MARTIN WAS MURDERED WHEN I WAS A RESIDENT. FREDDIE GRAY WHEN I STARTED MY CRITICAL CARE FELLOWSHIP, MARKING TIME PERIODS IN MY LIFE, AND THAT'S WHY I'M STARTING WITH BREONNA TAYLOR. BREONNA WAS A 26-YEAR-OLD BLACK WOMAN MURDERED IN HER LOUISVILLE KENTUCKY APARTMENT BY WHITE PLAINS CLOTHES OFFICERS. ONE OFFICER WAS FIRED FOR BLINDLY FIRING THROUGH THE APARTMENT WALL, GRAND JURY INDICTED ANOTHER FOR ENDANGERING TAYLOR'S NEIGHBORS BUT NONE OF THE OFFICERS WERE CHARGED IN HER DEATH. THE APARTMENT WALL, THE NEIGHBORS IN DANGER RECEIVED MORE JUSTICE THAN THE ACTUAL PERSON WHO WAS MURDERED. THIS STARTED THE SAY HER NAME CAMPAIGN, WHICH CALLED ATTENTION TO THIS, BLACK WOMEN 17% MORE LIKELY TO BE STOPPED, 1 1/2 TIMES MORE LIKELY TO BE KILLED BY POLICE AND WHITE COUNTERPARTS. THIS IS NOT AN ANTI-POLICE TALK, BUT THIS IS ONE OF THE WAYS WHICH THE INSTITUTIONAL STRUCTURAL RACISM AT THE INDIVIDUAL LEVEL, WHEN THAT HAPPENS AT THE OTHER END OF GUNS YOU CAN HAVE STARK CONSEQUENCES. I WANT TO CONNECT INCIDENTS LIKE THIS WITH A RECENT EPISODE OF JAMA BEING UNDRESSED IN PUBLIC BY A PODCAST THAT WAS PUT OUT ABOUT STRUCTURAL RACISM. IT BEGAN WITH A TWEET FROM EARLY -- OR LATE FEBRUARY, HOW CAN THERE BE STRUCTURAL RACISM IN HEALTH CARE? EXPLANATION BY DOCTORS AND USER FRIENDLY PODCAST. I DON'T MEAN TO HIGHLIGHT TO ATTACK THEM, YOU MAY KNOW OR BE FRIENDS WITH THEM, AND I THINK THEY ARE GOOD PEOPLE, BUT I THINK THIS DEMONSTRATES SOME OF THE PROBLEM HERE THAT STRUCTURAL RACISM ENDED UP MORE ABOUT BEING ABOUT DR. LIVINGSTON'S REACTION, SAYING MANY PEOPLE LIKE MYSELF ARE OFFENDED BY THE IMPLICATION WE'RE SOMEHOW RACIST. FURTHER SAID MINORITIES ARE NOT IN THOSE NEIGHBORHOODS, MEANING RED LINE NEIGHBORS, NOT ALLOWED TO BUY HOUSES OR GET JOBS BECAUSE THEY ARE BLACK OR HISPANIC WOULD BE ILLEGAL. SO THE BASIC ARGUMENT HERE THAT STRUCTURAL RACISM IS ILLEGAL, THEREFORE IT DOESN'T EXIST, IT'S ALSO AN UNFORTUNATE TERM BECAUSE IT MAKES PEOPLE LIKE MYSELF FEEL OFFENDED. SO MAKING RACISM NOT ABOUT WHO IS BEING AFFECTED BY IT BUT BY YOUR RESPONSE TO IT WAS PROBLEM NUMBER ONE. ALSO SHOWING LACK OF UNDERSTAND UNDERSTANDING TRYING TO UNDERSTAND AT A DEEPER LEVEL, THE C.E.O. SAID WE'RE DEEPLY DISTURBED AND ANGERED BY A RECENT PODCAST, IN CONTRAST TO THE AMA WHICH TAKES A STRONG ANTI-RACISM PLEDGE. JUNE OF 2020 THE BOARD PLEDGED TO CONFRONT, OUTLINED FIVE STEPS YOU CAN SEE ON THE RIGHT SIDE. THEY DEFINED SPECIFICALLY THREE FORMS OF RACISM, STRUCTURAL, CULTURAL, INTERPERSONAL. POLICY ACKNOWLEDGED RACISM'S ROLE IN PERPETUATING HEALTH INEQUITIES, INCITING HARM AGAINST HISTORICALLY MARGINALIZED COMMUNITIES. STATED GOALS OF MOVING TOURS ANTI-RACISM APPROACH IS THERE BUT WHEN IT PLAYS OUT SOMETIMES MISTAKES ARE MADE. THIS WAS A LETTER THAT DR. BOCKNER ISSUED AFTER HE RESIGNED, THERE CONTINUED TO BE MORE FALLOUT FROM THIS. LATER LEARNED FROM A COLLEAGUE, DR. WYATT, WHO IS A CARDIOLOGIST AT COLUMBIA, HOW THIS MANIFESTED AT THE INDIVIDUAL LEVEL FOR MINORITY RESEARCHERS WHO ARE TRYING TO SUBMIT ARTICLES THAT ADDRESS RACISM. IN 2015, HE SUBMITTED AN ARTICLE IN JAMA, RACISM IN HEALTH AND HEALTH CARE, CHALLENGES AND OPPORTUNITIES. THE EDITOR ADVISED HIM THAT THE WORD "RACISM" COULD NOT BE PUBLISHED AND RACIAL BIAS WOULD BE SUBSTITUTED. USING RACISM EDITORS SAID WOULD RESULT IN LOSING READERS. DR. WYATT LATER SAID WE COMPROMISE, AGREED TO THE CHANGE, ARTICLE WAS PUBLISHED. MAKING THAT SUBTLE CHANGE, WHAT THAT DOES IS MAKES IT MORE COMFORTABLE, USER FRIENDLY TO TAKE THE WORDS OF THE TWEET, FOR THE AVERAGE READER OF JAMA TO READ AN ARTICLE AND MAKE IT MORE PALATABLE, BUT RACISM IS RACISM, A STATE IS A STATE, SO MAKING IT MORE COMFORTABLE FOR YOUR AUDIENCE DOESN'T MAKE IT ANY LESS COMFORTABLE FOR THOSE WHO ARE EXPERIENCING IT. AND WOULDN'T IT BE BETTER JUST TO CALL SOMETHING WHAT IT ACTUALLY IS RATHER THAN TRY TO DANCE AREN'T IT? -- AROUND IT? MANY HAVE EXPRESSED SIMILAR CONCERNS A LOT OF THEIR EDITORIAL, THAT INPUT, IS TO SOFTEN THE LANGUAGE AROUND TALKING ABOUT RACISM. THAT IN AND OF ITSELF IS A PROBLEM. THIS EVENTUALLY GENERATED ONLINE PETITION FROM DR. JAMES THAT GATHERED 8,000 SIGNATURES, DR. LIVINGSTON WAS ASKED TO RESIGN FROM THE BOARD, DR. BOCKNER RESIGNED. SO LEADING TO SOME SYSTEMIC CHANGES, CERTAINLY WHILE PUBLICIZED, HIGHLIGHTING THIS NEED TO CALL SOMETHING WHAT IT IS AND TO SAY ITS NAME. TO EXPAND UPON THIS FURTHER, AN ARTICLE PUBLISHED IN HEALTH AFFAIRS BY DR. BOYD AND COLLEAGUES TALKED ABOUT THIS FURTHER, AND SAID DESPITE RACISM, JOURNALS THAT PUBLISH THEM ROUTINELY FAIL TO INTERROGATE RACISM AS CRITICAL DRIVER OF HEALTH INEQUITIES. CONSEQUENCE, BAR TO PUBLISH RACIAL HEALTH INEQUITIES IS LOW, NO UNIFORM PRACTICE REGARDING USE OF RACE AS STUDY VARIABLE, LITTLE TO NO EXPECTATION THAT AUTHORS RACISM AS CAUSE OF INEQUITIES AMONG RACIAL GROUPS. ABSENT THESE STANDARDS PRACTICES OF SCHOLARSHIP OFFERS CAN BE CONFLICTING, POTENTIALLY DANGEROUS, ULTIMATELY INEFFECTIVE. THIS WAS A CALL REALLY TO TRY TO STANDARDIZE LANGUAGE WE USE AROUND TALKING ABOUT RACISM AND RACE RACIAL INEQUITIES SO WE CAN ACTUALLY STUDY IT IN A VERY RIGOROUS FORM, AND HAVE COURAGE AND CONFIDENCE TO STUDY THESE SO WE CAN ACTUALLY LEAD TO STRUCTURAL CHANGE. RECOMMENDATIONS FOR SCHOLARSHIP WERE DEFINE RACE DURING THE EXPERIMENTAL DESIGN, IDENTIFY THE FORM AND INTERSECTING FORMS OF OPPRESSION, SEXISM, ORIENTATION, AGE, REGIONALITY, RELIGION OR INCOME, SOLICIT PATIENT INPUT TO ENSURE OUTCOMES REFLECT POPULATIONS YOU STUDY, AND WE HAVE SEVERAL EXAMPLES WHERE UNDER CERTAIN POPULATIONS WERE TAKEN ADVANTAGE OF BY MEDICAL ESTABLISHMENT. I WANT TO CITE EXPERTS, OF COLOR, SO GOING BACK TO THE JAMA PODCAST WOULD HAVE MADE SENSE TO REACH OUT TO ONE OF THE SCHOLARS WHO ACTUALLY STUDIES AND TALKS ABOUT STRUCTURAL RACISM TO REALLY COUNTER AND ILLUMINATE WHAT THESE ISSUES ARE. I THINK IT WOULD HAVE BEEN A VERY INTERESTING PODCAST TO LISTEN TO. TO GET DOWN TO SOURCE CONTROL, HOW DO WE GET SOURCE CONTROL HERE FOR JAMA AND NEW ENGLAND JOURNAL, TWO OF THE HIGHEST MEDICAL JOURNALS, DR. DEBRA KARASEK, IT'S SEEN AS AN IMPORTANT OPPORTUNITY. SO THE IMPORTANCE PLACED ON JOURNALS IS I THINK DISPROPORTIONATELY HIGH RELATIVE TO THEIR VALUE. THAT MEANS IF YOU WANT TO PUBLISH SOMETHING, YOU ARE TENDED TO MOLD TO THEIR VISION OF WHAT SCHOLARSHIP SHOULD BE. THE PROBLEM HERE IS THAT A LOT OF THESE JOURNALS ARE NOT DIVERSE, IN THE SENSE REPRESENTATION IS JUST NOT ADEQUATE. AND SO WHEN YOU HAVE LACK OF DIVERSITY IN THE EDITORIAL STAFF, LEADERSHIP OF A JOURNAL, YOU MAY NOT HAVE THE ABILITY TO SEE OR UNDERSTAND SOME ISSUES THAT YOU'RE PRESENTED WITH, ARTICLES THAT ARE SUBMITTED. DR. RAYMOND GIVENS ALSO AT COLUMBIA NOTED IN A STUDY THAT THE STAFF OF BOTH JOURNALS WERE EACH AROUND 80% WHITE, 70% MALE. AND NOTED WITH HUMOR THERE WERE MORE EDITORS NAMED DAVID THAN THE POPULATION OF OTHERS, UNDERSCORING THE NEEDS TO INCREASE DIVERSITY AT OUR TOP MEDICAL JOURNALS. MY SUGGESTION IS MAKE A COMMITMENT TO INCREASING DIVERSITY AMONG EDITORIAL STAFF, TO MAKE TRUE ALLYSHIP A FOCUS RATHER THAN MAXIMIZING READERSHIP, TO MAKE AN ACTIVE EFFORT TO PROMOTE SCHOLARS OF COLLAR REGARDLESS OF DISCIPLINE. HOPEFULLY A GOOD MESSAGE FOR THIS AUDIENCE, A LOT OF YOU ARE ON SOME OF THESE EDITORIAL BOARDS FOR HIGH IMPACT JOURNALS. DR. WALENSKY IS A PERSON I TRAINED UNDER WHEN I WAS A FELLOW AT MASS GENERAL, HAD JUST INCREDIBLE TIME WORKING WITH HER. A BIG FAN OF HERS. ONE OF THE THINGS SHE DID RECENTLY THAT I HIGHLY APPLAUD, SHE NAMED STRUCTURAL RACISM AS A PROBLEM IN HEALTH CARE, SOMETHING THAT NEEDS TO BE COMBATED, IT'S NOT JUST DISCRIMINATION AGAINST ONE GROUP BASED ON COLOR OF SKIN OR RACE BUT BARRIERS, WHERE THEY LIVE, WORK, PLAY, CHILDREN PLAY, WORSHIP, GATHER IN A COMMUNITY, HIGH LEVELS THAT STRUCTURAL RACISM HAS ON SOCIETY AND HOW THAT DIRECTLY CONNECTS TO HEALTH. THE CDC MAKING A STATEMENT THROUGH DR. WALENSKY THIS IS A PROBLEM THAT NEEDS BE TO BE COMBATED AND NAMED AS RACISM IS A POSITIVE STEP TOWARDS TRYING TO IMPROVE OUR PUBLIC HEALTH. MY NEXT SECTION IS ADDRESSING ACADEMIC RESEARCHERS AND PHYSICIANS, ACADEMIC INSTITUTIONS, CALLED "I CAN'T BREATHE." THIS IS GEORGE FLOYD, 46-YEAR-OLD BLACK MAN MURDERED IN MINNEAPOLIS, IN MAY OF 2020, AFTER A WHITE POLICE OFFICER KNELT ON HIS NECK FOR NINE MINUTES AND 29 SECONDS SPARKING WORLDWIDE PROTEST AGAINST POLICE BRUTALITY, OTHER OFFICERS INVOLVED WERE FIRED, THE OFFICER WHO KNELT ON MR. FLOYD'S NECK IS SENTENCED, I NEED TO UPDATE THAT. BUT THIS WAS CERTAINLY A WATERSHED MOMENT, IT COINCIDED WITH THE COVID-19 PANDEMIC, RENEWED FOCUS ON STRUCTURAL INEQUITIES AND HEALTH CARE DELIVERY, AT THE SAME TIME THERE WAS A NEED FELT BY MANY INCLUDING MYSELF TO PROTEST AGAINST SYSTEMIC INSTITUTIONAL RACISM IN THE FORM OF OUR POLICE FORCE, WHICH WENT AGAINST PUBLIC HEALTH MEASURES AND A LOT OF US FOUND OURSELVES PULLED BETWEEN TWO NEEDS TO EXPRESS OURSELVES, HEALTH CARE SIDE OF US THAT WANTED TO MASK UP AND STAY INDOORS AND THE PART OF US THAT WANTED TO PROTEST AGAINST POLICE BRUTALITY TO PROTECT OUR OWN LIVES. REFLECTION FROM A COLLEAGUE WHO ASKED TO REMAIN UNNAMED, I THINK GEORGE FLOYD KILLING RESONATED SO MUCH BECAUSE OF THE SYMBOLISM OF THE PLEA "I CAN'T BREATHE." HERE IS A MAN LITERALLY LYING UNDER THE WEIGHT OF RACISM AND OPPRESSION OVER A FAKE $20 BILL, I'M IN A DIFFERENT CIRCUMSTANCE AS AN ACADEMIC RESEARCHER BUT HIS FINAL WORDS SPEAK FOR US WHO FEEL UNSEEN AND UNAPPRECIATED IN PLACE OF OUR WORK. IT'S SUFFOCATING. THAT'S A POWERFUL CONNECTION TO MAKE BETWEEN SOMEONE WHO IS, YOU KNOW, SUFFOCATING AND SOMEONE WHO ACTUALLY SUFFOCATED, AND SOMEONE WHO FEELS LIKE THEY ARE SUFFOCATING IN THEIR PLACE OF WORK. SO WHAT'S UNDERNEATH THIS? I THINK WE SHOULD TALK ABOUT THE FOUNDATION OF ACADEMIC MEDICINE, THREE MAIN PILLARS RESEARCH, EDUCATION AND PATIENT CARE. YOU SEE THERE'S A SHAKY FOUNDATION IF YOU INVESTIGATE FURTHER. STRUCTURAL ISSUES WITH, YOU KNOW, REALLY EACH LEG HERE. SO ALONG RESEARCH, FUNDING DISPARITIES WITH UNDERREPRESENTED MINORITY RESEARCHERS, MINORITY TAX THAT WE'LL TALK ABOUT, THE FACT THAT THE WORK OF ANTI-RACISM OFTEN INVOLVES TOO A DISPROPORTIONATE SMALL NUMBER OF RESEARCHERS WORKING IN ACADEMIC INSTITUTIONS. SO THERE'S DISPROPORTIONATE HIGH AMOUNT OF WORK, DISPROPORTIONATE NUMBER OF PEOPLE, MAKING IT HARD TO THRIVE IN ACADEMIC ENVIRONMENT. LACK OF INSTITUTIONAL SUPPORT WHEN IT COMES TO THE DEPARTMENT LEADERSHIP. IN EDUCATION, UNWELCOMING TRAINING ENVIRONMENT WHICH TRAINEES POINT TO IN THEIR RESIDENCY AND FELLOWSHIP TRAINING, A LACK OF MENTORSHIP, WHEN IT COMES TO FINDING THE DIRECTION THAT YOU WANT TO FIND. I WAS LUCKILY ABLE TO FIND GOOD MENTORS ALONG THE WAY BUT I'VE HAD COLLEAGUES WHO STRUGGLED IN THAT REGARD AND LACK OF COMMITMENT TO EXPANDING THE PEOPLELINE. PEOPLELINE -- PIPELINE. I'M LOOKING AT THE COLLEGE LEVEL, WE NEED TO GO FAR UPSTREAM THAN THAT POINT BECAUSE A LOT OF PEOPLE GET WEEDED OUT MUCH EARLIER ON IN THE PROCESS. WHEN IT COMES TO PATIENT CARE SOMETHING WE DISCUSSED, A LOT IN THE CONTEXT OF THE PANDEMIC, SOCIAL DETERMINANTS OF HEALTH, HEALTH DISPARITIES, LACK OF ADEQUATE DATA COLLECTION UNDERSTANDING RACIAL INEQUITIES AND HEALTH CARE. I WANT TO START WITH RESEARCH FUNDING DISPARITY, WATERFALL PLOT THAT SHOWS ON THE RED, APPLICANTS WHO ARE UNDERREPRESENTED COMPARED TO WHITE APPLICANTS IN BLUE. YOU CAN SEE DIFFERENT PHASES OF THE FUNDING PROCESS. SO APPLICATIONS SUBMITTED, PROPORTIONALLY LOWER, SO OFF THE BAT 18% OR 17% DISPARITY. APPLICATIONS THAT GET DISCUSSED FOR R01 FUNDING, THERE'S ANOTHER DROP-OFF, AS WELL, 24%. ANOTHER DROP-OFF WHEN IT COMES TO APPLICATIONS THAT ACTUALLY GET FUNDED. SO AT THE END OF THIS PROCESS, THERE'S A 50% DIFFERENCE BETWEEN URM RESEARCHERS AND WHITES SUBMITTING FOR FUNDING. 24% BLACK RESEARCHERS LESS LIKELY TO BE DISCUSSED, LOWER IMPACT SCORES, 22% LESS LIKELY TO BE FUNDED. WHAT'S BEHIND THAT AND HOW CAN WE PUMP THESE NUMBERS UP? PART OF THE PROBLEM IS THAT THERE ARE SOMETIMES DIFFERENCES BETWEEN BLACK RESEARCHERS INTERESTED IN STUDYING VERSUS NON-URM RESEARCHERS, AN INTERESTING STUDY THAT DID A WORK CLOUD ASSOCIATION FOR THE KINDS OF WORDS THAT TEND TO POP UP IN JOURNAL ARTICLES, SUBMISSIONS FROM URIM VERSUS NON-URM. YOU CAN SEE HIV, INTERVENTION, PATIENT OUTCOME, HEALTH, TREATMENT, THESE ARE BY AND LARGE COMMUNITY BASED INTERVENTIONS, CLINICAL STUDIES LOOKING AT ASSESSING SOCIAL DETERMINANTS OF HEALTH OR DESIGNING A PROGRAM OR INTERVENTION AROUND TRYING TO CORRECT THAT. WE SEE ON THE RIGHT IN NON-URIM RESEARCHERS OSTEOARTHRITIS, NEURAL, PRION, CELL, ALONG THE LINES OF BASIC SCIENCE TOPICS. TRADITIONALLY MORE HEAVILY FUNDED. WHAT YOU SEE ON THE LEFT, THAT'S NOT TO SAY THERE AREN'T URIM RESEARCHERS WHO ARE INTERESTED IN CARTILAGE OR OSTEOARTHRITIS BUT THERE'S A TENDENCY HERE TO GRAVITATE TOWARDS THESE ISSUES ON THE LEFT, URIM RESEARCHERS, WE NEED TO MAKE SURE WE'RE ADEQUATELY FUNDING THE LEFT SIDE AS WELL AS THE RIGHT SIDE. I WANTED TO MAKE SURE I DIDN'T LEAVE OUT OTHER COLLEAGUES IN HEALTH CARE PRACTICE. RACISM IN NURSING EDUCATION IS SOMETHING THAT COMES UP FREQUENTLY, YOU ASK OF YOUR COLLEAGUES, TESIAH COLEMAN IS ON THE WEST COAST, A RESEARCHER WHO WROTE ABOUT A CLINICAL ROTATION. DURING MY FIRST ROTATION, SHE SAID, A WELL-MEANING INSTRUCTOR DEMONSTRATED FUNDAMENTALLING OF WOUND CARE AT THE BEDSIDE, I BEGAN TO MIRROR HER, MY WHITE INSTRUCTOR CALLED OUT "WORK SLAVE WORK," WHEN I RELATED IT TO FACULTY, THEY ASKED IF I THOUGHT THE INSTRUCTOR'S INTENTION WAS TO BE RACIST. FORTUNATELY I REALIZED MY BLACK IDENTITY I NEEDED TO LEAVE THEY DOOR IN EXCHANGE FOR MY NURSING EDUCATION. SHE FELT THIS INTERACTION SHE HAD TO PUT ASIDE HER BLACK IDENTITY BECAUSE FOR SOME REASON SHOULDN'T BE ASSOCIATED WITH THE NURSING PROFESSION, THAT'S THE MESSAGE THAT WAS INTERNALIZED. THEN, AGAIN, INTENT IS ONE THING BUT RESULT IS ANOTHER THING. WHAT WE REALLY SHOULD RESPOND TO IS THE RESULT. SO IF SHE IS OFFENDED BY BEING REFERRED TO AS A SLAVE, EVEN IF IT'S IN A JOKING FASHION, THAT'S SOMETHING THAT SHOULD BE ADDRESSED. WE SHOULDN'T FOCUS ON WHAT WAS THE INTENTION OF THE PERSON WHO OFFENDED YOU. SO, WE HAVE TO BE ABLE TO REALLY FOCUS ON THE INJURY THAT WAS DONE HERE, YOU KNOW, THE ACTUAL VIOLENCE DONE HERE. HER SUGGESTIONS WERE SOURCE CONTROL IN THE NURSING PROFESSION TO ADOPT ANTI-RACIST POSITION TO INCLUDE EVERYONE IN ANTI-RACISM WORK, TO INSTITUTE POWER AND PRIVILEGE COURSE TO DISCUSS THIS AT A HIGH LEVEL, TO IMPLEMENT INTERSECTIONALITY AS A CORE COMPETENCY, HOW RACISM INTERACTS WITH SEXISM AND ISMS, IN SOCIETY, TRANSDISCIPLINARY RESOURCES MEANING DRAWING EXPERTISE FROM OUTSIDE YOUR IMMEDIATE FIELD SO YOU CAN HAVE BETTER DISCUSSIONS AROUND RACISM AND STRUCTURAL INEQUITIES. I ALSO WANT TO TALK ABOUT THE LEAKY POSITION PIPELINE, TRYING TO IMAGINE THIS FROM MY DAYS IN LYNCHBURG, VIRGINIA, AS A HIGH SCHOOL STUDENT TO WHEN I BECAME A PHYSICIAN IS MORE LIKE A MINE FIELD. THAT'S A MORE APPROPRIATE COMPARISON, A LEAKY PIPELINE SUGGESTS PASSIVE MOTION GOING OUT OF WATER PIPE NOT INTACT BUT IN REALITY IT'S MORE DANGEROUS THAN THAT. I THINK THAT THERE ARE MOMENTS WHEN YOU ARE ACTIVELY KNOCKED OFF YOUR PATH OR DISCOURAGED, AND THOSE MOMENTS ARE LIKE ATTACKS, LIKE STEPPING ON A MINE. THERE ARE MANY TIMES WHEN I WAS TOLD THAT EITHER I SHOULD NOT PURSUE BECOMING A PHYSICIAN, I SHOULD DO SOMETHING ELSE, I WAS ACTUALLY TOLD THAT I SHOULD GO TO COMMUNITY COLLEGE AND BECOME AN OUGHT BODY TECHNICIAN, BY MY HIGH SCHOOL GUIDANCE COUNSELOR. SO BEING A PHYSICIAN WAS NOT BY ANY MEANS COMMON FOR PEOPLE OUT OF MY HIGH SCHOOL, SERVING PREDOMINANTLY LOW INCOME POPULATION IN LYNCHBURG, BUT THAT WAS MY DREAM, I HAD GOOD GRADES. 5% OF MEDICAL SCHOOL GRADUATES ARE BLACK. WE MAKE UP 30% OF THE U.S. POPULATION. THAT IS A SHOCKINGLY LOW, EMBARRASSINGLY LOW NUMBER, ONLY 5.8% ARE HISPANIC, EVEN WORSE DISAPPEARED, 18% OF THE U.S. POPULATION. 1.3%, NOT AS MUCH WITH INDIGENOUS AND ALASKA NATIVE, 1.3 VERSUS 1.7% OF THE POPULATION. WE HAVE ONGOING DISPARITY AND THE PROBLEM HERE IS EVEN THOUGH THE ABSOLUTE NUMBER OF APPLICANTS HAS INCREASED, YOU WOULD THINK IS A GOOD THING, THE PERCENT REPRESENTATION HAS ACTUALLY GONE DOWN. IF YOU ACCOUNT FOR POPULATION GROWTH AMONG BLACK AND LATINO COMMUNITIES, YOU SEE THAT THE DISPARITIES ACTUALLY BECOME WORSE DESPITE ABSOLUTE NUMBERS GOING HIGHER. THIS WAS A STUDY THAT LOOKED AT REPRESENTATION QUOTIENT, WHAT THAT BASICALLY MEANS IS YOUR REPRESENTATION IN THE MEDICAL FIELD RELATIVE TO YOUR REPRESENTATION IN THE POPULATION, IT'S BASICALLY ADJUSTING FOR POPULATION GROWTH, CHANGES IN POPULATION OVER TIME. WHAT YOU SEE HERE IS BROKEN DOWN BY MANY RACIAL CATEGORIES, REMAINING FLAT FOR URIM APPLICANTS, BLACK FEMALES DOWN HERE IN THE BLACK HERE, IT'S JUST REMAINING FLAT FOR 2001 TO 2017. THE ABSOLUTE NUMBER HAS INCREASED, WE'RE NOT CLOSING THE GAP WHEN IT COMES TO ACHIEVING ADEQUATE REPRESENTATION. WE NEED TO BE ABOVE ONE, GROWING AT A RATE HIGHER THAN REPRESENTATION POPULATION TO CATCH UP AND MAINTAIN THAT. SO NOTABLY THERE'S NO URIM GROUP THAT SHOWED INCREASE IN REPRESENTATION QUOTIENT MATRICULATION TO MEDICAL SCHOOL, SO THIS GAP IS ONLY GOING TO GROW LARGER AS LONG AS THE DISPARITY CONTINUES. WE HAVE TO THINK HOW DO WE CATCH UP IN THE FIRST PLACE, FIND MORE TALENT, AND HOW DO WE ENCOURAGE PEOPLE TO GO INTO MEDICINE. MY FIRST PUBLICATION IN THE NEW ENGLAND JOURNAL, AGAIN, MOVING OUTSIDE MY COMFORT ZONE, WAS NOT WHAT I ANTICIPATED TO PUBLISH, WAS ATTEMPT TO ESTABLISH A PATH FORWARD IN ANTI-RACISM APPROACH TO ACADEMIC MEDICINE, I PUBLISHED THIS WITH HISHAN YOUSIF AND NWORAH AYOGU, WHO I MET IN TRAINING. GEORGE FLOYD SAGA, COVID-19 PANDEMIC, DISCUSSING BEING BLACK MEN IN MEDICINE TO MAKE A STRONG STATEMENT AS TO WHAT WE THOUGHT THE PROBLEMS WERE IN ACADEMIC MEDICINE, WHAT WE FELT SOLUTIONS SHOULD BE. THIS WAS OUR STAB AT GETTING SOURCE CONTROL ESSENTIALLY. WE BROKE IT ALONG THREE COLUMNS, FIRST FINANCIAL COMMITMENT TO COMBATING THIS. START-UP PACKAGES FOR RECRUITS, LOAN REPAYMENT PROGRAMS, PROTECTED TIME FOR DIVERSITY-RELATED WORK. THIS IS AVOIDING MINORITY TAX THAT CAN DISPROPORTIONATELY AFFECT URIM FACULTY WHO GET PULLED INTO DIVERSITY-RELATED WORK. IN HOSPITAL AND LEADERSHIP LEVELS, MAKING PEOPLE ACCOUNTABLE FOR PATIENTS, STUDENTS, STAFF, THAT MEANS BEING ABLE TO RECRUIT PEOPLE, RETAIN PEOPLE, BEING ABLE TO KEEP PEOPLE HAPPY, FEELING SUPPORTIVE IN THEIR ENVIRONMENTS. IF YOU DON'T MEET THAT MARK SOMEONE ELSE COMES IN. HAVING TRANSPARENCY BECAUSE WHEN THINGS FADE IN SHADOWS THEY DON'T BECOME DISCUSSED, WHY NOT HAVE DISAGGREGATED DATA. WE CAN SEE HOW IT MOVES OVER TIME, THAT'S A GOOD LAUNCHING POINT FOR HOW TO FIX IS. WHEN THEY STAY IN THE SHADOWS, NO ONE SHOWS, ONLY A FEW PEOPLE HAVE ACCESS TO DATA, IT STAYS WHERE IT IS, IT'S HARD TO START THAT CONVERSATION. IF YOU HAVE A TRUE COMMITMENT TO FURTHERING DIVERSITY AMONG FACULTY AND STAFF YOU WANT TO MAKE SURE PEOPLE ARE BEING TREATED FAIRLY AND EQUITABLY. IN A DATA-DRIVEN WORLD AND INSTITUTION AND PROFESSION, THIS IS ONE AREA WHERE WE HAVE TO REALLY BEEF UP OUR DATA AGGREGATION AND REPORTING AND TRANSPARENCY. ONE OF MY LAST SECTIONS IS TALK ABOUT THE ACTUAL PANDEMIC. THIS IS A SAYING FROM MY GREAT GRANDMOTHER CHRISTINE TAYLOR, WHEN WHITE FOLKS CATCH A COLD, BLACK FOLKS GET PNEUMONIA. I HEARD THIS WHEN I WAS 6 OR 7 AND HAD NO IDEA WHAT IT MEANT AT THE TIME. SHE WAS GETTING AT WHEN THERE'S SOMETHING OF CONSEQUENCE THAT HAPPENS IN WHITE COMMUNITY, YOU CAN BE SURE THAT ONCE IT GETS TO THE OTHER SIDE OF THE RAILROAD TRACKS, IN HER WORDS, THAT IT'S GOING TO BE EVEN MORE DEVASTATING. THIS IS TRUE FOR ACTUALLY PNEUMONIA OR EVEN INFLUENZA WHERE YOU SEE DISPROPORTIONATELY WORSE OUTCOMES IN BLACK AND BROWN COMMUNITIES BUT APPLIES TO ECONOMIC RECESSIONS THAT HAVE MORE PROFOUND IMPACTS IN UNDERSERVED COMMUNITIES OF COLOR. SO, A LOT OF YOU HAVE SEEN DATA LIKE THIS ALREADY. WE DON'T HAVE TO DWELL HERE BUT WE DO SEE THAT THERE'S BEEN OVER TIME PERSISTENT DISPROPORTIONATE BURDEN SHARED BY BLACK, INDIGENOUS AND LATINO AMERICANS WHEN IT COMES TO COVID-19. THIS IS LOOKING AT MORTALITY RATES PER 100,000, OVER TIME, SO SHOWING THAT IT'S GROWING AND IT'S BEEN PERSISTENT. YOU'RE MORE LIKELY TO DIE IF YOU'RE LATINO, BLACK, INDIGENOUS, TWO TIMES MORE LIKELY, WELL KNOWN IN THIS AUDIENCE, REAL NUMBERS TRANSLATES TO 1 IN 600 VERSES ONE IN 550 AND 390. WHEN I TALK ABOUT THIS DISPARITY, IT'S EASY TO GET LOST IN NUMBERS, AND TO DISCONNECT THAT FROM ACTUAL LIES. AND SO WHAT I TRY TO THINK ABOUT ARE THE MOMENTS THAT ARE LOST IN THIS, BE IT THE DAUGHTERS WHO AREN'T GIVEN AWAY AT WEDDINGS, NOT AT BIRTHDAY PARTIES, BARBECUES NOT HAD BECAUSE PEOPLE AREN'T HERE ANYMORE BECAUSE OF COVID-19, UNDERLYING STRUCTURAL RACISM WHICH HAS DISPROPORTIONATELY IMPACTED SOCIETY, LESS HEALTHY, MORE LIKELY TO HAVE BAD OUTCOMES WITH COVID-19 IN TERMS OF THE HUMAN TOLL. UNDERLYING REASONS, CARDIOVASCULAR, DIABETES, CHRONIC LUNG DISEASE AND CHRONIC CONDITIONS. HOSPITALIZATIONS SIX TIMES HIGHER, DEATHS 12 TIMES HIGHER FOR COVID-19 PATIENTS WITH REPORTED UNDERLYING CONDITIONS. THIS TRANSLATES TO HEALTH DISPARITIES THAT EXISTED BEFORE COVID-19, BUT COVID-19 EXPLOITED, HALF OF BLACK AMERICANS HAVE A CHRONIC CONDITION COMPARED TO 39% OF GENERAL POPULATION, COMPOUNDED ON THIS IS LACK OF ACCESS TO INSURANCE, 1 IN 3 HISPANIC AMERICANS, 1 IN 5 BLACK AMERICANS, 1 IN 8 WHITE AMERICANS HAVE LACK OF ACCESS, MORE CHRONICALLY ILL, LESS ACCESS TO HEALTH CARE, A PERFECT SETUP FOR COVID-19 TAKING HOLD AND RAVAGING THE COMMUNITY. IN ADDITION TO BEING MORE PRONE TO WORSE DISEASE, BLACK AMERICANS IN PARTICULAR MAKE UP 13% OF THE GENERAL POPULATION ARE MORE LIKELY TO WORK AT FRONTLINE ESSENTIAL WORK JOBS, SO I THINK ABOUT PEOPLE LIKE MY MOM WHO WORKS AS A CASHIER AT TARGET, MY DAD DRIVES A CHARTER BUS, BLACKS ARE MORE LIKELY REPRESENTED IN THESE PROFESSIONS WHICH MEANS THAT FROM THE BEGINNING OF THE PANDEMIC AND THROUGH THEY HAVE BEEN SHOWING UP AND GOING TO WORK AND EXPOSING THEMSELVES, COMING BACK HOME TO MORE LIKELY INTERGENERATIONAL HOUSING, MORE LIKELY TO HAVE CHRONIC CONDITIONS. SO THE HEALTH AND WEALTH GAPS IN OUR SOCIETY WHICH ARE UNDERPINNED BY STRUCTURAL RACISM IS WHAT YOU SEE AT THE DOWNSTREAM END OF THIS. THIS DIFFERENCE IS LARGELY RELATED TO SOCIAL DETERMINANTS OF HEALTH WHICH ARE CONDITIONS IN THE ENVIRONMENTS IN WHICH PEOPLE ARE BORN, LIVE, LEARN, WORK, PLAY, WORSHIP, AND AGE, AFFECT A WIDER RANGE OF HEALTH FUNCTIONING AND QUALITY OF LIFE OUTCOMES AND RISK. THE ARGUMENT I WANT TO MAKE IS A LOT OF SOCIAL DETERMINANTS OF HEALTH ARE DIRECT RESULT OF SYSTEMIC RACISM, A WAY TO DANCE AROUND IT. ONE, ECONOMIC STABILITY, REDLINES AND DISCRIMINATORY PRACTICES LED TO A WEALTH GAP. HOUSING MARKET, NUMBER ONE DRIVER OF WEALTH, BLACK AND LATINO AMERICANS LOW ACCESS TO GAINING WEALTH THROUGH THE HOUSING MARKET. SOCIAL AND COMMUNITY CONTEXT, IF YOUR COMMUNITY IS OVER-POLICED, YOU'RE LESS LIKELY TO HAVE GOOD OUTCOMES WHEN IT COMES TO HEALTH AND WEALTH. YOUR ACTUAL NEIGHBORHOOD AND HOW IT'S MADE UP, THE ENVIRONMENTAL SABOTAGE THAT SOMETIMES HAPPENS, THAT CAN POINT TO AN ARTICLE THAT SHOWS IN RICHMOND, VIRGINIA, AN HOUR AWAY FROM ME, IN THE SUMMERTIME IT'S 10 TO 15 DEGREES HOTTER IN UNDERSERVED UNDERPRIVILEGED BLACK NEIGHBORHOODS, BECAUSE THERE'S LACK OF TREE COVER COMPARED TO LEAFY SUBURBS. SO THE LACK OF PARK SPACE, LACK OF TREES, LITERALLY TRANSLATES TO MORE HEAT-RELATED EMERGENCIES IN THESE COMMUNITIES. WHICH MAKES IT LESS LIKELY TO WANT TO GO OUTSIDE AND EXERCISE WHEN YOU'RE IN OPPRESSIVE HEAT LIKE THAT. WE'VE TALKED A LOT ABOUT LACK OF ACCESS TO HEALTH CARE, ETHICAL EXPERIMENTATION IN THESE COMMUNITIES WHICH FEEDS DISTRUST, IMPLICIT AND EXPLICIT BIAS AND EDUCATION. WE'VE HAD BROWN V BOARD SEVERAL DECADES AGO THE SYSTEM HAS AREAS THAT ARE STILL SEGREGATED, STRONGLY. LACK OF DISCIPLINARY -- DISPROPORTIONAL AGAINST BLACK BOYS RESULTS IN LOWER SOCIAL DETERMINANTS OF HEALTH OR MORE SOCIAL DETERMINANTS OF HEALTH THAT IMPACT HEALTH CARE THAT LEAD TO MORE CHRONIC DISEASE AND ILLNESS. TO CHANGE OUR FOCUS, THIS IS GETTING TO WHAT'S THE SOLUTION HERE, THAT'S THE THING ABOUT EQUITY THROUGH A LENS. I LIKE THIS ANALOGY BECAUSE ME, MYSELF, I DON'T SEE WELL WITHOUT MY GLASSES. WHAT THAT MEANS, IF I DON'T HAVE MY GLASSES ON, I KNOW I'M NOT SEEING THINGS CLEARLY OR MIGHT BE MISSING THINGS. SIMILARLY IF YOU HAVE AN EQUITY LENS, AND YOU'RE THINKING ABOUT PROBLEMS YOU'RE FACING ON A DAILY, WEEKLY, YEARLY BASIS, YOU'RE THINKING THROUGH THE LENS OF IS THIS AN EQUITABLE SOLUTION, AND IF YOU'RE NOT THINKING ABOUT THAT SPECIFIC QUESTION, YOU SHOULD KNOW YOUR VISION IS NOT CLEAR. THAT'S REALLY THE CONCEPT WE'RE GETTING AT HERE. I'LL GIVE AN EXAMPLE. THIS REQUIRES DEEPER LEVEL OF QUESTIONING, SO THIS WAS A TWEET FROM SCOTT GOTTLIEB, WASHINGTON POST. "WALL STREET JOURNAL." HE TALKED ABOUT LEVERAGING PHARMACIES TO DISTRIBUTE COVID-19 VACCINES, WHICH ARE VERY WIDELY DISTRIBUTED THROUGHOUT SOCIETY. HE LATER SAID THERE'S A RESPONSIBILITY TO HELP THE MOST VULNERABLE, TWO GOALS NOT IN CONFLICT, SAYING THE RIGHT THINGS BUT IF YOU ASK, CVS AND WALGREEN'S, ARE THEY IN COMMUNITIES OF EXPLORE THE ANSWER BY AND LARGE IS ACTUALLY NO. IT'S WELL REPORTED DEARTH OF PRIVATE CHAIN PHARMACIES IN COMMUNITIES OF COLOR BECAUSE THEIR BUSINESS MODEL IS BASED ON HIGH MARGINS FROM SELLING DRUGS, YOU GET HIGHER MARGINS FROM PRIVATE INSURED PATIENTS. WHEN YOU HAVE AREAS WHERE THERE'S MORE UNDERINSURED OR GOVERNMENT INSURED, POTENTIAL CLIENTS, OR CUSTOMERS, YOU HAVE LOW MARGINS. AND SO THESE PRIVATE CHAIN PHARMACIES AVOID THESE AREAS AND SO THERE'S ACTUALLY LACK OF ACCESS THERE. I KNEW THIS BECAUSE I GREW UP IN THE AREA IN LYNCHBURG, VIRGINIA, THAT I WOULD NOT COME ACROSS THESE PHARMACIES ON A DAILY BASIS. AND IT WAS SEPARATED BY SEVERAL MILES. AND SO WHEN YOU THINK ABOUT DISTRIBUTING A VACCINE TO A COMMUNITY THAT ALREADY HAS DISPROPORTIONATELY LOW ACCESS TO TRANSPORTATION, HEALTH OUTCOMES, DISTRIBUTE TO PRIVATE CHAIN PHARMACIES NOT IN THEIR NEIGHBORHOODS, IT'S NOT CLOSING THE GAP TO THE EXTENT YOU THINK IT IS. JUST BECAUSE IT'S IN NEIGHBORHOODS SOME OF US MAY LIVE IN DOESN'T MEAN IT'S IN NEIGHBORHOODS WHERE THEY REALLY NEED TO GET TO. SOURCE CONTROL, TO MAKE RACISM AND HEALTH CARE A REGULAR CONVERSATION. MY HOSPITAL HAS A DASHBOARD, IN A MEETING WE DISCUSS RATES OF MORTALITY, ANY TEAM SAFETY-RELATED ISSUES, I THINK HAVING EQUITY-RELATED CONVERSATION ON A WEEKLY BASIS IS SOMETHING THAT IS APPROPRIATE IN THAT SORT OF SETTING SO EVERYONE IS HAVING THAT CONVERSATION, SPECIFICALLY AROUND EQUITY. WANT TO INFORM DISCUSSION WITH ROBUST DATA COLLECTION EFFORT, COLLECT DATA ON HEALTH INEQUITIES IN YOUR HEALTH CARE SYSTEM. SO, WHEN YOU ASK WHAT IS OUR DISCHARGE AND READMISSION RATE FOR OUR PATIENTS, DISCREPANCIES, YOU WANT TO BE COLLECTING THAT DATA. WHAT ARE OUR PRESS GAINEY SCORES FOR UNDERSERVED, THOSE WHO DON'T SPEAK ENGLISH AS PRIMARY LANGUAGE, AND CLOSE THESE GAPS, MAYBE THESE ARE AREAS WHERE YOU WANT OUTSIDE HELP BUT YOU HAVE AN EQUITY FOCUS. YOU WANT TO KEEP SEARCHING FOR EQUITY OPPORTUNITIES BECAUSE THEY ARE ALWAYS THERE, BECAUSE THEY ARE NOT BEING DISCUSSED DOESN'T MEAN THEY ARE NOT THERE. THERE ARE ALWAYS OPPORTUNITIES TO TRY TO FIND WAYS WE CAN DELIVER BETTER HEALTH CARE, LOT OF THE TIME WE MAY HAVE TO DIG FURTHER, AS LONG AS WE'RE HAVING THAT CONVERSATION, VERY FOCUSED INTENTIONAL WAY, I THINK THAT'S A WAY TO REALLY DRIVE TOWARDS THAT CHANGE. THIS IS AN EXAMPLE OF A DASHBOARD. THIS IS MASSACHUSETTS DEPARTMENT OF HEALTH LOOKING AT CANCER MORTALITY, 2013-2017. YOU CAN SEE BROKEN DOWN NICELY HOW CANCER, ALL CANCER, BREAST CANCER, PROSTATE CANCER BREAK DOWN BY DIFFERENT RACIAL AND ETHNIC GROUPS. FOR INSTANCE BLACK RESIDENTS, MASSACHUSETTS, HIGHER RATES OF PROSTATE AND BREAST CANCER. THIS CAN HELP YOU FOCUS AROUND YOUR INTERVENTIONS BUT, AGAIN, AS FAR AS -- IT STARTS WITH COLLECTING THE DATA. YOU HAVE TO RECOGNIZE WHEN SOMETHING IS NOT HAVING INTENDED EFFECT. IF I ASKED YOU LET'S CREATE A QUALITY PROGRAM THAT EXTRACTS WEALTH FROM POOR HOSPITALS THAT PREDOMINANTLY SERVE BLACK AND BROWN PATIENTS AND GIVE IT TO HOSPITALS THAT SERVE WEALTHIER PATIENTS, I SUSPECT YOU WOULD SAY LET'S NOT DO THIS. IF I SAID LET'S CREATE A QUALITY PROGRAM THAT INCENTIVIZES TO IMPROVE OUTCOMES BY REWARDING HIGH PERFORMERS, IF YOU LOOK AT PENALTIES DOLED OUT YOU SEE THERE ARE MORE LIKELY TO AFFECT HOSPITALS THAT SERVE HIGH PROPORTION OF BLACK PATIENTS. THIS WAS A STUDY LOOKING AT THIS. HIGH PROPORTION BLACK INSTITUTIONS, LARGE URBAN TEACHING, LESS LIKELY TO RECEIVE BONUS, NEARLY TWO TIMES MORE LIKELY TO BE PENALIZED BY ALL THESE PROGRAMS. IF YOU THINK ABOUT HOW DO WE CLOSE THE GAP BETWEEN INEQUITABLE HEALTH CARE AND INSTITUTIONS NORTH SOUND ALREADY, BEING PENALIZED FURTHER, NOT TAKING CARE OF UNHEALTHIER POPULATIONS, TAKING MONEY FROM THEM AND GIVING TO HIGHER PERFORMING HOSPITALS IN WELL-TO-DO NEIGHBORHOODS TAKING CARE OF WELL-TO-DO PATIENTS, THAT'S NOT HOW YOU CLOSE THE GAP. WE NEED MORE RESOURCE FOR INSTITUTIONS LIKE THIS THAT NEEDED HELP TO ACTUALLY CLOSE THE GAP IN DELIVERING HEALTH CARE. SO EVEN WITH WELL-INTENTIONED PROGRAM YOU CAN HAVE TERRIBLE CONSEQUENCES WHEN IT COMES TO EQUITABLE DELIVERY IN HEALTH CARE. HAVING THAT EQUITY LENS MAKES YOU ASK THAT QUESTION, IS THIS PROGRAM PERFORMING THE WAY THAT WE WANT IT TO, AND ARE WE CLOSING THE EQUITY GAP THAT WAY. THE LAST PART I WANT TO TALK ABOUT IS ALLYSHIP. I THINK SPIKE IN ANTI-ASIAN SENTIMENT DURING THE COURSE OF THE COVID-19 PANDEMIC HAS BEEN ONE OF THE REALLY LOW POINTS OF THE COUNTRY BUT PROVIDES AN OPPORTUNITY TO DISCUSS HOW TO ENGAGE IN THESE MOMENTS OF PAIN. THE SAN FRANCISCO HOSPITAL, CHINESE SAN FRANCISCO HOSPITAL WAS A HOSPITAL -- IS A HOSPITAL WHERE CHINESE IMMIGRANTS WERE SCAPEGOATED FOR JOB LOSS AND SPREADING DISEASE IN THE 19th AND 20th CENTURIES, CHINESE EXCLUSION ACT LED TO SEGMENTS, THEY HAD TERRIBLE HEALTH OUTCOMES. THE HOSPITAL OPENED IN RESPONSE TO PUBLIC HEALTH DISCRIMINATION IN 1925 BECAUSE THESE IMMIGRANTS HAD NOWHERE ELSE TO GO. IN THE COURSE OF TAKING CARE OF THESE COMMUNITIES THEY WERE ABLE TO PROVIDE LANGUAGE TRANSLATION, HEALTH OUTREACH AND HAD FANTASTIC OUTCOMES DELIVERING EARLY DOSES OF COVID-19 VACCINATION BUT NOTICED A LOT OF ELDERLY POPULATION WERE NOT COMING TO CLINIC OR AFRAID TO GO OUTSIDE BECAUSE THEY WERE SEEING CLIPS OF PEOPLE IN SAN FRANCISCO, OAKLAND, NEW YORK, BEING PUSHED DOWN IN THE STREET BY PEOPLE WITH ANTI-ASIAN SENTIMENTS. PEOPLE WERE AFRAID TO GO OUTSIDE THEIR HOUSE. AND SO THEY HAD TO ACTUALLY GO DOOR TO DOOR TO DELIVER VACCINES, RESPONDING TO COMMUNITY NEED. AND THIS SHOWS THIS IS REALLY DISPROPORTIONATELY SPIKED IN THE COURSE OF THE PANDEMIC. IN 2020 YOU SEE A LARGE INCREASE OF ANTI-ASIAN HATE CRIMES REPORTED. I THINK A LOT OF THIS UNDERLYING IS CULTURAL NORMS AND EXPECTATIONS OF THE ASIAN POPULATION. SO ON THE LEFT HERE, PERCENT OF ASIAN AMERICANS PERSONALLY DISCRIMINATED AGAINST BECAUSE THEY ARE ASIAN, HIGH NUMBERS WHEN APPLYING FOR JOBS, BEING PAID OR PROMOTED, TRYING TO RENT OR BUY HOUSING, APPLYING TO COLLEGE. KIM SUMMED IT UP WELL WITH A TWEET DISCUSSING ANTI-ASIAN RACISM. SHE DISCUSSED A QUESTION, SHOCKING EVENT SHED LIGHT ON RISING GENERAL ANTI-ASIAN RACISM, ARE THERE PROBLEMS IN ACADEMIA, AND SHE CONNECTED US TO THE FACT THAT OVERREPRESENTEDDATION IN ONE SPHERE JUST MEANS THAT THERE'S SUPPRESSION ELSEWHERE. SO WHAT IF HER SON WANTED TO BE AN ACTOR OR A DANCER OR ARTIST OR CREATIVE, BUT THERE'S THIS EXPECTATION, CULTURAL NORM, ASIANS ARE OVERREPRESENTED AND SHOULD GO INTO MEDICINE OR SCIENCES, AND SO SHE CONNECTED TO THE FACT THERE'S OVERREPRESENTATION IN THESE FIELDS WITH THE FACT THAT MEANS BY DEFINITION THERE'S SUPPRESSION IN OTHER FIELDS. SO FEEDING INTO THIS NOTION OF WHAT ASIANS SHOULD DO, I THINK UNDERLIES A LOT OF ANTI-ASIAN SENTIMENT WHEN IT FLARES, A LOT OF TIMES RELATES TO WHAT SOCIETY'S EXPECTATION OF A GROUP OF PEOPLE SHOULD BE DOING. SO IT WAS FASCINATING DISCUSSION AROUND HOW TO ACTUALLY ENGAGE WITH THIS TOPIC, HOW TO ASK THE DEEPER QUESTIONS, HOW TO ENGAGE WITH COLLEAGUES EXPERIENCING PAIN. SUGGESTIONS FOR ALLYSHIP, AVOID ENGAGE JUST IN TIMES OF CRISIS, COME INFORMED, IT'S NOT THE ROLE OF URIM AND COLLEAGUES TO INFORM YOU ON THE ISSUES. AVOID MAKING IT ABOUT YOU AND YOUR REACTION. A LOT OF TIMES WHEN SOMETHING HAPPENS IN THE NEWS, YOU GET SUPPORTIVE MESSAGES FROM COLLEAGUES, A LOT IS ABOUT HOW THEY FEEL ABOUT IT. AND HOW THEY ARE RESPONDING TO IT, INSTEAD OF HOW YOU ACTUALLY FEEL ABOUT IT. YOU WANT TO EXPECT TO BE UNCOMFORTABLE BECAUSE THEY ARE UNCOMFORTABLE BUT THAT DOESN'T MEAN WE SHOULDN'T DO IT, EXPECT TO MAKE MISTAKES AND MOVE ARE MY SUGGESTIONS FOR CREATING ALLYSHIP IN THESE COMMUNITIES. THERE'S ALWAYS SOMEONE'S FRAMEWORK TO ENGAGE WITH. I LIKE THIS FROM DR. CREARY AT WHAT ARE SON SCHOOL OF BUSINESS, REDUCE ANXIETY BY TALKING ABOUT IT ANYWAY, CALL ON INTERNAL AND EXTERNAL ALLIES FOR HEALTH, EXPECT TO PROVIDE PRACTICAL TOOLS AND FRAMEWORKS AVAILABLE, MANY PLACES, BUT THE KEY HERE IS ACTUALLY HAVE THAT CONVERSATION. LASTLY I THINK IT'S IMPORTANT TO DISCUSS WHO IS AT THE TABLE. THE INAUGURATION OF PRESIDENT JOE BIDEN WAS A WONDERFUL MOMENT WHERE WE SAW SOME TALENT FROM THE LIKES OF AMANDA GORMAN, YOUNGEST POET LAUREATE, AND V P HARRIS, TALKING ABOUT POWER OF BLACK WOMEN AND POWERFUL SPACES, BUT WE HAVE TO TAKE THAT CONVERSATION TO OUR OWN SPACES AND SAY WHO IS AT THE TABLE OF POWER WHERE WE HAVE OUR CONFERENCE AND WHERE WE HAVE OUR MEETINGS? WHO IS THERE, WHO IS NOT THERE? WHO NEEDS TO BE REPRESENTED? BECAUSE WE CAN CELEBRATE THE FACT THAT WE HAVE PEOPLE LIKE THIS ON PUBLIC STAGES, WE NEED TO HAVE PEOPLE LIKE THIS IN OUR NON-PUBLIC STAGES, NOT AS VISIBLE SPACES, NOT ON TV CAMERAS BUT IN IMPORTANT PLACES OF POWER. SO ASKING THAT QUESTION WHO IS REPRESENTED, WHO IS NOT REPRESENTED, IS SOMETHING WE ALWAYS HAVE TO DO. I KNOW THAT SOMETIMES THIS CAN SEEM LIKE A TALL TASK, BUT REMEMBER THEY EVENTUALLY GOT THE SHIP DISLODGED. IT TAKES COORDINATION AND EFFORT BUT THIS IS SOMETHING WE CAN ACHIEVE, I FUNDAMENTALLY BELIEVE. THE LAST THINK IS A STORY FROM MY CHILDHOOD, THAT HELPED ME THROUGH HARD TIMES, I WAS 5 OR 6 YEARS OLD CLIMBING A HILL IN MY YARD AND KEPT FALLING DOWN, I WANTED TO CLIMB THE APPLE TREE TO GET AN APPLE BUT COULDN'T MAKE IT UP. IT RAINED AND WAS SLICK. I CAME IN THE HOUSE WITH TEARS. MY GRANDMOTHER SAID YOU KEEP FOCUSING ON THE TOP OF THE HILL WHEN YOU CLIMB. YOU SHOULD CONCENTRATE ON THE NEXT STEP, THE NEXT STEP, THE NEXT STEP AND THE ONE AFTER THAT. I GOT SO CAUGHT UP WITH THIS OVERALL GOAL THAT I FORGOT TO LOOK DOWN AT WHERE MY FEET WERE GOING. SIMILARLY, WHEN I THINK ABOUT TOPICS LIKE THIS THAT ARE SO BIG AND SO CHALLENGING, WHAT I TRY TO THINK ABOUT IS NOT THAT ULTIMATE GOAL BUT OFTENTIMES WHAT'S THAT NEXT STEP I'M GOING TO TAKE TO GET TOWARDS THAT GOAL? HOW DO I WAKE UP IN THE MORNING A BETTER VERSION OF MYSELF? HOW DO I ADVANCE THAT CONVERSATION AROUND STRUCTURAL INEQUITY AND RACISM? HOW DO I MAKE PROGRESS HERE? AND THEN IF YOU KEEP MAKING PROGRESS ONE STEP AFTER ANOTHER YOU EVENTUALLY MAKE IT TO THE TOP OF THE HILL. SO THAT'S THE THOUGHT I WANT TO LEAVE YOU WITH. I'M SORRY I RAN OVER BUT SOMETIMES THESE TOPICS TAKE A LITTLE BIT LONGER TO GET THROUGH. BUT I'M HAPPY TO TAKE ANY QUESTIONS OR ANY COMMENTS AND SINCERELY THANK YOU FOR YOUR TIME. >> WELL, WE ARE APPRECIATIVE OF ALL THE CONTENT OF THIS PRESENTATION, AND WE UNDERSTAND THAT THERE WAS A LOT TO TALK ABOUT. SO NO PROBLEM GOING OVER. THIS WILL LIMIT THE NUMBER OF QUESTIONS THAT WE CAN HAVE YOU ENTERTAIN THOUGH, DR. BELL. I WANT TO SORT OF GET TO ONE HERE THAT I REALLY THINK IS VERY APROPO OF THIS DISCUSSION. AND IT'S AS FOLLOWS. WHAT ARE YOUR THOUGHTS ON THE RECENT DECISION BY THE ACP TO PUT ALL GME PROGRAMS AT TULANE UNIVERSITY UNDER PROBATION, SPECIFICALLY CITING THE NEED TO ENHANCE EQUITY, DIVERSITY, AND INCLUSION? THIS IS IN THE CONTEXT OF RECENT ALLEGATIONS OF WIDESPREAD RACISM AT THE INSTITUTION. >> THANKS FOR THAT QUESTION. I ADMIT I KNOW A LITTLE BIT ABOUT WHAT HAPPENED AT TULANE, I BELIEVE AT THE RESIDENCY AND ALLEGATIONS THERE, THIS CONNECTS WITH I THINK DR. AISHA CURRY AT KAISER SYSTEM WHO HAD ALLEGATIONS OF RACISM, THEY NEED TO BE CAREFUL AINVESTIGATED FOR SURE. OUT OF MANY COLLEAGUES WHO HAVE CONSISTENTLY SAID THEIR VOICES HAVE NOT BEEN HEARD OVER TIME I BELIEVE BLACK WOMEN ARE ONE OF THE HIGHEST WHO HAVE SAID THAT, FACING DISRESPECT ON A CONSTANT BASIS. IT'S IMPORTANT TO INVESTIGATE ACTIONS LIKE THIS. I BELIEVE SOMETIMES PROBATION AND PUNITIVE MEASURES ARE NOT THE WAY TO GO. AND I THINK IT'S A CASE-BY-CASE BASIS. WE CERTAINLY HAVE TO HAVE MECHANISMS AND STRUCTURE IN PLACE TO MAKE SURE THAT WHEN PROGRAMS CROSS THE LINE, WHEN LEADERSHIP CROSSES THE LINE THERE'S ACCOUNTABILITY AT THAT LEVEL. BUT I DO THINK THAT A PROBATION OR PUT AN ENTIRE PROGRAM AT RISK CAN SOMETIMES MAKE ADVERSE OUTCOMES FOR PEOPLE THAT ARE TRYING TO APPLY TO THOSE PROGRAMS OR ARE IN THOSE PROGRAMS. SO YOU HAVE TO BE CAREFUL WHEN IT COMES TO THAT STEP. I THINK IT SHOULD BE IN THE TOOLBOX OF PROGRAMS THAT MAKE EGREGIOUS STEPS OVER THE LINE IN THAT REGARD BECAUSE YOU DO WANT TO SEND A MESSAGE THIS IS VERY IMPORTANT. YOU JUST WANT TO USE THAT SPARINGLY SO THAT WHEN IT DOES HAPPEN THERE REALLY ARE DEEP-SEATED ISSUES THERE. >> GREAT. AND ONE PERSONAL QUESTION FROM ME, BECAUSE I WAS INTRIGUED BY THE GRAPH THAT YOU SHOWED, REFLECTING TRENDS IN TIME IN RECRUITING DIFFERENT GROUPS INTO MEDICINE. AND WHAT CONTINUES TO DISAPPOINT ME IS THE LACK OF AFRICAN AMERICAN MALES IN MEDICINE. AND DO YOU HAVE INSIGHTS? NUMBER ONE, INTO WHY, AND NUMBER TWO, DO YOU HAVE ANY THOUGHTS ABOUT WHAT CAN BE DONE? >> THANKS FOR THAT QUESTION. OBVIOUSLY VERY PERSONAL TO ME. THE REPRESENTATION OF AFRICAN AMERICAN MALES HAS GONE DOWN FROM THE '80s AND '70s. I THINK WE CAN MAKE THAT A CONVERSATION EVEN BROADER THAN MEDICINE BUT, YOU KNOW, S.T.E.M. IN GENERAL, SCIENCES AND PROFESSIONS, THERE'S LACK OF ACCESS THERE. I THINK PART OF THE REASON IS A HIGH NUMBER OF AFRICAN AMERICAN MALES FACE INCREASED LEVELS OF DISCIPLINARY ACTION, EVENTUALLY END UP IN JAIL OR PRISON, NOT EVERYONE BUT A HIGH DISPROPORTIONATE NUMBER AFFECTS ABILITY TO OBTAIN EDUCATIONA GOOD JOB, ACHIEVE DREAMS LIKE BECOMING PHYSICIANS, LAWYERS, SCIENTISTS. SO, I THINK WHAT NEEDS TO HAPPEN AT THE MEDICAL SCHOOL AND HEALTH SYSTEM LEVEL IS A COMMITMENT TO INCREASING DIVERSITY AMONG BLACK MEN. BUT IT MEANS REACHING FAR DEEPER THAN THE COLLEGE LEVEL, EVEN THE HIGH SCHOOL LEVEL. I THINK THAT MEDICAL SCHOOLS SHOULD FUND PROGRAMS IN ELEMENTARY AND MIDDLE SCHOOL TO TRY TO INCREASE REPRESENTATION FOR UNDERREPRESENTED COMMUNITIES, IN PARTICULAR FOR BLACK MEN. I THINK THAT'S IMPORTANT BECAUSE WE HAVE TO MAKE SURE THAT THERE ARE ROLE MODELS FOR YOUNG BLACK BOYS, THAT THERE ARE PATHWAYS THAT ARE ESTABLISHED, PEOPLE THAT BELIEVE IN THEM, THAT THEY CAN ACHIEVE THESE DREAMS. THE BLACK MEN IN WHITE COATS DOCUMENTARY HIGHLIGHTS THIS WELL, THEY MAKE THE ARGUMENT THAT IT'S THE RESPONSIBILITY OF MEDICAL SCHOOLS TO INCREASE DIVERSITY, DOESN'T JUST START WITH TRYING TO, YOU KNOW, SEND OUT MORE PEOPLE TO RECRUITMENT FAIRS AT COLLEGES. BY THE TIME YOU GET TO COLLEGE, YOU'VE TRUNCATED SO MUCH OF THE POTENTIAL THAT'S THERE. THAT IT'S HARD TO EXPAND FOCUSING AT THAT LEVEL. YOU HAVE TO GO DEEPER. OF COURSE THIS IS A VERY DIFFERENT MISSION FOR MEDICAL SCHOOL THAN WHAT'S TRADITIONALLY BEEN THERE BUT WHEN YOU THINK ABOUT WHO IS IN CHARGE OF PRODUCING PHYSICIANS THAT'S WHO IS RESPONSIBLE FOR DOING THAT. IF THAT'S WHERE OUR ISSUE IS, I THINK THAT'S INSTITUTIONS LIKE MEDICAL SCHOOLS AND ACADEMIA SHOULD TAKE THE LEAD IN THAT. WHAT I WOULD LOVE IS A LARGE MULTI-MILLION DOLLAR GRANT SO I COULD BUILD A TEAM AT UNIVERSITY OF VIRGINIA AND START A PROGRAM THAT INFILTRATES ALL OF ALBEMARLE, CHARLOTTESVILLE, FOR TUTORING PROGRAMS FOR PEOPLE THAT LOOK LIKE ME. >> HOPEFULLY THAT WISH WILL BECOME A REALITY. WE APPRECIATE YOU COMING BACK TO NIH, EVEN VIRTUALLY, AND DISCUSSING THIS ISSUE. AND I WILL SEND YOU SOME OF THE ADDITIONAL QUESTIONS THAT HAVE COME BY E-MAIL AND YOU MAY WISH TO CHOOSE TO RESPOND INDIVIDUALLY. SO THANK YOU AGAIN, AND HAVE A GREAT AFTERNOON. >> THANK YOU, EVERYONE. THANK YOU, DR. LEMBO.