GOOD MORNING, EVERYONE,
WELCOME.
IT IS A BEAUTIFUL, BEAUTIFUL
MORNING --
[ AWAY FROM MICROPHONE ]
WE'RE REALLY EXCITED FOR
TODAY'S WEBINAR AND OUR
WONDERFUL SPEAKERS, THIS IS A
NIH UNITE INITIATIVE AND NIH
HEALTH DISPARITIES INTEREST
GROUP WORKSHOP ENTITLED WHO WE
ARE, THE MULTIPLE DIMENSIONS
OF RACE AND ETHNICITY.
TODAY WE HAVE A PANEL OF FOUR
SPEAKERS.
WE ARE SAVE A GOOD AMOUNT OF
TIME AT THE END FOR FOLKS IF
YOU HAVE QUESTIONS.
WE REALLY ENCOURAGE YOU TO
TAKE DOWN YOUR QUESTIONS.
THOSE ONLINE WILL BE
MONITORING THE CHAT FOR
EVERYONE'S QUESTIONS.
TODAY'S TOPIC WE WILL TALK
ABOUT THE DIMENSIONS OF RACE
AND ETHNICITY THAT ARE SOCIAL
CONSTRUCTS.
WE WANT TO THANK EVERYONE FOR
ALL THEIR HARD WORK FOR
PUTTING THIS EVENT TOGETHER.
IT DOES TAKE A VILLAGE TO PUT
ON A WORKSHOP LIKE THIS.
WE REALLY WANT TO THANK EACH
AND EVERYONE OF OUR
OUTSTATUTING COMMITTEE.
AND THEN A ACTUAL VERY SPECIAL
THANKS TO OUR SPONSORS AND
CONTRIBUTORS WITH THE NATIONAL
INSTITUTES OF HEALTH AND
HEALTH DISPARITIES AND NIH AS
WELL.
WE WILL BE INTRODUCING OUR
SPEAKERS NOW AT THE BEGINNING
SO THAT WAY THEY CAN JUST JUMP
RIGHT INTO THEIR
PRESENTATIONS.
THEY HAVE A LOT TO COVER THIS
MORNING.
I WILL INTRODUCE TWO SPEAKERS
AND HAVE MY COLLEAGUES
INTRODUCE THEMSELVES AS WELL.
I DON'T THINK SO YOU CAN SEE
US ONLINE BUT I AM CHRISTINA
BORBA, DIRECTOR OF THE NIH
OFFICE OF HEALTH DISPARITIES
AND WORKFORCE ETHNICITIES AND
STARTED HERE ONE WEEK AGO.
>> AND I AM JENNA NORTON WITH
NIH DIABETES AND BEEN AT NIH
FOR TEN YEARS.
IT IS A PLEASURE TO BE HERE
AND THANK YOU ALL FOR JOINING
US.
>> SO WE WILL INTRODUCE ALL
FOUR SPEAKERS NOW AND THEN WE
CAN GET STARTED WITH THE
PRESENTATIONS.
Dr. KELLY WISE, ASSOCIATE
PROFESSOR OF HOME HEALTH AND
MANAGEMENT, PROGRAM DIRECTOR
OF EQUITY CONCENTRATION AND
ASSISTANT DIRECTOR OF THE
MARYLAND --
[INDISCERNIBLE]
AT THE UNIVERSITY OF MARYLAND.
HER WORK TODAY WILL ADDRESS
MECHANISMS THAT ADDRESS RACIAL
HEALTH INEQUALITY,
PARTICULARLY RACISM IN HEALTH.
MULTIFACTORS WITH INEQUITY IN
ALL DISEASE.
Dr. EVELYNN HAMMONDS,
PROFESSOR OF AFRICAN-AMERICAN
STUDIES IN THE FACULTY OF ARTS
AND SCIENCES AND PROFESSOR OF
SOCIAL AND INDIGENOUS SCIENCES
AT THE HARVARD UNIVERSITY.
IT INCLUDES SCIENCE, HEALTH IN
THE UNITED STATES, RACE,
GENDER, SEXUALITY SO SCIENCE
STUDIES AND MY COLLEAGUE WILL
INTROTHE OTHER TWO SPEAKERS.
>> WE ALSO HAVE JOINING US
TODAY Dr. ERIKA BLACKSHER
FROM THE UNIVERSITY OF KANSAS
AS AN ETHECIST AND SCIENTIST,
SHE STUDIES INEQUAL QUALITY IN
HEALTH VALUES AND HER WORK
FOCUSES ON --
[INDISCERNIBLE]
AND FINALLY WE HAVE Dr.
JESSICA CERDENA WHO RECEIVED
HER MEDICAL DEGREE AND
DOCTORATE FROM YALE
UNIVERSITY.
SHE STUDIES RACISM, RACE
ILLNESS AND HEALTH.
NEXT SLIDE.
SO I WANT TO BRIEFLY WALK YOU
THROUGH TODAY'S GENDER.
THIS IS THE INTRODUCTION AND
WELCOME PORTION OF OUR TALK --
OF OUR SESSION.
NEXT WE WILL BE HEARING FROM
Dr. EVELYNN HAMMONDS ON RACE
AND HISTORICAL PERSPECTIVES,
Dr. KELLEE WHITE ON SOCIALLY
ASSIGNED RACE.
Dr. ERIKA BLACKSHER ON RACE
AND ETHNICITY AND Dr.
CERDENA.
SO THIS VIDEO IS BEING
RECORDED AND THOSE OF YOU
JOINING US ON VIDEOCAST, IF
YOU HAVE QUESTIONS, E-MAIL
THEM TO ME AT THE ADDRESS ON
THE SLIDE AND FOR THOSE
LISTENING, IT IS JENNA
NORTON@NIH.GOV SO IF YOU HAVE
QUESTIONS, E-MAIL ME AND WE
WILL MAKE SURE WE ENTER THEM
IN THE DISCUSSION.
THANK YOU FOR JOINING US TODAY
AND WITH THAT, WE CAN BEGIN
THE LECTURES.
Dr. HAMMOND?
>> YES, CAN YOU HEAR ME NOW?
>> YES, WE CAN.
>> THANKS A LOT.
SO I JUST WANT TO MAKE A FEW
BRIEF AMOUNTS ON ON RACE FROM
A HISTORICAL PERSPECTIVE.
I WANT TO THANK FOLKS FOR
INVITING ME TO BE WITH YOU
THIS MORNING AND I KNOW WE
HAVE A LOT TO COVER SO I WILL
JUST MOVE AHEAD.
THESE SLIDES DON'T WANT TO
MOVE AND IT IS NOT MOVING SO
HOLD ON A SECOND.
WE DID THIS EARLIER AND IT
WORKED PERFECTLY FINE AS USUAL
AS THESE THINGS TEND TO DO.
OKAY.
OKAY, I THINK IT IS GOING TO
WORK.
SO I ALWAYS START WITH
CONVERSATIONS ABOUT RACE IN A
HISTORICAL PERSPECTIVE BY
TALKING ABOUT THE QUESTION OF
WHAT IS RACE AND SO THE FIRST
QUESTION I HAVE IS WHAT IS
RACE IN CLASS AND THEN 13
WEEKS LATER, I ASK THEM WHAT
IS RACE.
SOMETIMES THEY ARE MORE
CONFUSED AND WE HAVE TO SORT
IT OUT BUT USUALLY, WE MOVE
THEM TO A DIFFERENT PLACE.
SO THE EARLIEST KNOWN USAGE
COMES FROM THE 1500S.
THE ENGLISH WORD RACE HAS
CONTAINED SEEMINGLY
CONTRADICTORY ELEMENTS.
AT ONCE NATURAL AND SOCIAL,
FIXED AND MUTABLE, INHERITED
AND ACQUIRED.
FROM THE OUTSET, THE MATTER OF
RACE HAS BEEN THE TOPIC OF
DEBATE FROM THE NUMBER OF
RACES TO THE CRITERIA FOR
IDENTIFYING MEMBERS OF A GIVEN
RACE AND MY AIM FOR THE
STUDENTS IS TO GET THEM TO
DISPLAY THE PROTEAN AND DEEPLY
POLITICAL CHARACTER OF THE
WORD AND CONCEPT.
SO WHAT IS RACE, I HAVE USED
THE DEFINITION BEFORE, IT
STANDS FOR CON EXCEPTIONS OR
DOCTRINE THAT NATURE PRODUCED
HUMANKIND IN DISTINCT GROUPS
EACH DEFINED BY INPORN TRAITS
THAT ITS MEMBERS SHARE AND
DIFFERENTIATE THEM FROM
MEMBERS OF OTHER DISTINCT
GROUPS OF THE SAME KIND BUT
UNEQUAL RANK.
SO REALLY WHEN RACE IS THE
OBJECT OF EXPLICIT STUDY, ITS
DEFINITION IS RARELY PLAIN OR
STABLE.
WITHIN A SINGLE DOCUMENT YOU
OR STUDY YOU CAN TRACK THE
VARIOUS IDEAS 'EMEDDED IN THE
TERM INCLUDING ALL OF THESE
ABSOLUTELY CHARACTERISTIC
TERMS OF THIS VERY OLD AND
VERY COMPLICATED TERM SHOW UP
EVEN IN THE MODERN-DAY
SCIENTIFIC AND BIOMEDICAL
WORK.
BUT I ALSO LIKE TO POINT OUT
THAT MOST ORDINARY PEOPLE GO
ABOUT THEIR DAILY BUSINESS
ASSUMING EVERYBODY KNOWS WHAT
RACE IS.
THE IDEA OF RACE IS A
SELF-EVIDENT FACT AND IT
REQUIRES NO PROTRACTED --
[INDISCERNIBLE]
THAT A PERSON OF DIFFERENT
COLOR.
[ BACKGROUND SPEAKING ]
>> SORRY, Dr. HAMMOND S,
PLEASE MUTE ON THE ZOOM?
>> YOU WANT ME TO MUTE?
>> NO, I WAS SPEAKING TO
EVERYBODY.
>> SO WHAT WE ARE ASSUMING THE
ETHNIC DIVERSITY WE SEE ALL
AROUND US HAS ALWAYS EXISTED
AS A HISTORICAL, SOCIAL AND
BIOLOGICAL FACT THAT NEEDS TO
FURTHER INTERROGATION AND THIS
IDEA THAT HUMAN BEINGS ARE
OBVIOUSLY MEMBERS OF RACES
BEGS THE WHOLE QUESTION OF
SAYING ALL MEMBERS OF A RACE
ARE A BIOLOGICAL TRANSMISSION
OF INNATE QUALITIES, OR THAT
RACE IS AN ALL-PREVADING
NATURAL PHENOMENON, AN AWESOME
AND MYSTERIOUS PRIMORDIAL
FORCE.
SO IT IS OUT THERE SO STUDENTS
CAN NAIL DOWN WHAT IT IS BUT
THE NOTION THAT IT IS OUT
THERE AND ONE DAY WE WILL HAVE
THEM GET IT IS THE WORK THAT
WE NEED TO UNTANGLE.
SO IT IS AN IDEA THAT PER PET
WAITS AND REINFORCES THE
NOTION THAT HUMAN BEINGS
BELONG TO OR HAVE ALWAYS
THOUGHT THEY BELONGED TO,
ENORMOUS PHYSICO-NATURAL
FAMILIES OF PRIMATES DIVISABLE
INTO RACES AND SUB-DIVISIBLE
INTO ETHNIC GROUPS.
SO KNOWING THAT, IT TAKES A
MATTER OF COMMON SENSE THAT
INDIVIDUALS ARE LINKED IN SOME
EVENTLESS WAY BY COMMON BLOOD,
CLIMATE, SO I WILL, CULTURE,
LANGUAGE, MENTAL DISPOSITION
OR SOME COMMON PLACE FEATURE
SUCH AS SHAPE, COLOR OF EYES,
SKIN PIGMENTATION, SIZE AND
SHAPE OF NOSE, SLOPE OF
FOREHEAD, CRANIAL CAPACITY AND
SO WE GATHER THESE FACTS AS
NOT TAKEN FOR GRANTED AND
ENSHRINED AS GIVENS IN
VALUE-FREE STUDIES OF RACE AND
COURSE OF DAILY LIFE.
THEY ARE USED IN SUPPORT OF
THE NOTION THAT HUMAN BEINGS A
DESCENDED FROM COMMON NATURAL
ORIGINS AND POSSESSED OF
RECOGNIZABLE PHYSICAL, MENTAL
AND CULTURAL TRAITS THAT ARE
TRANSMITTED BIOLOGICALLY AND
USED MORE OFTEN THAN NOT TO
GROUP AND CLASSIFY PEOPLE INTO
FOUR OR FIVE IN EARLY
CENTURIES OR 38 DIVISIONS IN
LATER CENTURIES AND THEY ARE
IN SOME KIND OF ARBITRARY
HIERARCHICAL ORDER.
BUT WE CONTINUE TO HAVE THESE
QUESTIONS OF RACE TO INHABIT A
MILIEU IN WHICH PEOPLE'S
BODIES ARE MARKED AS DIFFERENT
BECAUSE OF THEIR RACE.
AND FURTHERMORE, RACE IS
VIEWED AS A PROXY FOR DEEPER
INNATE DIFFERENCES OF WHETHER
THERE MIGHT BE SOMETHING IN
BLACK PEOPLE'S BODIES THAT
MAKES THEM DIFFERENT FROM
WHITE PEOPLE'S BODIES.
SO THIS APPROACH AS THOSE OF
YOU WHO STUDY THIS KNOW THAT
THERE ARE SOME DIFFERENCES IN
BODIES BUT THIS APPROACH
ENCOURAGES SCRUTINY OF BLACK
PEOPLE'S BODIES, THEIR HABITS
AND CUSTOMS.
WE MIGHT CONSIDER VIEWING
DISPARITIES AS A FUNCTION OF
HOW BLACK PEOPLE'S BODIES HAVE
BEEN REGARDED BY THE MEDICAL
PROFESSION SHIFTING OUR
EFFORTS AWAY FROM TRYING TO
UNDERSTAND WHAT MIGHT BE
DIFFERENT ABOUT A BLACK
PERSON'S BODY.
THE DIFFERENCES IN THE 18TH
AND EARLY 19TH CENTURY ASSUMED
THERE WERE BIOLOGICAL AND
MENTAL OR PHYSIOLOGICAL
DIFFERENCES UNDERLYING ANY
DIFFERENCES.
THIS WAS WIDELY ASSUMED THAT
THE CAUSE OF SUCH DIFFERENCES
WAS RACIAL AND NO FURTHER
EXPLORATION OR EXPLANATION WAS
NEEDED.
SO THE CULTURAL DIFFERENCE OF
SEPARATING BLACK BODIES FROM
WHITE BODIES, FOCUSING ON
CULTURES AND THINGS THAT MADE
US DIFFERENT AT THAT TIME.
SO THEY FOCUSED ON RACE AS A
STATISTICAL INTEGRATED
PHYSICAL, LINGUISTIC AND
CULTURAL TOTALITY.
THROUGH THE 20TH CENTURY, THIS
INTEGRATED TOTALITY HAS BEEN
DIVIDED, BROKEN APART AND
QUESTIONED BY MANY SOCIAL
SCIENTISTS AND LEGAL SKAL LARS
AND SINCE RACE IS BEING USED
AS A WAY TO CATEGORIZE
INDIVIDUALS, IT PASSES THE
RESULT OF GENETIC DIFFERENCES
THAT MAY ACTUALLY BE DUE TO
INTERACTIONS OR SOME ASPECT OF
LIVED EXPERIENCE BUT USING
RACE TENDS TO CONFLATE
GENETICS AND LIVED EXPERIENCE.
SO WHAT DOES IT MEAN?
WHAT DOES CAUCASIAN MEAN?
IT IS EVERYTHING FROM SOMEBODY
LIVING IN BELFAST TO SOMEBODY
LIVING IN SOUTHERN SPAIN TO
SOMEBODY LIVING IN TUNISIA TO
SOMEBODY LIVING IN SRI
I LANKA.
THAT IS A HUGE VARIATION.
SO WHAT DOES BLACK MEAN OR
AFRICAN-AMERICAN?
THERE'S MORE VARIATION IN THE
AVERAGE AFRICAN VILLAGE THAN
THERE IS IN THE REST OF THE
WORLD COMBINED.
AND EVEN ASIDE FROM PANOFSKY,
THE PROBLEM BEFORE US IS THOSE
COMING IN AS IMMIGRANTS ARE TO
BE LABELED BY RACE AND
DETERMINED BY THE STOCK FROM
WHICH ALIENS SPRING AND THE
LANGUAGE THEY SPEAK AND SOME
DEGREE NATIONAL NATIONAL.
THIS IS THE INHERITANCE WE
HAVE OF TRYING TO SEEK THROUGH
WHAT RACE ACTUALLY MEANS TODAY
AFTER THE PRACTICE OF THE
UNITED STATES GOVERNMENT TO
CATEGORIZE PEOPLE IN THIS
CONFUSING AND ABSOLUTELY BIAS
WAY SO MANY YEARS AGO.
SO I THINK THIS POINT IS KIND
OF CLEAR.
GENETIC AND BIOLOGICAL
DEFINITIONS OF RACE AND THE
PRACTICE, THE ANSWERS TO WHAT
IS RACE VARY ACROSS THE FIELD.
AND THE QUESTIONS, WHAT ARE
THE CAUSES AND NATURE OF
RACIAL DIFFERENCES IN DISEASE?
TO WHAT EXTENT ARE THE CURRENT
DESIGNATIONS USED BY THE OMB
ADEQUATE, APPROPRIATE OR VALID
TO USE IN ANALYZING GENETIC
DIVERSITY WITHIN AND BETWEEN
CONTEMPORARY RACIALLY
DESIGNATED GROUPS IN THE U.S.?
IS RACE A USEFUL OR VALID
BIOLOGICAL VARIABLE AT THE
GENETIC LEVEL OR CAN IT ONLY
BE ANSWERED IF DISCIPLINARY
DIFFERENCES AND HISTORICAL
PRACTICES WITH RESPECT TO THE
USE OF RACE ARE ASSESSED?
AND THE SAME THING CAN BE SAID
OF ANCESTRY.
SO I WOULD ARGUE THERE IS NO
STANDARD WAY OF CHAT GUYING
POPULATIONS IS EMERGING,
RATHER GENUINE NETTIVITY BLEND
POPULATION CLASSIFICATIONS
SYSTEMS AT THE FIELD, PAPER
AND SAMPLE LEVELS CONTRIBUTING
TO THE CLASSIFICATORY
AMBIGUITY.
SO THAT IS WHAT I WANTED TO
SAY AND THAT CONCLUDES MY
TALK.
>> THANK YOU, Dr. HAMMOND S.
OUR NEXT SPEAKER IS Dr.
KELLEE WHITE.
>> GOOD MORNING, I WILL BEGIN
SHARING MY SLIDES MOMENTARILY.
CAN EVERYONE SEE THE SLIDES?
>> YES.
>> OKAY, THANK YOU.
SO THANK YOU FOR BEING ABLE TO
BE A PART OF THIS ESTEEMED
PANEL TO TALK ABOUT RACE.
I WILL BE TALKING ABOUT
SOCIALLY ASSIGNED RACE AND
DISCUSSING BRIEFLY
IMPLICATIONS FOR POPULATION
HEALTH EQUITY.
SO AS Dr. HAMMONDS TALKED
ABOUT RACE, ETHNICITY ARE
POWERFUL PREDICTORS OF HEALTH.
MOST PUBLIC RESEARCH EXAMINES
SELF-IDENTIFIED RACE WHICH IS
A KEY CONSTRUCT OF DEFINING A
GROWING BODY OF WORK THAT
DISCUSSES RACE, ETHNICITY,
MULTIDIMENSIONALITY OF RACE,
SOCIALLY-ASSIGNED RACE AND
IMPLICATIONS FOR POPULATION
HEALTH.
SO I WILL TALK ABOUT RACE AS A
SOCIAL CONSTRUCT AND THE MOST
COMMON MEASURE FOR RACE AND
ETHNICITY IN THE UNITED STATES
AND ITS LIMITATIONS.
I WILL BRIEFLY INTRODUCE THE
CONCEPT OF THE
MULTIDIMENSIONALITY OF RACE
AND IMPLICATIONS FOR
POPULATION HEALTH AND THEN THE
REMAINDER OF THE TALK I WILL
FOCUS ON SOCIALLY-ASSIGNED
RACE, HOW IT IS DEFINED, HOW
IT IS OPERATIONALIZED
INCLUDING HOW SOME ARE USING
THE SOCIALLY-ASSIGNED RACE.
AND FORGIVE ME FOR THE NEXT
SLIDE.
IN CLASS, THIS SLIDE IS A
LITTLE MORE INTERACTIVE AND I
WOULD ASK WHAT RACIAL CATEGORY
DO YOU GIVE TO THE PERSON AND
I THINK I HAVE MESSED THAT UP
AND I DON'T THINK I AM ABLE TO
SEE THE TAGS BUT THE PURPOSE
OF THIS SLIDE IS JUST TO SHOW
VARIATIONS AND THE WAY PEOPLE
LOOK AND THAT SOME PEOPLE MAY
ASCRIBE A RACE OR ETHNICITY TO
SOMEONE AND IT MAY BE
DIFFERENT THAN THE WAY SOMEONE
ELSE DESCRIBES A RACE OR
ETHNICITY FOR THAT SAME
PERSON.
AND SO THIS WAY IN WHICH YOU
AS INDIVIDUALS RACIALLY
CLASSIFY PEOPLE CAN SERVE AS A
BASIS FOR INTERACTION BETWEEN
INDIVIDUALS AND INSTITUTIONS.
AND SO I WOULD LIKE TO ADD ON
TO Dr. HAMMONDS' DEFINITION
OF RACE.
I APPRECIATE THIS DEFINITION
AND ORIGINALLY DEFINED AS A
SOCIAL CONSTRUCT THAT DEFINES
A SKIN COLOR THAT INDEXES
ONE'S LOCATION IN A SOCIAL
HIERARCHY.
THE STRUCTURES OPPORTUNITY AND
GOVERNS DISTRIBUTION OF RISK
BY ASSIGNING VALUE BASED ON
THE SOCIAL INTERPRETATION OF
HOW ONE LOOKS.
THIS IS FOLLOWING THE U.S.
BUDGET AND MANAGEMENT PROCESS
OF COLLECTING STANDARDS TO
DEFINE RACE AND ETHNICITY AND
USED TO IDENTIFY AND MONITOR
AND EXAMINE RACIAL/ETHNIC
HEALTH INOOH QUALITIES.
AND I KNOW THIS HAS CHANGED
RECENTLY BUT IT HAS PREDEFINED
CATEGORIES TO PRE-DEFINE,
COLLECT AND MONITOR
ETHNICITIES' HEALTH.
IT DOES NOT CAPTURE THE LIVED
EXPERIENCE OF RACE.
IT IS ARGUED THAT RACE IS MORE
COMPLEX THAN A SINGLE MEASURE
AND MORE COMPLEX AND THAT
THERE ARE OTHER KIND OF
MEASURES AND WAYS IN WHICH YOU
CAN CAPTURE THE FULL KIND OF
COMPLEXITY OF RACE AND
MULTIDIMENSIONALITY OF RACE.
THERE IS HOW RESPONDENTS
IDENTIFY AND HOW OTHERS SEE
THEM.
THERE IS WORK FROM ROTH AND
OTHERS THAT SHOW THE
LIMITATIONS OF SELF-IDENTIFIED
RACE AND YOU KNOW THERE IS
RESEARCH THAT SAYS THE
CLASSIFICATIONS DO NOT ALWAYS
MATCH ONE'S PREFERRED
IDENTITY.
SO THEREFORE THE LIMITATIONS
IN OF SELF-IDENTIFIED RACE
OVERLOOKS THE RESEARCH AND
OVERLOOKS RECENT WORK ON
MULTIDIMENSIONALITY OF RACE OF
INDIVIDUALS AS WELL AS THOSE
AROUND THEM.
SO A GROWING AMOUNT OF WORK IN
THE SOCIOLOGICAL LITERATURE
OVERLOOKS THIS AND CONSIDERING
RACE AS A FUNCTION OF
CONTACTS, APPEARANCE,
STEREOTYPES, NORMS, SOCIAL
INTERACTIONS AND SEXUAL
DYNAMICS.
IT CONCEPTUALIZES CONTEXT AND
SOCIETAL RELATIONS.
FOR EXAMPLE, WHEN ASKED, THERE
WERE DIFFERENT PICTURES OF
RACE AFFECTING EQUALITY.
EVEN THE CHANGING DEMOGRAPHICS
IN THE U.S. IN PARTICULAR
WHICH REFLECTS AN INCREASINGLY
MULTIRACIAL AND MULTIETHNIC
SOCIETY, THE POSSIBILITY OF AN
INCREASE OR MISMATCH OF
IDENTIFICATION AND THAT OF
OTHERS IS POSSIBLE.
SO IT CAN HELP BROADEN OUR
UNDERSTANDING BY TAKING INTO
ACCOUNT THE
MULTIDIMENSIONALITY OF RACE,
IT CAN HELP BROADEN THE
MECHANISMS BY WHICH RACIAL
EQUALITY IS OBTAINED.
SO LOOKING AT ROSS' TABLES,
THIS REFLECTS THE
MULTIDIMENSIONALITY.
SO I WILL DISCUSS THE ISSUE OF
SOCIALLY-ASSIGNED RACE.
IT IS DEFINED AS THE
PERCEPTION OF HOW INDIVIDUALS
ARE CLASSIFIED BY OTHERS
RACIALLY AND ETHNICALLY.
THE SIGNIFICANCE IS THE PROBE
OF WHITE ADVANTAGE, IMPLICIT
BIAS AND RACIALIZATION AS A
FUNDAMENTAL ELEMENT OF RACISM.
THE WAY PEOPLE ARE RACIALLY OR
ETHICALLY VIEWED BY OTHERS IS
HOW THEY ARE TREATED AND THE
OPPORTUNITIES THEY RECEIVE,
WHICH MEANS THAT WITH THE
SOCIALLY-ASSIGNED RACE, WE GO
TO A HEALTH IMPACT OF THE
RADICALIZATION OF RACE.
[INDISCERNIBLE]
SOME OF THE WAYS RACE IS
REFERRED TO IS A TAXI DRIVER,
A JUDGE IN A COURTROOM AND
THIS IS CRITICAL TO THE SOCIAL
PROCESS THAT CAN LEAD TO
DISCRIMINATION PHARMA AND HARM
WHEN AN INDIVIDUAL OWNS SOME
OTHER IDENTIFICATIONS.
SO IT IS THE PROCESSES THAT
ARE LEGALLY INTERESTING THAT
MAY SEPARATE SET ADDITIONAL
RITUALS FOR ETHNIC HEALTH AND
EQUALITY.
SO SOCIALLY-ASSIGNED RACE, YOU
CAN SEE THAT IT IS FAIRLY
STATIC HOW ASIANS, WHITES AND
BLACKS AGREE TO BE
SELF-IDENTIFIED TO A
SOCIALLY-ASSIGNED RACE.
THERE IS A MODERATE TO HIGH
DEGREE OF MISMATCH WITH
LATINOS, NATIVE AMERICANS,
PACIFIC ISLANDERS AND
INDIGENOUS PEOPLE.
LIKE NEW ZEALAND IS FINDING
THERE IS A HIGH DEGREE OF
MISMATCH FOR INDIGENOUS,
SPECIFICALLY THE MAORI PEOPLE.
SO THE IN THE BRSS, THERE IS
AN OPTION -- BRFSS, THERE IS
THIS QUESTION OF HOW DO OTHER
PEOPLE USUALLY CLASSIFY YOU IN
THIS COUNTRY.
SO THIS IS NOT SO COMMON A
MODULE AND I THINK THIS MAY BE
CHANGING GIVEN SOME OF THE
MORE INTEREST IN MEASURING AND
CAPTURING SOCIALLY ASSIGNED
RACE AND ALSO THE EXPERIENCE
OF RACISM.
IT ALSO CAPTURES SOME SMALLER
GROUPS THAT ARE NOT
NECESSARILY REPRESENTATIVE OR
ACCORDING TO SURVEYS FROM THE
BRFSS.
SO COLLEAGUES ASK THE QUESTION
IF YOU WERE WALKING DOWN THE
STREET, WHAT RACE DO YOU THINK
OTHER AMERICANS WHO DO NOT
KNOW YOU PERSONALLY WOULD
ASSUME YOU WERE?
AND IN CANADA, THERE WAS WORK
THAT WAS ASKED, WHAT ABOUT THE
OTHER PEOPLE YOU MEET, WHAT
RACIAL BACKGROUND DO OTHER
PEOPLE TEND TO THINK YOU ARE?
SO IN A RECENT REVIEW, MY
COLLEAGUES AND I PERFORMED A
SYSTEMATIC REVIEW OF THE
LITERATURE, THIS WAS UP TO
2018 AT THE TIME, 19 AND WE
IDENTIFIED 18 ARTICLES THAT WE
FOUND THAT LOOKED AT
SOCIALLY-ASSIGNED RACE AND
SOME OF THE HEALTH OR
HEALTH-RELATED OUTCOMES.
THE MOST COMMON HEALTH OUTCOME
WAS SELF-RATED PHYSICAL HEALTH
WHICH WAS SELF-REPORTED HYPERT.
THERE WERE SEVERAL HEALTH
OUTCOMES STUDIES TO INCLUDE
MENTAL HEALTH, PREVENTIVE
HEALTH SCREENINGS, UTILIZATION
AND ENGAGEMENT OF HEALTH
SERVICES AND HEALTHCARE
DISCRIMINATION.
THESE STUDIES WERE ACROSS
U.S., CANADA, NEW ZEALAND, AND
SOUTH AMERICA, OVERALL THE
LOWER QUALITY OF HEALTH FOR
THOSE SOCIALLY-ASSIGNED TO THE
LOWER STATUS GROUP.
SO THIS PRETTY SIDES -- THIS
PROVIDES SOME CONSIDERATIONS
AND QUESTIONS OF WHAT IS THE
GREATER THEORETICAL CLARITY?
SHOULD ONE MEASURE BE USED IN
LIEU OF ANOTHER?
, DO ESTIMATES OF RACIAL
INEQUALITY VARY BY MEASURE AND
DOES THE MEASURE MATTER BY
DIFFERENT RACIAL/ETHNIC GROUP
OR UTCOMES AS THEY UNFOLD AND
HOW PEOPLE EXPERIENCE THEM.
SO IT IS NOT JUST ONE MEASURE
WE NEED TO UNPACK BUT THERE
ARE OTHER MEASURES THAT
PROVIDE SOME NUANCED
UNDERSTANDING OF THE
COMPLEXITIES OF RACE.
DO ESTIMATES OF INEQUALITY
VARY BY MEASURE AND DOES THE
MEASURE MATTER BY DIFFERENT
RACIAL/ETHNIC GROUPS OR
UTCOMES?
SO LOOKING AT THE EXPLORATORY
POWER OF RACE AND RACISM AND
THOSE PROCESSES,
SOCIALLY-ASSIGNED RACE BASED
AREAS FOR EQUITY RELATED
RESEARCH.
THERE IS THIS INVESTIGATION TO
HELP EXAMINE AND FIGURE OUT
THE PATTERNS THROUGH THEIR
ANSWERS.
THERE ARE A DEARTH OF DATASETS
WHICH PREVENTS OR KIND OF
HAMPERS THE ASSESSMENT BUT AT
THE END OF THE DAY, I THINK
THE TAKE-HOME IS BEING ABLE TO
USE THIS MEASURE TO
COLLECTIVELY ADVOCATE FOR THE
GREATER COLLECTION OF THIS, TO
FACILITATE MORE NUANCED
PATTERNS OF RACIAL AND ETHNIC
HEALTH ADVANTAGES.
>> THANK YOU VERY MUCH, Dr.
WHITE.
NEXT UP WE HAVE Dr. ERIKA BLAC.
ERIKA?
Dr. BLACKSHER, ARE YOU ABLE
TO PRESENT?
>> YES, YOU CAN HEAR ME NOW?
[ FAINT AUDIO ]
>> OKAY, GIVE ME A SECOND TO
PREPARE MY SLIDES --
>> YOUR AUDIO IS A LITTLE
FAINT --
>> CAN YOU HEAR ME NOW?
>> THERE WE GO.
>> I APOLOGIZE I HAD MY MIC
POINTED UP TO MAKE SURE YOU
DIDN'T HEAR ANY DISTRACTION.
SO GOOD MORNING, SEEMS LIKE
YOU CAN HEAR ME NOW AND ALSO
SEE MY SLIDES.
IT IS AN HONOR TO BE WITH YOU
ALL --
>> WE'RE NOT SEEING YOUR
SLIDES, IF YOU COULD GO TO
PRESENT MODE --
>> OKAY, APOLOGIZE FOR THIS.
CAN YOU SEE THEM NOW?
>> YES.
>> ALL RIGHT, LET ME GET THEM
ON FULL FORM.
HOW IS THAT?
>> VERY GOOD, THANK YOU.
>> SO YOU CAN HEAR MY VOICE,
SEE MY FACE AND MY SLIDES, IS
THAT CORRECT?
[INDISCERNIBLE]
>> SO FORGIVE THE TROUBLED
START THERE, THANK YOU FOR
ALLOWING ME TO BE PART OF THIS
PANEL THIS MORNING, AND I WILL
GET UNDERWAY.
THE TITLE OF MY TALK IS RACE
AND ETHNICITY AS PROXIES FOR
HEALTH-RELEVANT DISADVANTAGE.
THERE ARE THREE ELEMENTS TO MY
TALK AND IT IS WORTH NOTING
THAT I WAS ASKED TO SPEAK MORE
TO ETHNIC AND RACIAL
DISPARITIES AS POOR PROXIES IN
HEALTH DISPARITIES RESEARCH
BUT I THINK IT WOULD BE GOOD
TO PUT THE REMARKS ABOUT THE
POOR PROXIES IN THAT LARGER
CONTEXT.
MY THIRD OBJECTION IS TO PIVOT
TO THE MAIN PART OF THE TALK
WHICH IS TO IDENTIFY ENTECH
LIMITS OF RACE AND ETHNICITY
IN THE FOUR ADDITIONAL
CATEGORIES AND THEN FINALLY I
WILL IDENTIFY SEVERAL OTHER
RISKS OF RACIAL AND ETHNICITY
HEALTH RESEARCH.
SO A FEW DEFINITIONS OF THE
FIRST OBJECT, WHAT ARE RACE
AND ETHNICITY, Dr. HAMMONDS
DID A GREAT JOB OF DISCUSSING
THAT FOR SURE.
THE IDEA OF RACE AND ETHNICITY
THAT I WORK WITH ARE THERE ARE
SOCIOPOLITICAL CONSTRUCTS
CREATED AND MAINTAINED TO
DIFFERENTIATE AND STRATEGY
POPULATIONS BASED ON ARBITRARY
PHYSICAL CHARACTERISTICS AND
JUSTIFIED BY IDEOLOGIES THAT
SEEK TO BENEFIT PEOPLE
INTERPRETED AND CLASSIFIED AS
WHITE AND TO OPPRESS PEOPLE
WHO ARE OTHERWISE INTERPRETED
AND CLASSIFIED BASED ON RACE
AND ETHNICITY.
I WANT TO DESCRIBE THE
SOCIALLY CONSTRUCTED TERM OF
THE WHITE CATEGORY AND OVERALL
WHITENESS WHICH I WILL DEFINE
AS SOCIALLY CONSTRUCTED
RACIAL, SOCIAL AND SYMBOLIC
CATEGORY THAT AS I NOTED,
OFTEN GOES UNDER STUDIES AND
UNDEFINED YET FUNCTIONS AS THE
NORM OR REFERENT GROUP AGAINST
WHICH MINORRIZED OTHERS ARE
DEFINED AND VALUATED.
WHITENESS CREATES MATERIAL,
PSYCHOLOGICAL, POLITICAL AND
CULTURAL ADVANTAGES FOR PEOPLE
WHEN LIGHT-COLORED SKIN,
INTERACTS AND INTERACTS WITH
OTHER CONSTRUCTS SUCH AS
CLASS, GENDER, DISABILITY,
GEOGRAPHY, RELIGION AND MORE.
I WOULD NOTE TOO IT IS NOT A
STATUTE TICKER CATEGORY.
WHITENESS TODAY DOESN'T MEAN
WHAT IT MEANT 50 YEARS AGO,
100 YEARS AGO, IT IS A SOCIAL
DYNAMIC CATEGORY THAT EVOLVES
OVER TIMES IN CONNECTION WITH
SOCIAL AND SCIENTIFIC AND
POLITICAL MOVEMENTS.
AND MY SLIDES ARE NOT
ADVANCING -- THERE WE GO.
SO FOR THE SECOND CONCEPT, I
KNOW YOU KNOW WHAT A PROXY IS
BUT TO BE EXPLICIT, I WAS
ASKED TO SPEAK TO THE RACIAL
AND ETHNICITY OF PROXIES AS A
CONSTRUCT AND WHAT IS A PROXY?
IT IS SOMETHING THAT IS USED
TO REPRESENT SOMETHING ELSE
THAT YOU ARE TRYING TO MEASURE
SO IT IS A STAND-IN FOR THE
ACTUAL THING.
SO WHAT IS THE ACTUAL THING?
HERE I AM GOING TO PROPOSE THE
IDEA OF -- THAT WHAT WE'RE
TRYING TO GET AT WHEN WE ARE
DOING HEALTH DISPARITIES
RESEARCH, HEALTH AND EQUALITY
REAFTERNOON SEARCH ARE
EXPERIENCES AND EXPOSURES THAT
EXPOSE THE MIND AND BODY TO
HEALTH AND BECAUSE WE'RE
INTERESTED IN DISPARITIES,
WE'RE INTERESTED IN PARTICULAR
SUBGROUPS OR POPULATIONS,
THOSE THAT ARE SOCIALLY
DISADVANTAGED IN A VARIETY OF
WAYS.
THERE IS A LOT OF VARIABILITY
ACROSS THE HEALTH DISPARITIES
LITERATURE, DEFINITIONS ABOUT
HEALTH EQUITY AND CERTAINLY IN
THE JUSTICE LITERATURE BUT I
AM WORKING WITH THIS IDEA OF
WHAT DOES IT MEAN TO BE
SOCIALLY DISADVANTAGES IN THE
CONSTRUCT WHICH IS A
COMPLETELY DIFFERENT WORK TO
DIVING INTO OTHER ISSUES.
SO WHAT MANY PEOPLE MIGHT
REFER TO AS THE SOCIAL
DETERMINANTS OF HEALTH IN THE
APARTHEID FRAMEWORK AND I WILL
EXPLAIN THAT WITH MY WORK IN A
BROADER CONTEXT.
AND THE THREE-PART FRAMEWORK
IS COMPRISED OF RELATIONS,
REPRESENTATION AND RESOURCES
AND LET ME TELL YOU WHAT I
MEAN BY EACH OF THOSE.
BY RELATIONS, I AM REFERRING
TO EXPECTING DISCRIMINATION,
DEPRESSION, EXCLUSION AND
NOMINATION BASED ON THE
DIFFERENCES IN RACE,
REPRESENTATION, SOURCES AND
MORE.
IN THE ROUND OF
REPRESENTATION, I AM REFERRING
TO MARGINALIZATION AND
EXCLUSION FROM FORMAL AND
INFORMAL DECISION-MAKING
PROCESSES THAT CONVEY POLICY
PREFERENCES AND PRIORITIES AND
CREATE POLICY CONTEXTS.
AND WE SEE THIS IN THE EXTREME
GERRY MANDERING WITH VOTER
SUPPRESSION AND THEN
RESOURCES, THE LACK OF
AVAILABILITY, AFFORDABILITY
AND ACCESS TO SOCIAL AND
ECONOMIC GOODS WE KNOW ARE
IMPORTANT TO HEALTH SUCH AS
NUTRITION, EDUCATION,
EMPLOYMENT, INCOME,
HEALTHCARE, HOUSING,
TRANSPORTATION, PUBLIC
UTILITIES AND MORE.
SO AGAINST THIS BACK DROP OF
WHAT WE'RE TALKING ABOUT, WHY
IS RACE AND ETHNICITY RELEVANT
AND I WILL SHOW YOU VERY
QUICKLY SOME CHARTS THAT
ILLUSTRATE THIS, WHY RACE AND
ETHNICITY, EVEN IN SORT OF
BLUNT FORMS OF RACE ARE OFTEN
CAP SKPHAOURD NOT IN THE MORE
SOPHISTICATED WAY THAT Dr.
WHITE SAYS WE NEED TO BE
TALKING ABOUT RACE AND BECAUSE
THERE IS THIS AROUGH ALIGNMENT
BETWEEN MINORITY GROUPS AND
DISENFRANCHISEMENT FROM AND
THE UNDER REPRESENTATION IN
CIVIC AND POLITICAL PROCESSES
AND A ROUGH ALIGNMENT BETWEEN
MINORITY GROUPS AND
MALDISTRIBUTIONS OF RESOURCES.
AND THEN SHOWING YOU THE CHART
OF HEALTH OUTCOMES BUT I WILL
MOVE QUICKLY AND NOT TALK
ABOUT THE SOURCES IN THE CHART
AS I AM USING THEM FOR MORE
DEFINITIVE PURPOSES, AS
OPPOSED TO DEMONSTRATIVE
PURPOSES.
WE SEE THE MINORITY GROUPS
BEING LESS WELL OFF, WE SEE
THIS WITH BLACK, HISPANIC,
NONHISPANIC AND THEN WHITES
AND NONHISPANIC ILLUSTRATING
WA WE MIGHT CALL LATINO HAVE
BETTER HEALTH VERSUS THEIR
BEING SUBJECT TO THE LOWER
STATUS AND FORMS OF
DISCRIMINATION AND
MISTREATMENT.
HERE IS ANOTHER EXAMPLE HERE,
DIABETES AND AGAIN I USE THIS
TO ILLUSTRATE THE RELEVANCE OF
RACE AND ETHNICITY BECAUSE IT
IS CAPTURING, AGAIN,
GAUGING -- IT IS A GAUGE OF
SHORT FALLS AND RESOURCE
RELATIONS AND REPRESENTATION.
SO ALL OF THIS IS TO SAY WITH
REGARD TO THE RELEVANCE OF
RACE AND ETHNICITY, THERE ARE
DISPROPORTIONATE RACES WITH
PREMATURE DEATH RATES AMONG
MINORITY GROUPS AND HEALTH
OBJECTIVITY.
IF WE LOOK DEEPER IN THE DATA
AND USE OTHER PROXIES FOR
HEALTH DISADVANTAGE, THERE IS
A MORE COMPLEX PICTURE.
SO I WILL SPEAK TO THREE 'EM
PICKER LIMITS OF RACE AND
ETHNICITY RELATED TO
DISADVANTAGE, AND WHITENESS
WHICH GENERALLY IS PROTECTIVE
OF ADVANTAGE.
IT MASKS HETEROGENEITY WITHIN
ETHNORACIAL GROUPS, SUCH AS
DIFFERENCES ASSOCIATED WITH
SOCIAL CLASS, SOCIOECONOMIC
STATUS, POVERTY, UNDERSERVED
GEOGRAPHIES, CULTURE, EARLY
LIFE EXPOSURES AND GENDER,
SEXUAL IDENTITY ET CETERA.
I WILL SHOW YOU SOME GRAPHS
THAT ILLS TRAIT THESE AND I
WILL MOVE A BIT SLOWER BECAUSE
I WANT TO DIG INTO THEM A
LITTLE MORE BUT THE SOURCES
ARE ALL SHOWN AT THE BOTTOM OF
THE SLIDE.
SO THIS IS FROM 2016 AND WHAT
I WANT TO DO HERE IS JUST
DEMONSTRATE THE HETEROGENEITY
WITHIN CERTAIN POPULATIONS,
WITHIN EACH GROUP SO HERE YOU
HAVE WHITE WOMEN AND THE
10-YEAR GAP WITH THOSE WHO
LACK A COLLEGE DIPLOMA, AND
MORE.
AND WE SEE WITH MEN, A 12-YEAR
DIFFERENCE WITH THOSE WHO HAVE
A HIGH SCHOOL DIPLOMA, COLLEGE
DEGREE AND MORE AND HERE YOU
ARE LOOKING AT BLACK WOMEN AND
SEE A 5-YEAR DIFFERENCE FROM
THOSE WHO HAVE A HIGH SCHOOL
DIPLOMA OR COLLEGE DEGREE AND
THEN BLACK MEN, WE HAVE A
9-YEAR DIFFERENCE AMONG THOSE
WITHOUT A HIGH SCHOOL DIPLOMA
OR COLLEGE DEGREE OR MORE.
AND SO THIS IS THE DIFFERENCE
THAT MASKS A SORT OF MATRIX
VIEW AND THE COMPLEXITY THAT
COMES WITH IT.
USING THE SAME DATA AND WHERE
I HAVE HIGHLIGHTED IN YELLOW,
WHAT I WANT TO POINT OUT HERE
IS THIS POINT WHERE WE LOOK AT
HEALTH DATA ONLY BY RACE AND
ETHNICITY.
IT APPEARS SHARED HEALTH
BURDENS IS CONNECTED IN WOMEN
WITHOUT A HIGH SCHOOL DIPLOMA
AND BLACK WOMEN WITHOUT A HIGH
SCHOOL DIPLOMA, THEIR
EXPECTANCIES ARE ROUGHLY THE
SAME, SIMILARLY WITH MEN
WITHOUT A HIGH SCHOOL DIPLOMA
SO THERE IS A SHARED BURDEN
THERE WHICH YOU WOULDN'T SEE
OTHERWISE.
THIS HEALTH OUTCOME COMES FROM
MY COLLEAGUE ON SEVERAL
PROJECTS AND THE SOURCE OF THE
DATA IS THE NATIONAL CENTER
FOR HEALTH STATISTICS ON A
STUDY WE ARE DOING IN THE
MIDWEST.
THESE BLACK CIRCLES REPRESENT
WHITE MOTHERS, THE BLACK
TRIANGLES REPRESENT BLACK
MOTHERS AND WHAT I WANT TO
POINT OUT HERE IS THIS IDEA OF
MASKING HETEROGENEITY WITH
INTERSECTIONAL POPULATIONS
SHOWING THAT MOTHERS, BLACK
MOTHERS WITH COLLEGE DEGREES
OR DIPLOMAS HAVE A HIGHER
MORTALITY AND I WANT TO POINT
OUT OTHER PROXIES SUCH AS THE
MOTHER'S EDUCATION AND THE
SHARED BURDEN HERE OF HIGH
LEVELS OF INFANT MORTALITY FOR
WHITE AND BLACK WOMEN WITHOUT
A HIGH SCHOOL DIPLOMA AND I
THINK THAT'S IMPORTANT TO
POINT OUT AS WELL.
SORRY THE IMPERFECTION OF THIS
CIRCLING.
THOUGHT I WOULD GIVE THIS A
TRY AND DIDN'T HAVE IT DOWN.
THIS HEALTH MEASURE ARE
ADVERSE CHILDHOOD EXPERIENCES
AND WHAT IT ILLUSTRATES,
AGAIN, THE RED CIRCUMSTANCE
KEL DISPLAY DEPICTS
HETEROGENEITY WITHIN A
POPULATION.
THE BLACK BARS REPRESENT POOR
CHILDREN, THESE ARE WHITE,
THESE ARE BLACK AND THESE ARE
HISPANIC CHILDREN AND THE
GREEN SHOWS VERY HIGH LEVEL OF
AVERAGE CHILDHOOD EXPERIENCE
FOR WHITES, FOR BLACKS AND
HISPANIC CHILDREN, THE
COMMONALITY OF BEING POOR.
I DON'T REALLY HAVE TIME FOR
THAT SLIDE SO LET ME JUST SAY
MY OVER ARCHING POINT IS TO
REALLY DIG INTO THE DATA, WE
NEED TO COMBINE RACE AND
ETHNICITY WITH OTHER
CONSTRUCTS AND YOU CAN SEE
THIS POINTS TO SOME OF THEM
BUT NOT ALL THAT ARE LISTED
HERE AND THIS IS NOT AN
EXHAUSTED LIST, THE IDEA OF
SOCIAL CLASS, SOCIOECONOMIC
STATUS, POVERTY, GEOGRAPHY,
REGION, GENDER, SEXUAL
IDENTITY, COUNTRY OF ORIGIN,
CULTURE, ET CETERA.
SO WHO WE ARE HAVE THESE
CONSTRUCTS WHICH ARE DIFFERENT
THAN THOSE CLASSIFIED AS WHITE
AND OTHER FORMS OF
DISADVANTAGE OR ADVANTAGE.
SO WE REALLY NEED A
PLURALIST-INTERSECTIONAL
FRAMEWORK TO GUIDE THE 'EM
PICKER AND ETHICAL STUDY OF
HEALTH INEQUALITIES.
SO THIS SLIDE CAN SUGGEST THE
CROSS ROADS OF HEALTH
DISADVANTAGES AND ADVANTAGES
AND THERE ARE ETHICAL RISKS OF
OVER-RELIANCE WHICH ENCOURAGES
REDUCTIONISTIC AND RACIST
EXPLANATIONS.
THE OTHER ITEMS HERE, IT
SUPPRESSES SYSTEMS OF
MARGINALIZATION AND SHAPES
HEALTH AND LONGEVITY
PROSPECTS, CAPITALISM,
IMPERIALISM, PATRIARCH HE
COULD, HETEROSEXISM AND OTHER
ISMS AND NEGLECTS OR IGNORES
THE SIGNIFICANT HEALTH
DISPARITIES.
SO THANK YOU AND I WILL LOOK
FORWARD TO THE QUESTIONS YOU
HAVE TORE FOR ME.
>> SO THANK YOU VERY MUCH,
Dr. BLACKSHER AND NOW WE
HAVE OUR FINAL SPEAKER, Dr.
CERDENA.
>> THANK YOU SO MUCH FOR
HAVING ME.
INCREDIBLE TO BE PRESENTING
ALONGSIDE OTHER INCREDIBLE
SPEAKERS AND I HOPE THIS
INFORMATION WILL COMPLIMENT
WHAT HAS ALREADY BEEN SAID AND
TIE EVERYTHING TOGETHER.
SO THIS TALK IS ON RACE,
RACISM AND KIDNEY DISEASE AND
TO GIVE CONTEXT ON HOW WE CAN
CONTEXTUALIZE RACE, WHAT THE
IMPACTS ARE FOR HEALTH AND
ADDITIONAL ROLES OF HOW
GENETICS PLAYS IN ALL THIS AND
PERHAPS UNDERSTANDING UTCOMES
OR PERHAPS NOT AND DEALING
WITH A SPECIFIC STUDY OF
KIDNEY DISEASE IN THE WORLD OF
DISPARITIES AND DISEASE.
SO LOCKING AT THIS CASE STUDY
BECAUSE IT IS VERY PRONOUNCED
FOR BLACK AMERICANS.
THEY ARE THREE TIMES LIKELY TO
DEVELOP KIDNEY DISEASE AND TWO
TIMES MORE LIKELY TO
DEVELOP --
[INDISCERNIBLE]
, BLACK AMERICANS MAKE UP
13 PERCENT OF THOSE AFFECTED
BY KIDNEY DISEASE BUT
REPRESENT 35 PERCENT OF THOSE
WITH KIDNEY FAILURE.
THIS IS A VERY IMPORTANT STUDY
AND MANY SCHOLARS AND
NEPHROLOGISTS AND PEOPLE IN
THE COMMUNITY EXPLAIN IS
TRYING TO DEFINE KIDNEY
FAILURE AND WHEN IT IS
DISCUSSED WHAT IS THE DRIVER,
THE ANSWER IS ALWAYS APOLI L1.
AND THERE ARE MANY FEATURES
THAT LINK TOGETHER AFRICAN
ANCESTRY AND EGFR AND KIDNEY
DISEASE, APOLI L1 AND WHEN WE
READ THESE, IT WILL ALL KIND
OF STICK TOGETHER THAT THE
PHENOTYPE FOR THE APOL L1 RISK
VARIANTS, LOOKING INTO
ANYTHING FOCUSING ON THIS
POPULATION SO IT RACES THE
QUESTION, WHAT IS THE CONCERN,
IS IT THE RELEVANT EXPLANATION
AND IT RELEVANTLY KIND OF
BRINGS THE CONCERN ABOUT THIS
GENE AND GENETICS AND RACE,
WHETHER THIS IS AN APPROPRIATE
COUPLING OF THE TWO, GOING
BACK TO Dr. HAMMONDS TALK
ABOUT THIS KIND OF TOTALITY OF
RACIAL ASSOCIATION AND THE
CONCEPT OF RACE AND REALLY
THIS KIND OF ALLURE OF THE
GENE TO EXPLAIN SO MUCH OF THE
DISPARITIES AND WHERE WE GO TO
IN SCIENCE TO EXPLAIN WHAT WE
OBSERVE THE DIFFERENCES COME
FROM, GOING TO GENETIC
EXPLANATIONS, PARTICULARLY
WITH RACIAL DISPARITIES, IT
REALLY DONATES TO THE THINKING
THAT THE DIFFERENCE MUST BE
GENETIC BECAUSE THAT IS HOW WE
HAVE COME TO SEE HUMAN TYPES.
SO THE PURPOSE OF THIS TALK IS
TO KIND OF UNTANGLE THAT AND
DISTINGUISH THE THINKING AND
TEAR THAT APART A LITTLE BIT
AS SCIENTISTS, SCHOLARS, AS
YOU KNOW THINKERS IN CLINICAL
MEDICINE, CAN BE MORE
THOUGHTFUL AND CAREFUL MOVING
FORWARD AS WE COMBAT RACIAL
HEALTH DISPARITIES.
AND THERE ARE MORE EXAMPLES OF
PHASES OF THAT.
SO WHAT IS THE APOLI L1?
IT IS A MAMMALIAN GENE THAT
GOES BACK MILLIONS OF YEARS
AND TOUT THOUGHT TO HAVE A
SELECTIVE ADVANTAGE, HAD ITS
ORIGINS IN CENTRAL AFRICA,
FIRST EMERGED IN ANIMALS IN
THE ZYGOTE FORM, THAT IT HAD A
SELECTIVE ADVANTAGE FOR
AFRICANS AND SO THERE WERE
THESE LITTLE PARASITES AND IF
YOU HAD A WILD TYPE FORM OF
THE GENE AND ONE VARIANT, YOU
HAD LESS LIKELIHOOD OF DYING
FROM THIS SICKNESS.
AND THEN IT WAS FOUND THAT IF
YOU HAD SIMILAR TO, YOU KNOW,
THE ADVANTAGE OF MALARIA TO --
FOR YOU KNOW VARIOUS OTHER
SINGLE MUTATION THEMES WE KNOW
OF LIKE SICKLE-CELL, IT WAS
FOUND THAT IF YOU HAD TWO
HITS, YOU COULD DEVELOP THIS
FORM OF KIDNEY DISEASE.
SO IF IT IS EXPRESSED IN
CHROMOSOME 22, THERE ARE TWO
RISK VARIANTS THAT ARE
BASICALLY -- ONE IS A
MUTATION, THE OTHER IS A
COHESION AND IF YOU HAVE G1 OR
G2, YOU ARE CONSIDERED TO HAVE
TWO RECOMMENDS OR A DOUBLE HIT
AND THEN YOU ARE PREDISPOSED
TO DEVELOP THIS FORM OF KIDNEY
DISEASE.
NOW, THE MECHANISMS ARE NOT
ENTIRELY CLEAR.
IT IS THOUGHT TO HAVE EITHER
-- CAUSING MITOCHONDRIAL
DYSFUNCTION OR INFLAMMATION
THAT BASICALLY CAUSES DAMAGE
TO THE PRODUCTOCYTES AND THE
MECHANISMS OF L1 NEPHROPATHY
INVOLVE DAMAGE TO THE
GLOMERULAR PODOCYTE.
SO THIS BASICALLY IS A
MUTATION THAT CARRIES THE
DISEASE, NO ONE ELSE HAD THE
ADVANTAGE ON THE AFRICAN
CONTINENT BUT IT IS PRESERVED
IN THE HISTORY AND NOW THE TWO
VARIANTS ARE KNOWN TO
PREDISEASE THE INDIVIDUAL TO
KIDNEY DISEASE.
SO WHAT DOES IT MEAN IF YOU
HAVE TWO OF THE RISKS?
YOU HAVE 10.5 GREATER ODDS OF
DROPPING GLOMERULOSCLEROSIS
AND 7-POINT'PERCENT MORE
LIKELY TO EXPERIENCE
HYPERTENSION-ATTRIBUTED KIDNEY
FAILURE.
SO LOOKING AT THE DISTRIBUTION
OF THESE ALELES THROUGH THE
AFRICAN CONTINENT, JUST TO
ORIENT YOU A LITTLE BIT, G1 IS
DEPICTED ON THE LEFT AND G2 IS
DEPICTED ON THE RIGHT SO AS
YOU GET CLOSER TO THE RED, IT
IS HIGHER FREQUENCY AND ON THE
RIGHT SIDE, IT IS IN THE
ORANGE.
SO YOU CAN SEE THERE ARE A
HIGHER CONCENTRATION OR HIGHER
PREVALENCE MORE IN CENTRAL
AFRICA AND THEN IT KIND OF
VARIOUS WITH G2 BECAUSE THE
EVOLUTION OF G2 IS A LITTLE
LESS CLEAR AND WE HAVEN'T BEEN
ABLE TO TRACE IT OUT AS WELL.
SO AS YOU CAN SEE IT IS VERY
WHITE.
IT DOESN'T EXIST IN NORTH
AFRICA, REALLY IN SUBSAHARA
AFRICA, PULLING IT SOUTH
TOWARDS THE INTERIOR OF THE
DON'T COMMENT?
SEEMS TO VARY THROUGHOUT AND
DOES NOT EVEN ACHIEVE A
FREQUENCY BEYOND 50 PERCENT
MEANING THERE COULD BE ENTIRE
COMMUNITIES THAT DON'T HAVE IT
AT ALL AND SO IT IS NOT THE
KIND OF THING WHERE EVERYONE
HAS IT OR CARRIES IT.
IT CAN REALLY VARY, IS THE
POINT I AM TRYING TO MAKE.
AND I ALSO WANT TO MAKE THE
POINT THAT AMONG BLACK
AMERICANS, ABOUT 13 PERCENT OF
THE POPULATION CARRIES ONE
VARIANT AND ABOUT 20 PERCENT
OF THE POPULATION CARRIES TWO
VARIANTS.
AND I WANT TO DRIVE HOME THIS
POINT BECAUSE REMEMBER ALL
THOSE PAPERS I WAS SHOWING YOU
THAT WERE ATTRIBUTING THIS
RISK OF RACIAL DISPAINTER
ETHNOCITY OF DISEASE TO ONE,
THIS IS TALKING ABOUT THE
ORIGIN OF BLACK AMERICAN
DESCENDANTS OF THE ENSLAVED
AND THIS IS NOT WHERE YOU WILL
SEE THE HIGHEST PREVALENCE OF
THESE GENETIC VARIANTS.
SO IT IS REALLY A MISCONSTRUAL
TO SAY ALL OF THIS KIDNEY
DISEASE IS JUST LIKE FROM TWO
PEOPLE WHO CAME OVER AND THEN
POPULATED THE ENTIRE, YOU
KNOW, GROUP OF PROGENITORS OF
BLACK AMERICANS IN THE UNITED
STATES AND DEVELOPED KIDNEY
DISEASE.
THIS DEVELOPED OVER CENTURIES
FROM PEOPLE WHO HAD ALL SORTS
OF GENETIC VARIANTS, CAME FROM
DIFFERENT PARTS OF THE
CONTINENT AND HAD DIFFERENT
GENE POOLS.
SO IT IS A TOTAL MISCONSTRUAL
OF THIS AND OF COURSE NOT ALL
BLACK AMERICANS ARE PART OF A
SLAVE TRADE AND I DON'T MEAN
IF SAY THIS IN A VERY HARSH
WAY BUT OUR SCIENTIFIC
LITERATURE CAN BE SO
ENTRENCHED IN RACIST LOGIC
THAT IT CAN RECAPITULATE A
HARMFUL WAY OF THINKING ABOUT
RACE AND GENETICS.
SO I AM SURE YOU KNOW THE
ANSWER TO THIS BUT DOES THIS
EXPLAIN THE DISEASE IN
AFRICAN-AMERICANS, AND THERE
HAVE BEEN STUDIES ON THIS AND
THE ANSWER IS NO.
APOL1 CAN ACCOUNT FOR EXCESS
30 PERCENT OF NONDIABETIC
KIDNEY DISEASE IN BLACK
AMERICANS AND WITH ALL THE
MONEY AND RESEARCH WE HAVE PUT
INTO SAYING OH, IT IS ALL
ABOUT APOL1 HAS BEEN
DISCONNECTED TO THE OTHER
THINGS DRIVING THIS HEALTH
DISPARITY.
SO I WANT TO TALK ABOUT WHAT
ELSE CAN BE GOING ON AND THIS
BRINGS ME TO HOW RACISM IS
INVOLVED.
SO LIVING IN A RACIST
ENVIRONMENT CAN CAUSE CHRONIC
STRESS, VASCULAR TENSION,
GLYCEMIC CONTROL AND SALT AND
WATER RESORPTION.
AND HEALTHCARE WHICH INVOLVES
PREVENTIVE CARE, SCREENING AND
DIAGNOSIS AND SPECIALTY CARE.
AND THEN THERE IS A STRUCTURAL
OPPRESSION WHICH IS CHEAP,
HIGH-DENSITY FOOD INTAKE, LESS
FISCAL ACTIVITY, HARDER TO GET
YOUR BODY MOVING AND YOU ARE
MORE LIKELY TO BE EXPOSED TO
NEPHROTOXIC ELEMENTS, THINGS
LIKE LEAD AND AIR POLLUTION.
AND THEN RACIAL DISPARITY
THROUGH MULTIPLE MECHANISMS
SUCH AS GENOMIC OR EPIGENOMIC
FUNCTIONS, TELOMERE LENGTHS,
DNA METHYLATION, AND CHRONIC
ADAPTATIONS TO RACISM ARE RISK
FACTORS FOR KIDNEY DISEASE.
SO THEY SERVE AS RISK FACTORS
FOR KIDNEY DISEASE,
HYPERTENSION, HYPER AGREE SEEM
I CAN'T OR INFLAMMATION AND
AUTOIMMUNE DISEASE CAN ALL BE
THOUGHT OF AS CHRONIC
ADAPTATIONS TO RACISM.
SO WHAT CAN WE DO ABOUT IT?
WELL, WE ARE ALL HERE, AREN'T
WE?
TALKING ABOUT IT, THINKING
ABOUT IT.
SO IT IS IMPORTANT WE CONTINUE
TO COLLECT DATA BY RACE AND I
COMPLETELY AGREE WITH WHAT
Dr. WHITE WAS SAYING BEFORE,
WHAT DOES IT MEAN TO RARELYIZE
OR SELF-IDENTIFY AS A CERTAIN
RACE AND THEN WE CAN THINK
ABOUT IT ON A COLLECTIVE
BASIS.
WHEN IT IS TIME TO DO GENETIC
TESTING, THAT SHOULD BE BASED
ON CLINICAL FACTORS, NOT JUST
RACE.
SO IT IS NOT OH, WE HAVE A
PATIENT WHO IS A PROXY FOR
GENETIC RISK, BEING OF THE
BLACK RACE AND KIDNEY DISEASE
BUT THERE COULD BE OTHER
FACTORS THAT COULD BE DRIVEN
BY APOL1 OR THERE COULD BE
OTHER REASONS FOR DEVELOPING
KIDNEY DISEASE AND MIGHT NOT
APPROPRIATELY MANAGE THEIR
RISK FACTORS AND LOOKING FOR
ANOTHER DRIVER.
SO WE NEED TO THINK MORE
CRITICALLY ABOUT WHAT IS GOING
ON AND NOT JUST USE RACE OR
WHAT WE THINK OF AS
CONTINENTAL ANCESTRY FOR OUR
INDICATIONS FOR GENETIC
TESTING AND WE SHOULD CONTINUE
TO FUND RESEARCH ON THE
EFFECTS OF RACIST AND
ANTIRACIST POLICIES ON KIDNEY
HEALTH.
I WAS REALLY EXCITED -- BEFORE
THIS TALK, I LIKE TO LOOK IN
THE REPORTER AND SEE OH, ARE
THERE MORE STUDIES ON KIDNEY
HEALTH ADDRESSING RACIAL
DISPARITIES.
SO THINGS ARE MOVING IN THE
RIGHT DIRECTION.
AND THEN I HAVE IN HERE,
ADDING IN THE HEALTH
DISPARITIES, LESS HEALTHY FOOD
AVAILABLE.
PEOPLE WHO LIVE HEALTHY LIVE
LONGER AND HAVE SUPPORT WITHIN
THEIR COMMUNITIES AND THAT IS
SOMETHING THAT I THINK AS WE
GET CAUGHT UP IN OUR ACADEMIC
ENVIRONMENT, WE CAN GET VERY
STUCK ON.
SO THIS IS ME SAYING LET'S
KEEP OUR EYE ON THE PRIZE,
MAKE SURE WE ARE ALWAYS
THINKING ABOUT WHAT THE TRUE
DRIVERS ARE AND REMEMBER THAT
RACISM IS THE KEY DRIVER OF
RACIALIZED HEALTH DISPARITIES.
THANK YOU.
>> EXCELLENT.
MAYBE WE COULD START WITH A
BRIEF ROUND OF APPLAUSE FOR
OUR PANELISTS FOR THEIR
OUTSTANDING TALKS.
SO IF WE COULD SEE ALL THE
SPEAKERS SO WE CAN ASK THEM
QUESTIONS.
SO WE HAVE ALREADY RECEIVED A
COUPLE OF QUESTIONS FROM THE
VIDEOCAST SO WHILE FOLKS ARE
GATHERING THEIR THOUGHTS IN
THE ROOM, WE DO HAVE A
QUESTION REFERENCING THE FDA
WITH PROSTATE CANCER AND
TALKING ABOUT HOW
AFRICAN-AMERICAN MEN ARE MORE
LIKELY TO GET PROSTATE CANCER
AND DEVICE AS LIKELY TO DIE
THAN OTHERS.
AND HE ASK --
[INDISCERNIBLE]
AND I WANTED TO ASK THAT A
LITTLE BIT BECAUSE I THINK IT
BRINGS TO MIND RACE BLINDNESS
VERSUS RACE CONSCIOUSNESS IN
ADDRESSING HEALTH DISPARITIES.
SO I WOULD LIKE TO HEAR FROM
ALL OF THE PANEL ON THIS ONE
AND I DON'T KNOW IF ALL OF YOU
HAVE THOUGHTS BUT WHOEVER
WOULD LIKE TO GO FIRST.
>> I COULD START.
SO THIS WAS ACTUALLY BROUGHT
UP AT MY LAST INSTITUTION AT
YALE BECAUSE WE WERE TRYING TO
THINK ABOUT HOW TO INCORPORATE
SOME GUIDELINES ON HOW TO
HANDLE SCREENING FOR PROSTATE
CANCER AND WE WERE TAKING INTO
ACCOUNT A NUMBER OF DIFFERENT
ISSUES WITH THIS.
SO FIRST, WE KNOW THAT, YES,
PROSTATE CANCER IS PREVALENT
IN BLACK MEN, TENDS TO BE MORE
AGGRESSIVE, COULD BE THAT
BLACK MEN ARE MORE LIKELY TO
DIE OF PROSTATE CANCER AND AS
WE KNOW AT THIS POINT THERE
ARE DIFFERENT GUIDELINES FROM
THE CANCER NETWORK, THE
NEUROLOGICAL ASSOCIATION ABOUT
HOW TO DEVELOP SCREENING FOR
PROSTATE CANCER AND ALSO WHAT
DO -- WHERE IS THAT, OH, Dr.
WHITE'S COMMENT ABOUT HOW WE
HANDLE KIND OF ASSIGNED RACE
OR SELF-IDENTIFIED RACE.
SO WHAT DO WE DO IN THE
CREDITS?
ARE WE GOING TO RACIALLY
PROFILE OUR PATIENTS AND SAY
SO, YOU SEEM LIKE A BLACK MAN
TO ME, I WANT TO TALK TO YOU
ABOUT PROSTATE CANCER SO IT
BECOMES A TRICKY THING ON HOW
WE OPERATE.
SO THERE IS THE DATA AND WHAT
IT TELLS US AND WHAT WE KNOW
AND THEN WHAT DOES IT MOAN.
MEAN.
ON THE ONE HAND DO WE KNOW
THERE IS A GENETIC DRIVER OF
PROSTATE CANCER IN BLACK MEN
THAT IS MAKING IT MORE
AGGRESSIVE?
NO, I DON'T ACTUALLY BELIEVE
THAT.
YOU CAN LOOK AT STUDIES OF
PROSTATE CANCER IN VARIOUS
COUNTRIES, MORE OFTEN IN WEST
AFRICA AND THEY FIND THAT
THERE IS NO PREVALENCE OF
PROSTATE CANCER THERE.
SO THERE IS NO RACIST DRIVER,
SO THAT LEADS US TO ASK WHAT
IS IT THAT IS GOING ON IN OUR
CULTURE, OUR ENVIRONMENT, OUR
STRUCTURE, WHAT ARE THE
POLICIES THAT ARE MAKING IT SO
LETHAL AND DANGEROUS FOR BLACK
MEN HERE.
AND THE ONE THING WE WERE
DECIDING ABOUT HOW TO
OPERATIONALIZE IT IS TO SAY IF
SOMEBODY IDENTIFIES A CERTAIN
WAY, SOMEBODY COMES IN, TO BE
ABLE TO SAY HEY, WE OFFER
SCREENING AT THIS AGE BUT IT
IS UP TO YOU.
YOU CAN DECIDE.
HERE IS WHAT WE KNOW, HERE IS
THE DATA AND YOU CAN MAKE A
DECISION ON HOW YOU WANT TO
HANDLE THIS FOR YOUR
HEALTHCARE KNOWING THE RISKS
ARE WHAT THEY ARE AND IT CAN
BE PARTICULARLY DANGEROUS FOR
BLACK MEN.
BUT IT IS A REALLY CHALLENGING
THING AND AN UNFORTUNATE
REALITY WE'RE CONFRONTING.
>> Dr. HAMMONDS, I THINK YOU
MIGHT LIKE TO COMMENT ON THIS
QUESTION BUT WE GOT A REQUEST
TO RESTRAIGHT THE QUESTION.
THERE WAS A FDA E-MAIL ON
PROSTATE SCREENING AND IT
CITED AFRICAN-AMERICAN MEN
WERE MORE THAN TWICE AS
LIKELY TO DEVELOP PROSTATE
CANCER AND TO DIE FROM THE
DISEASE.
SO I ASK YOU ABOUT BEING
RACE-BLIND AS' AS OPPOSED TO
RACE FOCUSSED.
>> I THINK YOU CAN LOOK AT IT
IN MORE THAN ONE WAY AND THE
FOCUS OF MAKING IT DIFFERENT
FOR BLACK MEN AS OPPOSED TO
WHITE MEN OF THE WORLD SO THE
DIFFERENCE IS NOT THE DATA ON
THE GROUND WITH REFERENCE TO
MORBIDITY AND MORTALITY.
WE'RE NOT GETTING TO THE
CAUSES OF HOW WE'RE GETTING TO
MORBIDITY AND MORTALITY BY
FOCUSING ON THE DISEASE WITH A
CERTAIN RACE.
SO IT GOES BACK TO WHAT
EVERYBODY TRIED TO CONVEY THAT
IT IS DEFINITELY MORE NUANCE.
I WISH WE COULD HAVE A
REACTION TO THESE REPORTS TO
SHUT IT DOWN.
I DO A LOT OF TALKING WITH
SCIENCE JOURNALISTS TO GET
THEM TO DO JUST THIS, TO STOP
THE OVER ARCHING RACE
DIFFERENCE COMPARISON NATIVE
AND ACTUALLY LISTEN TO WHAT
THE PEOPLE WHO ARE DOING THE
WORK TELL US ABOUT WHAT MAKES
THIS DIFFERENCE SO
SIGNIFICANT.
I MEAN, MY FIRST THOUGHT IS IT
HAS A LOT MORE TO DO WITH WHAT
WE KNOW, THE SOCIAL
DETERMINANTS OF HEALTH, ACCESS
TO HEALTHCARE, HEALTH-SEEKING
BEHAVIORS AND REMEMBER, IT IS
NOT ALL MEN BUT WE KNOW MEN GO
TO THE DOCTOR LESS THAN WOMEN
DO SO THESE TYPES OF REPORTS
NEVER MENTION ANYTHING ELSE,
THEY ONLY TELL US THAT ONE
STORY AND THIS IS A GOOD
EXAMPLE OF FOCUSING ON THE
THING THAT MAKES THEM
DIFFERENT.
>> ANY OTHERS?
>> SORRY, I WAS APPLAUDING
Dr. HAMMONDS.
HERE, HERE!
[LAUGHTER]
>> I HAVE A QUESTION FOR OUR
PANELISTS.
YOU KNOW I HAVE BEEN STUDYING
THE SOCIAL DETERMINANTS FOR
OVER 20 YEARS AND WHEN I
STARTED MY CAREER, I THINK
MOST PEOPLE THOUGHT I LOST MY
MINE THAT I WANTED TO STUDY
THE SOCIAL DETERMINANTS OF
HEALTH.
I AM A SOCIAL SIGNIVITY AND
THIS IS ONE THEME I AM HEARING
ACROSS PANELISTS WAS REALLY
THE ROLE OF SOCIAL
DETERMINISM.
ERIKA WHEN YOU WERE TALKING
ABOUT THE REPRESENTATIVES,
CONSTRUCTS AND RESOURCES, I
GUESS MY QUESTION IS WHERE DO
WE GO FROM HERE IN TERMS OF
HEALTH RESEARCH, HEALTH
OUTCOMES AND REALLY THINKING
ABOUT HOW WE MEASURE SOCIAL
DETERMINANTS OF HEALTH ACROSS
ALL OF OUR STUDIES.
AND IT CAN BE MENTAL HEALTH,
HOW SOCIAL DETERMINANTS AFFECT
MENTAL HEALTH TO
CARDIOVASCULAR DISEASE AND I
THINK SOCIAL DETERMINANTS ARE
STARTING TO SEE RESULTS WE
HAVE NOT SEEN IN THE PAST.
SO HO DO WE START THAT AND GET
ALL OF OUR HEALTH RESEARCH TO
THINK ABOUT SOCIAL
DETERMINANTS OF HEALTH SO THAT
IT IS NOT JUST OH, IT IS A
BLOOD TEST BUT HOW DO WE GO
FORWARD?
>> THAT IS A REALLY GOOD
QUESTION.
>> I THINK SOMETIMES THERE IS
MORE FOCUS ON THE DATA FOR
OTHER PURPOSES BUT THE DATA
CAN BE VERY SCALED FOR HEALTH
PROPERLY AND IF YOU LOOK A LOT
ABOUT PUBLIC HEALTH
SURVEILLANCE AND MONITORING
SYSTEMS, JUST EVEN THE
COLLECTION OF RACISM DATA IS
NOT COMPLETE AND
COMPREHENSIVE.
SO TO EVEN THINK ABOUT THESE
DEMOGRAPHIC CHARACTERISTICS OF
PEOPLE AND TO THINK ABOUT THE
COLLECTIVE AND THEN STRUCTURAL
DETERMINANTS OF HEALTH, WE'RE
NOT THERE YET.
AND SO I THINK THERE NEEDS TO
BE A GREATER PART FOR
COLLECTING DATA IN THE HEALTH
DATA AND MONITORING SYSTEM
THAT TACKLE THE STRUCTURAL
DETERMINANTS.
>> YOU WANT TO COMMENT ON
THAT?
>> YES, I COMPLETELY AGREE,
COULDN'T AGREE WITH THAT MORE.
WE HAVE TWO EXAMPLES OF WHAT
DO WE DO.
I HAVE BEEN ADVOCATING WHEN WE
PRESENT DATA, TALK ABOUT DATA,
TO DO IT INTERSECTIONALLY.
NEVER WITH RESPECT TO RACE
ALONE BUT OTHER FACTORS AS
WELL WHICH THEN COMPLICATED
AND COLLECT GUYS THIS STORY OF
HEALTH INEQUALITY AND HEALTH
SHORTFALLS, RIGHT?
AND TRANSLATING THAT
CONNECTIVITY TO THE PUBLIC IS
IMPORTANT AS THERE ARE PEOPLE
WHO SPECIALIZE IN THAT BUT WE
NEED TO DO IT BECAUSE IT TELLS
A VERY NEEDED STORY.
AND I WILL TELL A QUICK STORY
IN 2022 WHEN I WAS INTERVIEWED
ABOUT A NEW TREATMENT FOR
APOL1 KIDNEY DISEASE, AND
Dr. CERDENA, I WAS
ENTHRALLED WITH YOUR TALK AND
WHAT I WANT TO ZERO IN ON
HERE, WITH THE HEALTH
JOURNALIST I WON'T NAME, I
SAID IT IS NOT ABOUT RACE
FACTORS BUT RACISM.
AND HE HAD NO IDEA AND SAID
HUH, WHAT?
SO THAT LED TO ANOTHER TEN
MINUTES OF WHAT WAS A BRIEF
INTERVIEW AND BY THE WAY, THAT
DID NOT MAKE IT INTO THE QUOTE
IN NEW YORK TIMES AND ENDED UP
BEING SOMETHING ABOUT THE
SOCIAL DETERMINANTS AEFFECTING
HEALTH SO WE NEED TO BE ABLE
TO TRANSLATE THE STORIES SO
THE PUBLIC UNDERSTANDS ARE AND
ONE OF THE WAYS TO DO THAT IS
NEVER TO USE THE UNDERPINNING
OF HEALTH AND ETHNICITY ALONE.
IT JUST TELLS THE WRONG STORY
AND IS A DANGEROUS STORY.
>> I WILL ADD TO THAT, WE
ALWAYS SAY WHAT DO YOU DO, BUT
RATHER HOW DO WE DEVOICE THIS.
WE STARTED OFF TALKING
ABOUT --
[INDISCERNIBLE]
AND HE COLLECTED ALL KIND OF
DATA BECAUSE THE DISTRIBUTION
OF DATA AT THAT TIME WAS
TERRIBLE.
IT IS BETTER NOW BUT STILL
SERIOUSLY FAR FROM
PROBLEMATIC.
SO HE WAS COLLECTING THE DATA
AND HE HAD HOW BLACK MEN
DIFFER IN TERMS OF DISEASE
THAN THE WHITE MEN AND ASKED
ME AT THE BEGINNING AND THAT
IS THE KIND OF THINKING THAT
IS ABSOLUTELY CRITICAL TO HOW
WE GO ABOUT THIS WORK.
AND I COMPLETELY AGREE, WE
CAN'T HAVE STORY AFTER STORY
THAT FOCUSES ON THESE
DIFFERENCES AND HELP THE
GENERAL PUBLIC WITH HOW THEY
THINK ABOUT RACISM IN THAT
CONTEXT SO I ALWAYS ASK THE
QUESTION IF IT IS ABOUT RACE.
>> MY RESPONSE MAY BE A LITTLE
CONTRARIAN BUT I AM ALWAYS
LIKE I THINK WE HAVE A LOT OF
DATA AND I THINK I KNOW THAT,
YOU KNOW THERE ARE A LOT OF
FOLKS WHO LOOK LIKE ME, TALK
LIKE ME, WHO I HANG OUT WITH
WHO, YOU KNOW, COME FROM OUR
NEIGHBORHOODS WHO ARE SICKER,
HAVE SUFFERED MORE AND I
KNOW --
[ GARBLED ]
AND I CAN TELL YOU THE REASONS
WHY.
I WANT TO KNOW IT WILL WORK ON
A SYSTEM LEVEL FOR HEALTH AND
THAT IS WHERE WE WANT TO GO.
IS IT CANCERS, MAKING
DETERMINATIVE THE CHILD TAX
CREDIT.
THESE ARE THE THINGS I FEEL
REALLY PASSIONATE ABOUT IN
TERMS OF USING HEALTH POLICY
TO BE ABLE TO LEVEL THE
PLAYING FIELD AND KIND OF
ERADICATE SOME OF THE
STRUCTURAL INEQUALITY THAT WE
KNOW ARE MAKING SOME OF THESE
HEALTH DISPARITIES.
AND IN TERMS OF THE DATA THAT
I WANT TO SEE, THE DATA THAT I
WANT TO SEE ARE MEASURING
IMPACTS OF SOME OF THESE
POLICIES AT LARGER SCALE TO BE
ABLE TO SEE SOME OF THESE
HEALTH DISPARITIES GO AWAY.
[ OFF MICROPHONE ]
>> WE NEED SOMEBODY TO COME TO
THE MICROPHONE FOR A QUESTION.
BEAR WITH US.
SO MY APOLOGIES.
HOPEFULLY YOU GUYS CAN HEAR ME
AND MY QUESTION IS NOT WELL
FORMED JUST YET BUT FIRST I
WANT TO AMPLIFY Dr. HAMMONDS
AND BLACKSHER FOR NOT ONLY
TALKING ABOUT THE SOCIAL
DETERMINANTS OF HEALTH AND
ANALYSIS.
I AM A CLINICAL PSYCHOLOGIST
BY TRAINING AND KNOW THE
IMPORTANCE OF BEING ABLE TO
PLAY THE TAPE ALL THE WAY
THROUGH SO WHEN I THINK FOR
EXAMPLE OF AMPLIFYING OR
CREATING THIS IDEA THAT
WHITENESS IS THE SORT OF
BEAUTY STANDARD FOR ALL
THINGS, SO WHEN YOU THINK
ABOUT WOMEN OF COLOR AND SOME
OF THE THINGS THEY ARE EXPOSED
TO IN SELLERS -- IN TERMS OF
ENVIRONMENT, LIKE HAIR
PRODUCTS, WHAT IS IN THE
PRODUCTS WE USE OVER A
LIFETIME AND TALKING ABOUT
CHEMICALS THAT CAN BE ADVERSE
TO THEIR HEALTH.
WHEN THOSE WOMEN GET TO BE
ADULTS AND SEEING MORBIDITIES
IN THESE WOMEN, WE NEED TO
START THINKING ABOUT HOW TO
PACKAGE OR CHANGE THESE
PRODUCTS FOR THE BETTER PART
OF THE COMMUNITY.
SO THE IMPORTANCE OF TALKING
TO REPORTERS ABOUT RESEARCH
AND HOW TO GO ABOUT TALKING
ABOUT DATA SO THEY ARE
INFORMED OF THE HEALTH IMPACT
WITH THE PUBLIC, THOSE HEALTH
NARRATIVES THAT CAN KEEP
PEOPLE FROM MAKING INFORMED
DECISIONS ABOUT THEIR BODY AND
THE FOOD THEY ARE PITCHING
WHEN PURCHASING WHEN THEY GO
TO THE GROCERY STORE AND THESE
THINGS.
SORRY, BIG REQUEST BIG
QUESTION BUT...
[LAUGHTER]
[INAUDIBLE] -- BUT I THINK THE
OTHER PART OF IT IS IT REALLY
HAS TO DO WITH AGAIN HOW EASY
IT IS TO FRAME THESE QUESTIONS
FOR WHAT WE REALLY WANT TO
UNDERSTAND.
YEARS AGO I GOT A JOURNALIST
WHO SAID SOMEONE WAS GOING TO
PRODUCE A PRODUCT WHERE THEY
WERE GOING TO TRY TO FIGURE
OUT WHY BLACK PEOPLE DIDN'T
LIKE FRESH FRUIT AND I SAID
EXCUSE ME?
AND I SAID WHY DO YOU THINK
BLACK PEOPLE DON'T LIKE FRESH
FRUIT AND THEY SAID THE DATA
SAYS THE AMOUNT OF MONEY THAT
BLACK PEOPLE SPEND IN THIS
AREA OF FRESH FRUIT AND I AM
LIKE HAVE YOU EVER BEEN TO
THAT NEIGHBORHOOD?
HAVE YOU EVER SEENOF THE
"FRESH FRUIT" IN THE SMALL
CORNER STORE THAT PEOPLE HAVE
TO RELY ON BECAUSE THERE IS IN
BIG BOX GROCERY STORE IN THAT
NEIGHBORHOOD?
I MEAN IF I HAD TO RELY ON
THAT, I WOULDN'T EAT FRUIT
EITHER BUT IT HAS NOTHING TO
DO WITH ATTRIBUTING IT TO SOME
CULTURAL PRACTICE BY WHITE
PEOPLE.
AND IT IS THAT KIND OF FLIP
THAT CONTINUES TO HAPPEN THAT
WE HAVE TO BE MINDFUL OF.
THE OTHER POINT IS ONE
SCIENTIST SAYS A LITTLE BIT OR
SAYS A LOT AND THEN THEY
FILTER AND CUT AND PASTE AND
THERE ARE MANY INSTANCES LIKE
THE MAIN POINTS YOU WANT TO
MAKE DOESN'T GET TO BE THE
POINT THAT IS GOING TO BE
AMPLIFIED AND ON THEIR PART,
THE SCIENCE JOURNALISTS SAY
SCIENTIFIC RESEARCHERS TEND TO
BE THE --
[INDISCERNIBLE]
SO I THINK IT FALLS ON BOTH
SIDES BUT I THINK THERE NEEDS
TO BE MORE DIVERSITY OF
SCIENCE JOURNALISTS WHO CAN
THINK ABOUT THE DATA AND THE
CONVERSATION.
SO THERE NEEDS TO BE AN
ONGOING CONVERSATION ABOUT
THESE ISSUES AND SOMETHING I
MENTIONED EARLIER ABOUT WHAT
WE DO, WE REALLY HAVE TO
EDUCATE MORE BIOMEDICAL SOCIAL
SCIENCE RESEARCHERS AND THE
FACT THAT WE KNOW HOW TO DO
THIS WORK BETTER BUT IF WE
AREN'T EDUCATING THIS
GENERATION ON HOW TO DO THIS
BETTER, WE WILL SEE MORE
FLAWED STUDIES ON RACE-RELATED
DIFFERENCES AND TO THE POINT
OF SPEAKING TO THE QUESTIONER,
WE WON'T GET RELIABLE
INFORMATION THAT WILL BE
AVAILABLE TO THE PUBLIC WHEN A
SPECIFIC POPULATION FOR
EXAMPLE MIGHT BE AT RISK.
SO AT THIS POINT, LIKE THE
POPULATION USING PARTICULAR
HAIR PRODUCTS, THEY NEED TO
KNOW AND CONSUMER PROTECTION,
NEEDS TO KNOW.
BUT IF WE CAN'T THINK OUT OF
THE BOX ABOUT --
[INDISCERNIBLE]
I AM AFRAID WE ARE GOING TO BE
STUCK TRYING TO DEALING WITH
THESE STORIES FOR A LONG TIME.
[ OFF MICROPHONE ]
>> MY QUESTION IS WHEN YOU ARE
WORKING WITH PREVIOUSLY
COLLECTED DATA OR PARTICULARLY
WHEN YOU ARE DOING SOMETHING
LIKE A LITERATURE REVIEW WHERE
ERR-- YOU ARE AGGRAVATING
OTHER PEOPLE'S RESEARCH AND
THEY ARE DOING THEIR RESEARCH
THIS WAY, RACIST MIND-SET OF
GENETIC DIFFERENCES, HOW DO
YOU BREAK THE CHAIN AND STOP
THE FODDER OF WHITE
SUPREMACISTS BECAUSE THAT IS
SOMETHING I REALLY WANT TO
START DOING.
>> I THINK Dr. HAMMONDS SAID
EARLIER --
[INDISCERNIBLE]
[LAUGHTER]
ESPECIALLY WHEN RACE IS THROWN
IN AS A COVARIANT, I LIKE TO
ASK WHAT IS THE HYPOTHESIS YOU
ARE TRYING TO TEST TO?
NO, REALLY TELL ME, WHAT IS
THE RELATIONSHIP THAT YOU
BELIEVE UNDERPINS THESE
VARIABLES?
AND IF YOUR COLLEAGUE OR YOUR
PI OR YOUR COLLABORATOR CAN'T
ANSWER THAT, THEN I THINK THAT
IS GOOD FOR YOU TO PUSH BACK
AND THEN YOU SAY WELL, I AM
NOT SURE THIS IS THE BEST WAY
FOR US TO ANALYZE OUR DATA.
AND IF IT IS A LITERATURE
REVIEW, THEN YOU ONLY HAVE THE
ABILITY TO SAY, YOU KNOW, LIKE
THIS PERSON DEFINES THIS IN
THIS WAY, QUOTE CLOSED, AND
THEN SAY MOVING FORWARD, WE
WILL DEFINE IN THIS WAY, QUOTE
CLOSED.
[LAUGHTER]
>> COME ON UP.
>> THANK YOU SO MUCH FOR YOUR
WONDERFUL TALK.
I WOULD LIKE TO HEAR A BIT
ABOUT INTERSECTIONALITY..
[INDISCERNIBLE]
IT SOUNDS GOOD BUT WE ARE KIND
OF ADDING ONE GROUP TO RACE SO
IT GIVES THE APPEARANCE THAT
WE ARE DIGGING DEEPER BUT AT
THE SAME TIME WE MIGHT BE
DOING SOME SUPERFICIAL
TREATMENT AGAIN AT THAT LEVEL.
THAT IS ONE QUESTION.
AND THEN THE NEXT QUESTION,
THE ROLES WE ADDED TO THE
INTERSECTIONAL GROUP TO THE
PROTOTYPICAL GROUPS AND HOW WE
THOUGHT IT WAS GOING BUT GUESS
WHAT, WAS DIFFERENT FOR THOSE
INDIVIDUALS.
SO AT SOME POINT --
[INDISCERNIBLE]
AND THINKING ABOUT THERE ARE
SOME STRUCTURAL DIFFERENCES WE
WANT TO MENTION THAT ARE NOT
TANGIBLE.
SO HOW DO WE COMMENT?
LIKE I DON'T THINK THE ANSWER
IS HAVING MORE DATA AND THEN
JUST GOING TO THAT INDIVIDUAL
AND BECAUSE THAT INDIVIDUAL
THEMSELVES DO NOT INVOLVE
ANYTHING HAPPENING IN THE
ABSTRACT.
SO TRYING TO UNDERSTAND HOW
THE --
[INDISCERNIBLE]
AND I KNOW THIS IS ANOTHER BIG
QUESTION, SORRY.
>> THIS IS ERIKA.
BEING A COLLEAGUE, I WILL DARE
TO GO FIRST IN HOPES THAT YOU
ALL WILL FOLLOW.
ENTEKO AND EVERYONE, I WILL
TACKLE YOUR FIRST QUESTION BUT
NOT YOUR SECOND IN HOPES MY
PANELIST COLLEAGUES ADDRESS
THE SECOND.
THE TWO SLIDES THAT I SHOWED
YOU ABOUT THIS THREE-PART
FRAMEWORK I STARTED USING TO
TALK ABOUT THE SOCIAL
DETERMINANTS OF HEALTH,
WHOEVER COMMENTED THAT THAT
FRAMEWORK WAS A GOOD SOCIAL
DETERMINANT OF HEALTH,
ABSOLUTELY.
I HAVE BEEN TRYING TO ORGANIZE
THIS EVER-GROWING LIST OF
FACTORS AND VARIABLES AND
RESOURCES AND REPRESENTATIVES
ARE A GOOD WAY TO THINK ABOUT
THE SOCIAL DETERMINANTS OF
HEALTH BUT ALSO EMBEDDING THAT
IN THE LANGUAGE OF ETHICS,
RIGHT?
SO IT IS NOT JUST THINGS OUT
THERE, THESE ARE THINGS THAT
WE CAN MAKE MORAL JUDGMENTS
ABOUT THAT ARE WRONG.
SO IT GOES,ENTIKA, IF IT ADDS
SOME FORM OF POVERTY, ENTER
GENERATIONAL OR CONCENTRATED,
ISN'T THAT JUST ADDING ANOTHER
THING?
AND WHAT I WOULD GUESS, THIS
IS A LONG HAUL PROJECT.
MAYBE THE PROXIES THEMSELVES
ARE USEFUL BECAUSE IT IS HOW
WE COLLECT DATA AND MAYBE WE
NEED TO START COLLECTING DATA
DIFFERENTLY BUT WE NEED TO
START COLLECTING DATA ON THE
THING WE THINK IS WRONG, THE
THING WE CARE ABOUT, RIGHT,
RACISM, EARLY POVERTY,
STRUCTURAL SEXISM,
HETEROSEXISM SO WHAT I WOULD
SAY TO YOUR QUESTION IS, IS IT
ALSO A MISTAKE TO BRING IN
EDUCATION?
WHAT IS EDUCATION, WHY DOES
SOMEONE NOT HAVE A HIGH SCHOOL
DEGREE, BECAUSE THEY DECIDED
TO ONE DAY DROP OUT?
I DOUBT IT.
EITHER THEY ARE BEING PULLED
OUT BY WORK OR PUSHED OUT BY
OTHER NEEDS.
SO WHAT I WOULD SAY TO THAT
QUESTION IS WE NEED TO FIGURE
OUT HOW TO BEGIN MEASURING THE
THINGS WE'RE COLLECTIVELY
CONCERNED ABOUT THAT ARE WRONG
SO THAT IS THE EMPHASIS TO THE
SYSTEM.
AND THEN YOUR SECOND QUESTION
ABOUT THE MORE WE ADD DATA AND
COMPLEXITY PRETTY SOON WE'RE
AT THE LEVEL OF INDIVIDUAL,
THAT IS A REALLY TOUGH
QUESTION AND I WAS HOPING YOU
WOULD FIGURE OUT THE ANSWER TO
THAT ONE.
[LAUGHTER]
>> DOES ANYONE TO WANT TACKLE
THAT QUESTION, TOO?
>> I THINK IT IS AN IMPORTANT
QUESTION BUT I DO WORRY IN THE
CURRENT CONTEXT OR CURRENT
WAYS IN WHICH WE ARE
UNTANGLING THE PROBLEMATIC WAY
WE USE RACE, THE INTRODUCTION
OF TIME TO CORRELATE WHAT
DIFFERENCES AND DISPARITIES
THAT ARE PRODUCED BY RACISM
AND STILL IN THE MIDDLE OF
THAT ONE AS WELL, COMING DOWN
ALL THE WAY TO THE INDIVIDUAL
AT THIS POINT, IT SEEMS TO ME
MORE PROBLEMATIC THAN WE'RE
WILLING TO COME TO GRIPS WITH
RIGHT NOW.
I THINK THERE'S A GOOD AMOUNT
OF SENTIMENTS ON HYPERBOLE, IF
YOU WILL, ABOUT THE
POSSIBILITIES OF PERSONALIZED
MEDICINE, PERSONALIZED HEALTH
BUT THAT WILL NEVER BE THE
VOICE OF HOW WE THINK OF A
PERSON IN A CERTAIN WAY.
[INDISCERNIBLE]
AND PEOPLE CAN'T BE EASILY
CHARACTERIZED WITHOUT A
DISCUSSION THERE SO I FEEL AN
INTERSECTIONAL ANALYSIS GETS
US STARTED WHEN LOOKING AT
POPULATIONS BUT COMING DOWN TO
THE INDIVIDUAL IS GOING TO ASK
SOMETHING DIFFERENT AND MAYBE
THAT IS WHAT MY DESIRE WOULD
BE, IS TO USE THAT GREATER
EQUITY THAT EVERY INDIVIDUAL
IS CHEATED WITH SOME KIND OF
EQUITY IN WHATEVER SYSTEM WE
CONSIDER TO HAVE.
SO WITHOUT THAT, WITHOUT THAT
EQUITABLE SYSTEM, I DON'T
KNOW --
[INDISCERNIBLE]
>> I WANTED TO ASK IN TERMS OF
DATA, WE'RE NOT DOING A GOOD
JOB OF MEASURING STRUCTURAL
RACISM.
I MEAN, WE DEFINITELY ARE
TALKING ABOUT IT AND THERE IS
A LOT OF LITERATURE BUT I
THINK IT IS NOT ONLY THE
COLLECTION OF DATA, IT IS HOW
WE HANDLE THE COLLECTION AND
WHAT WE DO WITH THAT DATA AND
PART OF IT IS FOR THE WHOLE
SYSTEM, HEALTHCARE SYSTEM, OUR
GOVERNMENT OFFICIALS ARE
ACCOUNTABLE AND I THINK WE
HAVE TO BE MORE CREATIVE IN
HOW WE USE THE DATA TO HOLD
PEOPLE ACCOUNTABLE.
BUT ALSO TO SERVE AS AN
EVIDENCE BASE FOR POLICIES
THAT COULD HELP MAKE CHANGES,
TANGIBLE CHANGES IN PEOPLE'S
LIVES.
>> WE HAVE ONE QUESTION, YES,
COME ON DOWN.
LAUGH
>> OKAY, CAN YOU HEAR ME?
SO MY QUESTION COMES ON THAT
LAST POINT A LITTLE BIT,
KNOWING THERE ARE PEOPLE IN
THE FIELD LIKE HEALTHCARE
RESEARCH AND POLITICS WERE
TANGIBLE THINGS COULD BE MADE,
SOME PEOPLE WILL LIKE SEE THE
EVIDENCE AND THEN WON'T
BELIEVE IT, USUALLY THE PEOPLE
WHO BENEFIT FROM OPPRESSION SO
I WAS WONDERING HOW WE SHOULD
APPROACH GETTING THOSE PEOPLE
TO CHANGE THEIR LIVES OR
GETTING THEM OUT OF THE FIELD
SO WE CAN THEN --
[INDISCERNIBLE]
[LAUGHTER]
>> WHO WANTS TO TACKLE THAT
ONE?
[LAUGHTER]
>> IT IS NOT EASY.
I WAS GOING TO SAY TAKE A
MULTIPRONGED APPROACH.
YOU HAVE TO THINK ABOUT VOTING
AS A CERTAINLY DETERMINANT OR
ONE COMPONENT ABOUT HOW WE
THINK OF STRUCTURAL RACISM AND
THE RIGHTS OF THE MANY PEOPLE
IN THE COMMUNITY ARE AT RISK.
THERE WAS SOMETHING ELSE I
WANTED TO MENTION BUT I CANNOT
REMEMBER --
[INDISCERNIBLE]
>> I WANT TO INTERRUPT AND I
THINK IF I JUMP IN AND IT JOGS
YOUR MEMORY, FEEL FREE TO
INTERRUPT ME.
I WAS ALSO GOING TO SAY WE CAN
THINK ABOUT AS A STEP-WISE
APPROACH BASED ON GROUPS THAT
HAVE MORE AFIELD.
SO PEOPLE LIKE KIDS, KIDS ARE
COOL SO MAYBE YOUR AVERAGE
ADULT WHO MAKES THAT DECISION,
MAYBE YOUR POLITICIANS WON'T
LIKE THEM BUT LIKE YOUR CUTE
LITTLE 1-YEAR-OLD WHO HASN'T
DONE ANYTHING WRONG ARE LIKE
SURE, WE CAN TAKE POLICIES ON
1-YEAR-OLDS AND HISTORICALLY
THAT HAS BEEN THE CASE.
WE HAVE SIDS, WE HAVE THE TAX
CREDIT AND WE HAVE HAD MORE
SUCCESS IN CREATING POLICIES
THAT BENEFIT KIDS.
YOU KNOW, ALSO THE ELDERLY ARE
GOING TO BE IN A MORE
FAVORABLE GROUP.
THAT IS HOW WE HAVE SOCIAL
SECURITY, HOW WE HAVE MEDICARE
SO THERE ARE CERTAIN GROUPS
THAT, YOU KNOW CAN BE VIEWED
OR CONSTRUCTED AS MORE
FAVORABLE.
AND THEN THERE IS ALSO A WAY
OF THINKING ABOUT OUR RESEARCH
AS, YOU KNOW, OUR INEQUITABLE
ENVIRONMENT, IS IT JUST
UNHEALTHY AND HARMFUL FOR
MINORITY GROUPS OR IS IT ALSO
DAMAGING FOR THE RACIALLY
ADVANTAGED GROUPS?
THESE ARE QUESTIONS WE NEED TO
THINK ABOUT AND ASK BECAUSE
WHEN PEOPLE IN POWER ALSO HAVE
SKIN IN THE GAME AND RECOGNIZE
THESE POLICIES CAN BE HARMFUL
TO ALL, THAT CAN BE INCENTIVE
TO CHANGE THAT.
SO THESE ARE THE QUESTIONS WE
NEED TO CONTINUE TO ASK AND
STUDY AS WE THINK ABOUT, YOU
KNOW, FURTHER IMPLICANTS FOR
POLICY REFORM.
>> I WOULD LIKE TO JUMP IN AND
I REALLY APPRECIATE WHAT YOU
HAVE SAID, THE VALUE IS QUITE
LITERALLY PEOPLE'S SELF
INTEREST AND WHAT I MEAN BY
THAT IN THE VIEW OF PEOPLE'S
HEALTH, TO NOT ONLY THINK
ABOUT THE SOCIAL INEQUITIES,
BY RACE, BY GENDER, BY
POVERTY, AND SO ON BUT THE
OVERALL POPULATION AS A WHOLE
WHO ARE ADVANTAGED BY THEIR
SKIN COLOR, THEIR ECONOMIC
STATUS, THEY LIVE DIFFERENT
LIVES THAN PEOPLE IN OTHER
COUNTRIES AND I AM LEADING A
PROJECT NOW WHERE THAT IS A
HYPOTHESIS THAT WE WILL BE
TESTING WHERE IT DOESN'T MAKE
ANY DIFFERENCE HOW PEOPLE
THINK ABOUT HEALTH, HEALTH
INEQUALITY TO IMPROVE HEALTH
IF YOU FRAME HEALTH INEQUAL
QUALITY WITHIN THE CONTEXT OF
THIS OVERALL HEALTH
DISADVANTAGE THAT AFFECTS
EVERYONE.
BECAUSE AS YOU SAY, WE ALL
HAVE SKIN IN THIS GAME AND I
DON'T KNOW IF THAT WILL WORK
OR IF IT IS TRUE BUT I LIKE
YOU HAVE THAT INFORMATION AND
THINK IT COULD BE A USEFUL
APPROACH.
AGAIN, TO KELLEE'S POINT OF IT
BEING A MULTIPRONGED APPROACH,
WORKING UPSIDE, DOWNSIDE AND
INSIDE, THERE IS A LOT OF WORK
TO DO AND WE NEED SEVERAL
ARMIES ON THIS, RIGHT?
[LAUGHTER]
>> SO I WILL JUMP IN BECAUSE I
HAVE A QUESTION TALKED TO
EARLIER ABOUT TACKLING THE
INDIVIDUAL LEVEL AND I AM
BIASED BECAUSE I WORK IN
PUBLIC HEALTH AND COME FROM A
MORE POPULATION LEVEL APPROACH
OR BACKGROUND BUT I THINK IN
OUR RESEARCH AT NIH WE HAVE
TENDED TO MEASURE THINGS AT A
INDIVIDUAL LEVEL AND SOMETIMES
WE STACK UP THAT INDIVIDUAL
LEVEL CONTEXT INTO THE
POPULATION LEVEL ONE.
SO JUST GOING BACK TO A SAMPLE
OF RACE AND EDUCATIONAL
ATTAINMENT TOGETHER, I WANT TO
PUT FORWARD THE QUESTION OF
WHETHER WE SHOULD BE -- AND WE
HAVE ALREADY ADDRESSED THIS
QUESTION OF INSTEAD OF RACE,
LET'S ADDRESS RACISM, LET'S
MEASURE THE POLICIES THAT ARE
RACIST.
LET'S MEASURE THE
OPPORTUNITIES OR EDUCATION
SYSTEM THAT WE ARE PROVIDING
PEOPLE.
SO HOW DO WE -- YOU KNOW, AT
THE SAME TIME WHEN WE START
MESSAGING THAT AREA LEVEL,
SOME OF THE NUANCE CAN GET
LOST AND WE OFTEN CAN'T GET
DOWN TO A SMALL ENOUGH AREA TO
MEASURE EVERYBODY IN THAT
AREA.
SO HOW DO WE BALANCE AS A
SCIENTIST RESEARCHER TO LOOK
AT POPULATION FACTORS VERSUS
THE INDIVIDUAL LEVEL FACTORS,
SUCH AS THE ENVIRONMENT WHERE
PEOPLE LIVE.
>> ANOTHER SIMPLE AND EASY
QUESTION.
[LAUGHTER]
>> AND MAYBE THERE ISN'T A
SINGLE ANSWER, MAYBE WE JUST
HAVE TO BE BOLD.
>> I THINK IT IS REALLY TRICKY
BECAUSE I THINK IN A WAY IT
DEPENDS ON THE HEALTH OUTCOMES
WE ARE LOOKING AT BECAUSE YOU
KNOW WHEN YOU ARE LOOKING AT
SOMETHING LIKE ACROSS THE
BOARD MORTALITY, THE SCALE,
OFF LITTLE MORE WIGGLE ROOM TO
THINK ABOUT THE SCALE BUT IF
YOU ARE LOOKING AT A VERY
SPECIFIC HEALTH OUTCOME SUCH
AS ASTHMA RATES, YOU WANT TO
GET A LITTLE MORE LOCAL, I
THINK.
BUT I ALSO THINK WHEN WE ARE
TRYING TO THINK MORE
MECHANISTICALLY, THAT IS WHERE
WE WANT TO GET MORE LOCAL AS
WELL BECAUSE IT GETS TO THAT
PART OF INTERVENTION.
AND THEN I ALSO THINK WHEN WE
ASK THESE QUESTIONS OF WHAT
ARE WE STUDYING, WHAT ARE THE
EXPOSURE AND THE OUTCOMES, WE
HAVE TO THINK ABOUT THE
ULTIMATE QUESTION OF WHAT IS
OUR SIGNALING GOING TO BE AND
IS THAT GOING TO BE AT A
MUNICIPAL LEVEL, A STATE
LEVEL, AT THE FEDERAL
GOVERNMENT LEVEL, ON A PRIVATE
CORPORATION LEVEL AND YOU KNOW
THAT CAN SOMETIMES INFORM WHAT
WE'RE TRYING TO ASK, WHAT
WE'RE TRYING TO GET AT BECAUSE
YOU KNOW IF WE'RE THINKING
ABOUT, YOU KNOW A POWER PLANT
OR A SITE WHERE THEY FILL UP
THEIR TRUCKS IN THE WINTER TO
SALT THE ROADS AND IT IS JUST
CONTAMINATING THE STREETS,
LIKE IT IS A VERY LOCAL
PROBLEM AND WE CAN THINK ABOUT
THAT IN TERMS OF HOW WE ASK
THE QUESTIONS, WHERE WE ARE
GETTING THE DATA, WHO WE ARE
GETTING THE DATA FROM AND THE
SPECIFIC HEALTH OUTCOMES WE'RE
LOOKING AT.
SO I THINK WHEN WE'RE ASKING
QUESTIONS OF HOW GRANULAR WE
WANT TO GET IN THE SCALE, YOU
CAN ALSO TARGET IT BASED ON,
OKAY, WHERE DO I ULTIMATELY
WANT TO INTERVENE OR WHAT DO I
THINK IS THE PROBLEM HERE AND
HOW CAN I WORK BACKWARDS, IF
THAT MAKES SENSE.
>> ALL RIGHT, EVERYONE.
>> I THINK THAT POINTS OUT
SOME THINGS THAT -- JESSICA,
YOU SAID SOMETHING THAT REALLY
STRUCK ME.
WHAT OUTCOME ARE WE AFTER?
IN THIS COUNTRY WE HAVE A
INCREDIBLY FRAGMENTED
HEALTHCARE AND PUBLIC HEALTH
SYSTEM.
YOU CAN'T GET THE DATA.
WHEN COVID HAPPENED, THE
REPORTING SITUATION AROUND
DATA WAS MADE VISIBLE TO
EVERYBODY FROM RESEARCHERS TO
THE PUBLIC BUT YOU COULDN'T
GET STATE OR CITY LEVEL DATA
AND THEN PEOPLE, JOURNALISTS
WERE FINDING OTHER WAYS TO DO
IT, SETTING UP THE BUBBLES OF
DATA.
SO WE HAVE TO BE HELPFUL ABOUT
THIS BY SAYING WHAT WE WANT.
WE WANT THE PEOPLE OF THE
UNITED STATES TO HAVE BETTER
HEALTH, PERIOD.
THAT IS WHAT WE WANT.
AND WE WANT TO USE EVERY TOOL
THAT WE HAVE TO GET THERE.
I THINK SOMETIMES WE SPIN OUR
WHEELS TRYING TO GET AT THE
DEFINED GRAIN POINT AND I AM
NOT SAYING THEY ARE
UNIMPORTANT.
MY SCIENCE WHEN I STARTED WAS
PHYSICS AND YOU CAN GET WAY
DOWN IN THE WEEDS ON THAT AND
THEN COME BACK UP AND NOT
UNDERSTAND THE MOST
COMPLICATED PROCESS IN THE
WORLD.
SO I THINK ON HALT, WE NEED TO
BE ON THE SAME PAGE, AND I
THINK MOST OF US ARE, THAT OUR
GOAL IS THE HEALTH OF PEOPLE
AND THE FRAGMENTATION DOES NOT
MEAN THAT PEOPLE GET CARE AT A
LOCAL LEVEL, A REGIONAL LEVEL
BECAUSE OF SOME LONG-STANDING
PRACTICES WE HAVE ENGAGED IN
THAT DON'T THINK OF THE
AMERICAN PEOPLE AS A WHOLE AND
THAT WE WANT TO SEE EVERYTHING
MOVING TOWARDS MAKING US
HEALTHIER PEOPLE.
>> OKAY, THERE WERE A COUPLE
MORE QUESTIONS FROM THE
VIDEOCAST AND I DON'T HAVE
THEM IN FRONT OF ME SO I WILL
PARAPHRASE THEM, IF I CAN.
ONE QUESTION WAS ABOUT WE HAVE
OMB GUIDANCES ON RACE
CATEGORIES, THERE ARE ALSO
SOMETIMES NARROWER GUIDANCES
OR DIFFERENT GUIDANCES THAT
COME FROM DIFFERENT
ORGANIZATIONS SO AS WE'RE
THINKING ABOUT, YOU KNOW, WHEN
WE DO MEASURE RACE, WHAT ARE
THE BEST WAYS TO MEASURE IT
AND, YOU KNOW, HOW DO WE, YOU
KNOW, THINK ABOUT THOSE
GUIDELINES IN WAYS THAT ARE
COMING DOWN FROM FROM OMB AND
NOTING THE GUIDELINES FROM OMB
ARE CHANGING AS WE SPEAK.
>> SO IF WE UNDERSTAND WHAT
PREVIOUSLY WAS IN PLACE, THE
OMB SAID THAT THE CATEGORIES
THAT THEY USE TO COLLECT THE
CENSUS DATA IN THE UNITED
STATES WERE NOT NECESSARILY
THE CATEGORIES THAT SHOULD BE
USED IN BIOMEDICAL RESEARCH.
THAT GETS US INTO THE NEXUS OF
WHAT IS SOCIAL AND WHAT IS
BIOLOGICAL.
AND SO WHAT HAPPENS IS THE
GUIDELINES FROM OTHER FEDERAL
AGENCIES SUGGEST THAT IF YOU
ARE CREATING A POPULATION TO
DO SOME STUDY, THEN YOU HAVE
TO MAKE IT A POPULATION THAT
REPRESENTS THE UNITED STATES
AND THESE ARE THE CATEGORIES
YOU HAVE TO USE BECAUSE THOSE
ARE THE CATEGORIES YOU HAVE TO
REPRESENT THE PEOPLES OF THE
UNITED STATES.
DEEPLY FLAWED CATEGORIES WERE
USED IN ANY KIND OF MEDICAL
RESEARCH.
THAT DIFFERENCE, NO MATTER
WHAT THEY CHANGE THE
CATEGORIES TO, I KNOW BEHIND
THE SCENES IT HAS BEEN TEN
YEARS OF FIERCE DEBATE ABOUT
THIS.
LIKE WE DO GET, FOR EXAMPLE
THE MIDDLE EASTERN CATEGORY.
I DON'T KNOW WHAT THAT IS.
I DO KNOW ABOUT THE HISPANIC
CATEGORIES.
BEFORE THE 1970S, THERE WERE
NO PEOPLE WALKING AROUND TO
SAY THEY WERE HISPANIC BECAUSE
THERE WAS NO CATEGORY CREATED
FOR IT.
SO SAYING YOU ARE ONE THING
BUT IF THERE IS NOT A CATEGORY
FOR THAT, THEN YOU ARE NOT.
SO--
[INDISCERNIBLE]
IS A IS VAST GEOGRAPHY AND THE
DETERMINANTS THAT AFFECT THEIR
HEALTH IS VERY DIFFERENT.
SO THE OMB CATEGORIES, I WOULD
SAY NO MATTER WHAT THEY CHANGE
IT TO NEEDS TO SIT IN A PLACE
THAT REQUIRES INTERROGATION
AND TO DO THE KIND OF WORK,
THAT FOLKS CAN HERE AT THE NIH
DO.
THERE NEEDS TO BE A SEPARATE
SET OF GUIDELINES WITH
GEOPOLITICAL CATEGORIES TO
UNDERSTAND THE --
[INDISCERNIBLE]
OF THE VERY SAME PEOPLE.
>> ANYBODY ELSE WANT TO
COMMENT ON THAT ONE?
[INDISCERNIBLE]
>> AND I THINK WE ARE
APPROACHING THE END OF OUR
TIME TODAY SO I THINK WE CAN
START BY THANKING THE
PANELISTS.
I THINK IT HAS BEEN A
FASCINATING SERIES OF TALKS
AND EXCELLENT DISCUSSIONS.
THANK OUR AUDIENCE IN THE ROOM
AND ONLINE WHO POSED REALLY
INTERESTING QUESTIONS AND I
CERTAINLY THINK THE WAY YOU
THINK AND OTHERS IN THE ROOM
THINK AND THEN I WILL ADD FROM
A PERSONAL NOTE, I AM EXCITED
TO SEE THESE DISCUSSIONS
HAPPENING AT THE NIH AND I
HOPE WE HAVE MORE AS WE NEED
TO MOVE THIS FORWARD AND THEN
FINALLY I WANT TO THANK THE
RACIAL HEALTH DISPARITIES
COMMITTEE AND EVERYONE AS A
WHOLE FOR ALLOWING US TO HAVE
THIS PANEL DISCUSSION.
ANYTHING ELSE YOU WANT TO ADD?
>> A KEY THANK YOU TO ALL OF
OUR SPEAKERS.
THIS IS PROBABLY ONE OF THE
MOST STIMULATING CONVERSATIONS
I HAVE HAD ALONG THIS LINE AND
JUST--
[INDISCERNIBLE]
IT SEEMS LIKE AFTER TODAY WE
STILL HAVE A LOT OF WORK TO DO
BUT WE ARE ALL COMMITTED TO
THAT HARD WORK MOVING FORWARD.
SO REALLY --
[INDISCERNIBLE]
OKAY, THANK YOU ALL.
BYE, SPEAKERS.