>> SO I WANT TO START BY
WELCOMING A NEW MEMBER.
MR. JOSEPH HARRINGTON IS A
SEASONED EXECUTIVE WITH OVER
THREE DECADES OF MANAGEMENT AND
LEADERSHIP.
HE BRINGS WITH HIM A WEALTH OF
KNOWLEDGE AND EXPERIENCE IN
EDUCATION, SOCIAL SERVICES,
PUBLIC HEALTH AND HEALTH CARE.
HE SERVED ON THE BOARD OF THE
COOK COUNTY HEALTH AND IS THE
CO-LEAD OF THE PATIENT COMMUNITY
ADVISORY COMMITTEE OF THE
CHICAGO AREA PATIENT CENTERED
OUTCOMES NETWORK REFERRED TO AS
CAPRICORN.
WELCOME MR. HARRINGTON.
I WILL TURN THE MEETING OVER TO
THE COUNCIL SECRETARY WHO WILL
PROCEED WITH MEETING LOGISTICS.
>> GOOD MORNING AND WELCOME.
I WILL DO A ROLL CALL OF COUNCIL
MEMBERS.
PLEASE RAISE YOUR HAND.
>> DR. ATKINS.
>> HERE.
>> DR. AYALA.
>> DR. BEKEMEIER.
>> HERE.
>> MR. HARRINGTON?
>> PRESENT.
>> DR. STONE.
>> HERE.
>> DR. WANG.
>> HERE.
>> I NOTE THAT LIEUTENANT
COLONEL GARDNER IS JOINING US
VIRTUALLY AND DR. SULLIVAN IS
UNABLE TO ATTEND.
DR. ZENK, WE HAVE A QUORUM FOR
THIS MEETING.
I WILL TURN TO A VOTE OF THE
LAST COUNCIL MEETING.
THEY WERE MADE AVAILABLE ON THE
ELECTRONIC COUNCIL BOOK FOR YOUR
REVIEW.
MAY I HAVE A MOTION TO APPROVE?
>> MOVE TO APPROVE.
>> THANK YOU.
SECOND?
THANK YOU.
ANY DISCUSSION?
ANY OPPOSED?
MOTION CARRIES.
A BIT ON MEETING LOGISTICS.
PLEASE USE THE PUSH TO TALK
FEATURE ON THE MICROPHONE IN
FRONT OF YOU TO ENSURE THAT
EVERYONE CAN HEAR YOU.
ADDITIONALLY, PLEASE TURN AFTER
YOUR MICROPHONE WHEN NOT IN USE.
THIS IS A ONE-DAY MEETING.
AS ALWAYS, A RECORDING OF THIS
MEETING WILL BE AVAILABLE TO THE
ADDRESS SHOWN ON THE SLIDE.
CLOSED SESSION WILL BEGIN
APPROXIMATELY 15 MINUTES
FOLLOWING THE END OF OPEN
SESSION.
DATES FOR FUTURE COUNCIL
MEETINGS ARE LISTED ON THE NINR
COUNCIL WEBPAGE AS WELL AS IN
THE OPEN SESSION MATERIALS IN
THE ELECTRONIC COUNCIL BOOK.
PLEASE ADD THESE DATES TO YOUR
CALENDAR.
>> OUR NEXT MEETING IS SCHEDULED
FOR JANUARY 28, 2025.
THIS WILL BE AN IN-PERSON
MEETING IN BETHESDA.
I WANT TO REMIND COUNCIL MEMBER
S
OTHER THAN EX OFFICIO THAT YOU
ARE SPECIAL GOVERNMENT
EMPLOYEES.
AS SUCH, YOU MAY NOT ENGAGE IN
LOBBYING ACTIVITIES WHILE
RECEIVING PAY FROM THE FEDERAL
GOVERNMENT.
FURTHER INFORMATION REGARDING
CONFLICT OF INTEREST AND
CONFIDENTIALITY REQUIREMENTS ARE
POSTED IN THE ELECTRONIC COUNCIL
BOOK SO PLEASE REVIEW THOSE IF
YOU HAVEN'T DONE SO ALREADY.
I WILL GIVE MORE SPECIFIC
INSTRUCTIONS ABOUT CONFLICT OF
INTEREST CONFIDENTIALITY AT THE
BEGINNING OF THE CLOSED SESSION
LATER THIS AFTERNOON.
NOW I'LL TURN IT BACK TO DR.
ZENK FOR THE NINR DIRECTOR'S
REPORT.
>> THANK YOU, DR. TARLOV.
>> I HAVE HAD A CHANCE TO
REFLECT OVER THE INSTITUTE'S
ACCOMPLISHMENTS OVER THE LAST
YEAR.
I THINK THEY ARE QUITE
IMPRESSIVE.
WE HAVE HAD INCREASED INTEREST
IN OUR FUNDING OPPORTUNITIES AND
INCREASED ENROLLMENT FROM
INDIVIDUALS IN UNDERREPRESENTED
GROUPS IN OUR SUPPORTED SCIENCE.
WE CONTINUE TO MAKE PROGRESS ON
THE GOALS OF OUR STRATEGIC PLAN
AND MORE IMPORTANTLY, ALL OF OUR
ACTIVITIES ARE GUIDED BY OUR
MISSION.
HEALTH EQUITY IS NINR'S NORTH
STAR, THE CORE VALUE THAT
INSPIRES US AND ACTIVATES US.
WE ARE WORKING HARD EVERY DAY TO
ENSURE ALL OF OUR EFFORTS ARE
IMPLEMENTED WITH HEALTH EQUITY
IN MIND.
WE DESIGNED TODAY'S MEETING TO
REINFORCE THIS APPROACH AND TO
START A DISCUSSION ABOUT WHERE
WE'RE GOING NEXT.
I'M GOING TO SPEND A LITTLE BIT
OF TIME WALKING US THROUGH
TODAY'S MEETING SO WE KNOW WHERE
WE ARE HEADED.
AFTER MY UPDATE, DR. GUILAMO
RAMOS IS GOING TO PRESENT THE
UNEQUAL TREATMENT ON DISPARITIES
IN HEALTH CARE.
HE WILL PROVIDE US WITH THE
GENERAL ASSESSMENT OF THE MOST
CHALLENGING ASPECTS.
DR. COURTNEY AKIN WILL PROVIDE
AN OVERVIEW OF NINR'S HEALTH
EQUITY EFFORTS TO DATE, LOOKING
BACK AT OUR ACCOMPLISHMENTS IN
THE LAST SEVERAL YEARS.
SHE WILL PROVIDE SOME INSIGHT
INTO THE UPDATED LANGUAGE WE ARE
USING FOR THE STRATEGY PLAN'S
HEALTH EQUITY LENS, WITH THE
UNEQUAL TREATMENT REPORT IN
MIND.
NINR INVESTIGATOR AND HER
COMMUNITY PARTNER DISCUSSING A
PROJECT THAT ILLUSTRATES OUR
MISSION IN ACTION.
WE'LL BREAK FOR LUNCH AND AFTER
LUNCH WE'LL BEGIN OUR DISCUSSION
ABOUT HOW WE SEE NINR RESPONDING
TO THE ONGOING CHALLENGES WE
FACE IN HEALTH EQUITY,
SPECIFICALLY HOW WE BELIEVE NINR
CAN CONTINUE TO LEAD IN THIS
AREA.
SO FOR THAT DISCUSSION, WE'RE
JOINED BY TWO FANTASTIC NURSE
SCIENTISTS TO SHARE THEIR
PERSPECTIVE.
DOCTOR SHAWN KNEIPP AND DR.
MONICA McLEMORE WILL TALK ABOUT
MEANINGFUL COMMUNITY ENGAGEMENT.
WE BELIEVE STRUCTURAL
INTERVENTIONS AND COMMUNITY
ENGAGEMENT ARE ESSENTIAL
STRATEGIES IN THE PURSUIT OF
HEALTH EQUITY AND BOTH REPRESENT
REALLY IMPORTANT AREAS WHERE
NINR HAS EMERGED AS A LEADER.
SO WE'VE RESERVED 45 MINUTES
THIS AFTERNOON FOR DISCUSSION TO
BE LED BY DR. WANG.
THE GOAL FOR THAT TIME IS TO
HEAR FROM COUNCIL ABOUT THEIR
BIG, BOLD IDEAS FOR ADDRESSING
HEALTH EQUITY AND HOW NINR CAN
CONTINUE TO PLAY A PIVOTAL ROLE
IN THIS AREA OF RESEARCH AS WE
MOVE FORWARD.
SO ONE OF THE KEY MESSAGES OF
THE ENDING UNEQUAL TREATMENT
REPORT IS ACCOUNTABILITY AND
WHAT IT MEANS TO HOLD PEOPLE
ACCOUNTABLE FOR, IF, AND HOW
HERBAL DISPARITIES ARE
ADDRESSED.
AT THE INSTITUTE WE BELIEVE WE
CAN ABSOLUTELY NOT ACCEPT THE
STATUS QUO WHEN IT COMES TO
HEALTH EQUITY OR DISPARITIES.
OUR MISSION AND STRATEGIC PLAN
IS HOW WE WILL BE HELD
ACCOUNTABLE FOR OUR ACTION OR
INACTION IN THE FACE OF THIS
CRISIS.
NURSES, ESPECIALLY, KNOW THE
REALITIES OF HEALTH CARE.
AND HOW THE BROADER CONDITIONS
OF PEOPLE'S LIVES STRONGLY SHAPE
THEIR HEALTH.
IF WE ARE NOT ACTIVELY
CONTRIBUTED TO FAIR AND
EVIDENCE-BASED SOLUTIONS WE ARE
CONTRIBUTING TO THE PROBLEM.
I'M EXCITED TO LAUNCH OUR
CONVERSATION TODAY WHICH WILL
EVENTUALLY HELP TO DEVELOP OUR
FUTURE COLLECTIVE ACTION.
I WILL START WITH UPDATES IN THE
INSTITUTE, SOME OF THE GREAT
THINGS HAPPENING SINCE WE LAST
MET.
SO WE HAVE UPDATES RELATED TO
HOW WE ARE ADVANCING SCIENCE
THROUGH OUR FUNDING
OPPORTUNITIES, SCIENTIFIC
EVENTS, PUBLICATIONS AND OTHER
ACTIVITIES.
SO LET'S GET STARTED.
I'M PLEASED TO START OUT BY
SHARING WITH YOU SOMETHING I
ALLUDED TO A MINUTE AGO, THAT WE
UPDATED THE DESCRIPTIONS OF OUR
FIVE RESEARCH LENSES AND OUR
STRATEGIC PLAN.
TO PROVIDE MORE GUIDANCE TO
INVESTIGATORS.
YOU MAY RECALL THAT THE
STRATEGIC PLAN WAS DEVELOPED AS
A LIVING DOCUMENT, ENABLING THE
INSTITUTE TO STAY RESPONSIVE TO
THE DYNAMIC AND EMERGING HEALTH
ISSUES THAT OUR NATION FACES.
WE BELIEVE THAT THROUGH THIS
ADAPTABLE APPROACH, WE CAN
ASSURE THAT OUR ACTIONS ARE
TIMELY AND THAT THEY'RE
RELEVANT.
THE REVISIONS TO THE LENSES
REFLECT SCIENTIFIC ADVANCEMENT,
CHANGES IN LANGUAGE THAT WE'VE
SEEN SINCE THE PLAN LAUNCHED IN
MAY OF 22, INCLUDING THE NIH
SOCIAL DETERMINANTS OF HEALTH
RESEARCH COORDINATING COMMITTEE
CONCEPTUALATION.
THEY BUILD ON BUT DON'T
FUNDAMENTALLY CHANGE THE
STRATEGIC PLAN.
THEY ARE FOR ADDITIONAL GUIDANCE
FOR INVESTIGATORS TO APPLY NEW
SCIENCE AND TERMINOLOGY.
SINCE TODAY'S THEME IS HEALTH
EQUITY, I WILL START WITH AN
UPDATE ON OUR P.A.R. WE ISSUED
IN 2022 WHEN WE LAUNCHED OUR
STRATEGIC PLAN.
THIS FUNDING OPPORTUNITY, THERE
IS RO1, R21, CALLED FOR GRANT
APPLICATIONS CONSISTENT WITH THE
SCIENTIFIC FRAMEWORK DETAILED IN
OUR STRATEGIC PLAN, WITH A FOCUS
ON OPTIMIZING HEALTH AND
ADVANCING HEALTH EQUITY.
THIS IS A UNIQUE FUNDING
OPPORTUNITY AS IT ALLOWS
INVESTIGATORS TO APPLY FOR NINR
ON ANY TOPIC ALIGNED WITH OUR
STRATEGIC PLAN.
SO WE FUNDED SOME NEW RO1s SINCE
OUR LAST MEETING AND HERE ARE
SOME KPACHLS.
THE FIRST AIMS TO UNDERSTAND HOW
HOMELESSNESS AND ASSOCIATED
TRAUMAS DISPROPORTIONATELY
AFFECT THE HEALTH OF BLACK
WOMEN.
THE SECOND IS EXPLORING HOW TO
INCORPORATE SOCIAL DETERMINANTS
OF HEALTH INTO CHRONIC
MUSCULOSKELETAL PAIN
INTERVENTIONS.
THE THIRD WILL TEST A
COMMUNITY-BASED INTERCONVENIENCE
FOR ANTI-RETROVIRAL THERAPY AND
PREEXPOSURE PROPHYLAXIS AMONG
MALE HIV TESTERS IN TANZANIA.
SO AS YOU CAN SEE UNDER THE PIR,
WE HAVE UPCOMING RECEIPT DATES
IN OCTOBER AND AGAIN IN
FEBRUARY.
HERE ARE EXAMPLES OF R21 FUNDED
SINCE MAY COUNCIL THROUGH THAT
P.A.R.
THE FIRST PROJECT IS SEEKING TO
UNDERSTAND THE FEASIBILITY OF AN
INTERVENTION TO PROVIDE
MEDICALLY TAILORED MEALS TO
PEDIATRIC POPULATIONS
EXPERIENCING SERIOUS ILLNESSES,
IN WHICH INEQUITIES RELATE TO
FOOD AND NUTRITION INSECURITYING
CAN AFFECT SERIOUS ILLNESS
OUTCOMES.
AND THE SECOND IS A PILOT TEST
FOR AN INTERVENTION TO IMPROVE
FINANCIAL AND GLOBAL HEALTH
OUTCOMES FOR ADOLESCENT AND
YOUNG ADULT CANCER SURVIVORS
WITH UNMET HEALTH-RELATED SOCIAL
NEEDS AND FINANCIAL TOXICITY IN
NEW YORK CITY.
SO WE WANT TO CONGRATULATE THESE
AND OTHER RO1 AND R21
RECIPIENTS.
WE ARE DELIGHTED TO SUPPORT YOUR
SCIENCE THAT ADVANCES THE
STRATEGIC PLAN.
SO I WANT TO TELL YOU ABOUT A
NEW RO1, ALSO FUNDED BY OUR NINR
THROUGH OUR FIREARM INJURY
STRATEGIC IMPERATIVE, TO DELIVER
AN ADAPTED VERSION OF SAFE
FIREARM PROGRAM WITHIN FEDERALLY
QUALIFIED CENTERS TO SECURE
FIREARM STORAGE.
THIS IS AN EVIDENCE-BASED
PROGRAM THAT WILL BE MODIFIED
USING FEEDBACK FROM KEY
CONSTITUENTS AND THE COMMUNITY.
COUNCILING WITH PARENTS AND FREE
CABLE LOCKS.
UNDER THE FIREARM STRATEGIC
IMPERATIVE, WE HAVE RELEASED TWO
TRAINING INITIATIVES SO FAR AS
WELL AS A RESEARCH INITIATIVE ON
FIREARM INJURY PREVENTION IN
COMMUNITY HEALTH CARE SETTINGS.
AS YOU MAY RECALL, COUNCIL DID
APPROVE ANOTHER CONCEPT IN
JANUARY ON FURTHER EXPANDING
CAPACITY IN THIS AREA OF
RESEARCH AMONG NURSE SCIENTISTS.
SO ONE OF THE THINGS WE HEAR
CONSISTENCY IS THAT NURSE
RESEARCHERS ARE AWARE OF THE
CRITICAL IMPORTANCE OF
ADDRESSING SOCIAL DETERMINANTS
OF HEALTH IN THEIR WORK, BUT ARE
LOOKING FOR MORE OPPORTUNITIES
TO EXPAND THEIR KNOWLEDGE AND
SKILL SET IN THIS AREA OF
SCIENCE.
SO WE'VE RESPONDED IN SEVERAL
RAYS, INCLUDING NR25, WHICH I
WILL MENTION IN A MINUTE AS WELL
AS SDOH SUMMER INSTITUTE WHICH
WE LAUNCHED THIS SUMMER.
I THINK THE EVENT WAS REALLY AN
UNQUALIFIED SUCCESS.
WENT WE SENT OUT THE REQUEST FOR
LETTERS OF INTEREST AND RECEIVED
OVER 240 RESPONSES.
AND AFTER A REALLY PAINSTAKING
SELECTION PROCESS, WE HAD AN
AMAZING COHORT OF 16 NURSE
SCHOLARS WHO PARTICIPATED.
THIS WAS A DIVERSE GROUP WHO
CAME FROM SCHOOLS ACROSS THE
COUNTRY AND WERE INTERESTED IN
TOPICS RANGING FROM DISPARITIES
AND HEART DISEASE TO MASS
INCARCERATION.
THE FACULTY WHO JOINED THIS
SUMMER GUIDED OUR SCHOLARS
THROUGH RESEARCH DESIGN,
METHODOLOGICAL CON --
CONCEPTIONS.
I WANT TO THANK EVERYONE AND THE
NINR STAFF WHO HELPED TO PLAN
THE EVENT.
WE ARE PLEASED WITH THE FEEDBACK
AND HOPE TO DO MORE OF THESE
EVENTS.
SO I MENTIONED THE R25s, R25 WAS
RELEASED TO SUPPORT SHORT
COURSES AS ANOTHER WAY CAN
EXPAND OPPORTUNITIES FOR SDOH
TRAINING IN THE NURSING SCIENCE
COMMUNITY.
IT IS EXCITING TO REPORT THAT WE
HAVE FUNDED FIVE NEW R25s.
AGAIN, WITH THE GOAL OF
DEVELOPING AND IMPLEMENTS
COURSES FOR UP TO A YEAR FOR
NURSE SCIENTISTS AND SCIENTISTS
WITH ALIGNED INTERESTS TO HELP
PREPARE THEM TO CONDUCT
RIGOROUS, INNOVATIVE
SOLUTIONS-ORIENTED NURSING
RESEARCH TO ADDRESS SOCIAL
DETERMINANTS OF HEALTH AND
SYSTEMATIC MALE DISTRIBUTION ON
HEALTH AND HEALTH EQUITY.
WE HAVE NOW WITH THIS FUNDING
FIVE COURSES IN DEVELOPMENT BY
TEAMS AT YALE, JOHNS HOPKINS,
MICHIGAN STATE, GEORGE
WASHINGTON AND EMORY
UNIVERSITIES.
THESE TEAMS WILL RECRUIT
SCHOLARS BROADLY.
THOSE SCHOOLS MORE BROADLY TO
PARTICIPATE IN THEIR COURSES.
WE HAD A SECOND RECEIPT DATE
THIS SUMMER SO WE WILL SHARE
MORE ON AWARDS AT A FUTURE
COUNCIL MEETING.
I WAS GOING TO PAUSE FOR
DISCUSSION, BUT WE MIGHT BE
RUNNING A FEW MINUTES LATE.
SO I'M GOING TO GET GOING AND SO
WE CAN STICK WITH OUR AGENDA.
SO LET'S MOVE ON TO SOME RECENT
RESEARCH FUNDING OPPORTUNITY
ANNOUNCEMENTS.
NINR ISSUED A NOTICE OF INTENT
TO PUBLISH A FUNDING OPPORTUNITY
ANNOUNCEMENT THAT WILL SUPPORT
RESEARCH THAT ADVANCES HEALTH
EQUITY THROUGH DEVELOPMENT,
TESTING AND EVALUATION OF
INTERVENTIONS THAT PREVENT AND
ADDRESS HOUSING INSTABILITY.
THE ESTIMATED PUBLICATION DATE
IS IN OCTOBER.
BUT WE DO TRY TO ISSUE THESE
NOTICES TO ALLOW POTENTIAL
APPLICANTS MORE TIME TO DEVELOP
COLLABORATIONS AND TO DEVELOP
RESPONSIVE PROJECTS.
IN THIS OPPORTUNITY APPLICATIONS
FOCUS ON SDOA INTERVENTIONS THAT
MODIFY HOUSING OPPORTUNITIES AS
WELL AS INTERVENTIONS THAT
ADDRESS HOUSING INSTABILITY BY
ADDRESSING INTERPERSONAL OR
INDIVIDUAL HOUSING NEEDS.
WE ALSO CONTINUE TO SIGN ON TO
OTHER OPPORTUNITIES WITH OTHER
INSTITUTES AND CENTERS.
IN AREAS, REALLY, THAT ARE
SUPPORTIVE OF OUR STRATEGIC
PLAN.
SO ONE EXAMPLE OF THIS IS A SIGN
ON TO A NO SEED THAT HAS BEEN
REISSUED BY THE ADHERENCE
NETWORK BY NISSR.
THIS ADDRESSES ADHERENCE TO
RECOMMENDED TREATMENT REGIMENS
OR BEHAVIORS TO PROMOTE POSITIVE
HEALTH OUTCOMES.
APPLICATIONS WILL BE ACCEPTED
THROUGH JULY 14 OF 27.
WE'VE ALSO SIGNED ON TO AN
ANNOUNCEMENT WITH NIMHD, NCI AND
OTHERS TO ADVANCE HEALTH CARE
FOR OLDER ADULTS FROM
POPULATIONS THAT EXPERIENCE
HEALTH DISPARITIES.
THIS NISHTSIVE WILL SUPPORT,
RESEARCH, DESIGN TO GET A BETTER
UNDERSTANDING OF APPROPRIATE,
SCREENING, DIAGNOSTIC GUIDELINES
IN A PRIMARY CARE SETTING,
EXPLORE DECISION MAKING THAT IS
NEEDED TO ENHANCE CARE PLANNING
AND PATIENT AGENCY BETWEEN
CLINICIANS AND CARE TEAMS WITH
THE OLDER ADULT AND THEIR
CAREGIVERS AS WELL AS IDENTIFY
EFFECTIVE STRATEGIES FOR CARE
COORDINATION.
THAT FIRST RECEIPT DATE IS
COMING UP IN FEBRUARY.
SO I'M VERY PLEASED TO SHARE
SOME OF THE PUBLICATIONS THAT
HAVE COME OUT FROM NINR
SUPPORTED SCIENTISTS SINCE THE
MAY COUNCIL MEETING.
THESE ARTICLES INCLUDE STUDY
FINDINGS ON TOPICS RANGING FROM
STRUCTURAL RACISM AND RURAL
PRIMARY CARE FOR SUBSTANCE USE
TO COVID-19 OUTCOMES AND RACIAL
BIAS AND PEDIATRIC PAIN
PERCEPTION AS WELL AS A STUDY TO
TEST MACHINE LEARNING MODELS FOR
ASSESSING DISPARITIES IN
PREGNANCY RISK.
I WOULD LIKE TO CONGRATULATE ONE
OF NINR FUNDED INVESTIGATORS AS
A FINALIST FOR THE MITCHELL MAX
AWARD AT THE 19th ANNUAL NIH
PAIN CONSORTIUM ON MAY 30th.
SO THIS IS AWARDED ANNUALLY TO
THE BEST POSTER PRESENTATION AT
THE SYMPOSSYMPOSIUM.
DR. KENDRICK CAMP, AN ASSISTANT
PROFESSOR AT THE UNIVERSITY OF
WASHINGTON SCHOOL OF NURSING WAS
AN AWARDEE FOR A POSTER ON
COMPREHENSIVE INTERVENTIONS WITH
INDIVIDUALS WITH INFLAMMATORY
BOWEL DISEASE.
CONGRATULATIONS TO DR. KAMP.
LET'S TURN TO OUR INTRAMURAL
PROGRAM AT NINR.
WE ADDED A TENURE TRACK
INVESTIGATOR WHO BRINGS
EXPERTISE IN HEALTH EQUITY,
SOCIAL DETERMINANTS OF HEALTH
AND DATA SCIENCE TO OUR
INTRAMURAL PROGRAM.
DR. QUINN WIN JOINED US IN
AUGUST.
SHE COMES FROM THE UNIVERSITY OF
MARYLAND SCHOOL OF PUBLIC HEALTH
WHERE SHE WAS AN ASSOCIATE
PROFESSOR OF EPIDEMIOLOGY AND
BIOSTATISTICS.
DR. WIN IS AN EPIDEMIOLOGIST --
THAT CONTRIBUTE TO HEALTH
DISPARITIES WITH AS WELL AS
COMMUNITY-ENGAGED INTERVENTIONS.
SHE USES A RANGE OF
METHODOLOGIES IN THIS WORK
INCLUDING BUT NOT LIMITED TO
NATURAL LANGUAGE PROCESSING,
CONVOLUTIONAL NETWORKS FOR IMAGE
ANALYSIS.
TO ANALYZE DIVERSITY DATA
SOURCES SUCH AS LARGE SCALE
SOCIAL MEDIA POSTS, GOOGLE
STREET IMAGES AND INFORMATION
PROSIDED BY NIH AND FEDERAL
HOSPITALS.
PLEASE INDIAN ME IN WELCOMING
DR. NGUYEN.
WE ARE LOOKING FORWARD TO
WELCOMING DR. KIRSTIN DICKENS,
SHE IS AT RUSH UNIVERSITY
COLLEGE OF MEDICINE.
SHE BRINGS EXPERTISE IN
COMMUNITY-ENGAGED RESEARCH,
CLOSING THE GAP IN PREVENTIBLE
BIOPSYCHO SOCIAL FOR PEOPLE
FACING DISPROPORTIONATE
INTERSECTION ATH HEALTH
DISADVANTAGE.
SR. -- AMONG WOMEN EXPERIENCING
HOMELESSNESS AND
JUSTICE-IMPACTED WOMEN IN
KREGSAL SETTINGS SO AN EARLY
WELCOME TO DR. DICKENS.
WE WOULD LIKE TO CONGRATULATE
DR. LEO SALAGAN, A TENURED
INVESTIGATOR IN THE INTRAMURAL
PROGRAM.
HIS WORK WAS FEATURED IN A
RECENT ANALYSIS PAPER THAT
INCLUDED 2500 STUDIES FROM 70
STUDIES.
DR. SALIGAN HAS PUBLISHED THE
THIRD MOST PAPERS ON
CANCER-RELATED FATIGUE.
2015 REVIEW IS THE 10th MOST
CITED PAPER ON THAT TOPIC.
SO CONGRATULATIONS TO DR.
SALIGAN AND HIS TEAM.
OUR LAST INTRAMURAL UPDATE, OUR
SUMMER INTERN, AMARA WAS
FEATURED ON NIH IM INTRAMURAL
BLOG ABOUT THE SUMMER POSTER
DAYS.
ABOUT 800 INTRAMURAL SUMMER
INTERNS PARTICIPATED IN THIS
YEAR'S PROGRAM AND AMARA WAS ONE
OF FIVE SELECTED TO BE FEATURED
IN THE POST.
HER POSTER DESCRIBED HER WORK ON
A PILOT STUDY AND DR. SALIGAN'S
LAB FOR USING CHARACTERISTICS OF
A PERSON'S VOICE TO ASSESS
FRAILTY IN OLDER ADULTS.
IT WAS SUPPORTED BY NINR AS PART
OF A PARTNERSHIP WE TALKED ABOUT
DEVELOPING WITH SEVERAL
UNIVERSITIES IN SOUTHEAST
VIRGINIA.
AMARA IS CURRENTLY A RISING
SENIOR AT HAMPTON UNIVERSITY,
WHERE SHE IS MAJORING IN NURSING
AND HELPING RESEARCHERS DEVELOP
STRATEGIES FOR IMPROVING THE
SAFETY AND MENTAL HEALTH OF
BLACK WOMEN IN THE SURROUNDING
COMMUNITY.
SHE SAID SHE CHOSE TO WORK WITH
DR. SALIGAN BECAUSE HE IS BOTH A
NURSE AS WELL AS A GRADUATE OF
HAMPTON UNIVERSITY.
WE WANT TO TALK ABOUT IMPROVE.
I'M GOING TO TRY TO GO A LITTLE
FASTER, GIVEN THAT WE GOT THE
LATE START.
SO A LOT HAS BEEN HAPPENING WITH
IMPROVE.
THANKS TO ADDITIONAL SUPPORT
FROM CONGRESS THIS YEAR, IMPROVE
WAS ABLE TO FUND TWO ADDITIONAL
CENTERS OF EXCELLENCE.
ONE IS AT THE UNIVERSITY OF
PITTSBURGH, ONE AT THE
UNIVERSITY OF ILLINOIS CHICAGO.
THEY JOINED 10 OTHER CENTERS
ACROSS THE COUNTRY AND TWO HUBS.
THEIR FOCUS, AGAIN, IS
PARTNERING WITH COMMUNITIES TO
DESIGN AND IMPLEMENT RESEARCH
PROJECTS ADDRESSING MULTILEVEL
FACTORS THAT AFFECT PREGNANCY
COMPLICATIONS AND DEATH.
ONE OF THE INTERESTING PROJECTS
THAT HAS COME OUT OF IT -- I
LOST MY NOTES, BUT THERE WAS A
TRAINING OPPORTUNITY ON
INTERPERSONAL VIOLENCE AND
SUPPORTING TRAINING IN THAT AREA
TO IMPROVE AND ENHANCE RESEARCH.
SO I THINK THAT IS ANOTHER
INTERESTING AND IMPORTANT
DEVELOPMENT SINCE OUR LAST
MEETING.
AND THEN JUST LAST WEEK ON
SEPTEMBER 5th, NIH ANNOUNCED THE
WINNERS FOR CONNECTING THE
COMMUNITY FOR MATERNAL HEALTH
CHALLENGE.
THIS WAS A THREE-PHASE CHALLENGE
OPEN TO NON-ACADEMIC, NONPROFIT
ORGANIZATIONS BASED IN THE
UNITED STATES.
SO THIS INCLUDED ADVOCACY,
COMMUNITY, AND FAITH-BASED
NONPROFITS.
WITH THE AIM OF SUPPORTING
COMMUNITY ORGANIZATIONS AND THE
DEVELOPMENT, IMPLEMENTATION OF
RESEARCH PROJECTS TO IMPROVE
MATERNAL HEALTH OUTCOMES IN
THEIR COMMUNITIES.
WE HAD OVER 90 ORGANIZATIONS WHO
APPLIED TO PARTICIPATE IN THE
CHALLENGE, WHICH LAUNCHED IN
SEPTEMBER OF 22.
THERE WERE 15 WINNERS AT PHASE
ONE WHO RECEIVED CASH PRIZES.
ADDITIONAL CASH PRIZES OF
$150,000 WERE AWARDED TO NINE
WINNERS IN THE SECOND STAGE.
AND THEN IN THE FINAL STAGE,
EIGHT GROUPS RECEIVED ADDITIONAL
TRAINING AND MENTORSHIP TO
IMPLEMENT THEIR PLANS.
THE GROUPS CONDUCTED THE
PROPOSED RESEARCH AND REPORTED
PRELIMINARY RESULTS.
SO APPROXIMATELY $1.5 MILLION IN
CASH PRIZES WAS DISTRIBUTED
AMONG THOSE FINAL WINNERS.
SO I WANT TO MENTION A COUPLE OF
THE WINNERS.
SO NURTURELY OF EUGENE, OREGON,
RECEIVED FIRST PLACE FOR CARING
FOR THE CULTURE, INFANT CARING
FOR HEALTH EQUITY.
A PROJECT TO TEST THE EFFECT OF
AN INFANT CARING INTERVENTION ON
LACTATION AND POST PARTUM
DEPRESSION AMONG BLACK PARENTS.
SECOND PRIZE TO CENTRAL JERSEY
FAMILY HEALTH CONSORTIUM OF
NORTH BRUNSWICK, NEW JERSEY.
THEIR PROJECT SEEKS TO IDENTIFY
MATERNAL RISK FACTORS IN
PREGNANCY OUTCOMES.
SIX ADDITIONAL WINNERS YOU CAN
SEE ON THE SLIDE TIED FOR THIRD
PLACE.
SO CONGRATULATIONS TO ALL OF
THEM.
IT WAS REALLY AMAZING TO HAVE
THESE COMMUNITY ORGANIZATIONS
MOVE THEIR PROJECTS AND THEIR
VISION FORWARD.
I JUST WANT TO MENTION, THERE
WILL BE A FIFTH ANNIVERSARY
MEETING FOR IMPROVE TO RECOGNIZE
PROGRESS TO DATE AND WHERE WE'RE
GOING NEXT.
IT WILL BE IN BETHESDA ON
OCTOBER 15th AND 16th.
PART OF THAT AGENDA WILL INCLUDE
TALKING ABOUT WHERE IMPROVE
SHOULD GO NEXT SO WE ARE LOOKING
FORWARD TO THAT MEETING.
AND THEN I WANT TO UPDATE ON A
COUPLE OF THE COUNCIL WORKING
GROUPS THAT WE'VE DISCUSSED OVER
THE LAST SEVERAL MONTHS.
FIRST, I'M REALLY PLEASED TO
SHARE THAT WE'RE READY TO LAUNCH
THE WORKING GROUP TO ADVANCE
IMPLICATIONS ON THE RAPID
DEVELOPMENTS IN DATA SCIENCE AND
ARTIFICIAL INTELLIGENCE FOR
NINR'S RESEARCH AND TRAINING
INITIATIVES.
SO WE ARE GRATEFUL TO DR. STONE
FOR CO-CHAIRING THAT COMMITTEE
WITH DR. BRIAN WITH NINR.
DR. WANG AND DR. FITZ PATIK, WE
APPRECIATE YOUR SERVICE ON THAT
COMMITTEE AS WELL AS WELL AS THE
OTHER FACULTY SHOWN ON THE SLIDE
FOR THEIR VALUABLE SERVICE TO
THE INSTITUTE.
WE ARE LOOKING FORWARD TO YOUR
RECOMMENDATIONS TO COUNCIL IN AN
UPCOMING MEETING.
I WANT TO UPDATE YOU ON THE
WORKING GROUP ON SDOH COMMON
DATA ELEMENTS.
AS YOU MAY RECALL, NINR
CO-CHAIRS THE NIH-WIDE SERMON
DETERMINANTS OF HEALTH
COORDINATING COMMITTEE.
THE RCC ALSO REALLY IS
INTERESTED AND SEES THE VALUE IN
COMMON DATA ELEMENTS FOR SERMON
DETERMINANTS OF HEALTH.
SO WHEN I SHARED OUR PLANS TO
FORM A WORKING GROUP OF COUNCIL
TO PROVIDE RECOMMENDATIONS TO
US, THEY WERE REALLY EXCITED
ABOUT THE POSSIBILITY OF
PLANNING THAT GROUP IN A WAY
THAT ITS RECOMMENDATIONS CAN BE
MORE BROADLY APPLICABLE AND
RELEVANT ACROSS THE NIH.
SO THOSE CONVERSATIONS ARE
CONTINUING ABOUT WHAT THAT MIGHT
LOOK LIKE AND SO I'M HOPING TO
BE ABLE TO SHARE AN UPDATE ON
THAT SOON.
SO WE ARE ALWAYS TRYING TO SHARE
OUR WORK AND OPPORTUNITIES
THROUGH SCIENTIFIC EVENTS AND
OUTREACH.
I'M GOING TO SHARE SOME UPDATES
THERE.
WE'VE HOSTED TWO DIRECTOR'S
LECTURES.
SO AGAIN, DR. GUILAMO RAMOS
JOANED US FOR THE UNEQUAL
TREATMENT REPORT.
NINR CONTRIBUTED FUNDING TO FUND
THIS REALLY IMPORTANT FOLLOW-UP
REPORT.
WE ARE PLEASED DR. GUILAMO-RAMOS
WAS ABLE TO REPRESENT AS A
MEMBER OF THAT COMMITTEE THAT
AUTHORED THAT REPORT.
OVER 550 PEOPLE JOINED US FOR
THAT IN-DEPTH DISCUSSION IN
AUGUST.
I'M NOT GOING TO TALK ANYMORE
ABOUT IT BECAUSE I DON'T WANT TO
SPOIL WHAT IS YET TO COME.
OUR JULY DIRECTOR'S LECTURE FORE
CUSSED ON MATERNAL HEALTH AND
SOC
SOCIAL DETERMINANTS OF HEALTH.
DR. MUJAHID TALKED ABOUT HER
RESEARCH IN MATERNAL HEALTH.
FOR BOTH OF THOSE LECTURES YOU
CAN FIND THEM ON OUR WEBSITE.
WE ALSO HOSTED A PANEL AT --
THAT FOCUSED WAS FEATURING NINR,
DR. ROSA GARDA, DR. MATTHEW
McHUGH, FOR ATTENDES TO MAXIMIZE
RESEARCH THROUGH NINR PRIORITIES
AND RESEARCH LENSES.
PROGRAM STAFF MET WITH ATTENDES
AT THAT CONFERENCE AGAIN TO
DISCUSS FUNDING OPPORTUNITIES
AND ANSWER THEIR QUESTIONS.
AND THEN WE ALSO HAD PROGRAM
STAFF DOING ADDITIONAL OUTREACH.
HERE ARE SOME EXAMPLES SINCE
MAY.
AT THE ANNUAL MEETING FOR THE
SOCIETY FOR PREVENTION RESEARCH
DR. LIBBY BOWEN AND DR. GREER
COLLABORATED WITH STAFF AT THE
OFFICE OF DISEASE PREVENTION ON
A POSTER HIGHLIGHTING NIH'S
PORTFOLIO ON FOOD INSECURITY AND
HEALTH AMONG OLDER ADULTS AND
SPOKE WITH CONFERENCE
PARTICIPANTS ABOUT HOW THEIR
INTERESTS MIGHT BE ALIGNED WITH
NINR STRATEGIC PLAN AND WHERE
THERE IS THE MOST NEED FOR
FEDERAL FUNDING.
IN JULY DR. ROBERTS GAVE A
VIRTUAL PRESENTATION ON NIR'S
STRATEGIC PLAN AT APHA'S PUBLIC
HEALTH NURSING RESEARCH
COMMITTEE.
A MONTHLY WEBINAR TO SHARE MORE
INFORMATION ABOUT OPPORTUNITIES
FOR FUNDING.
IN OUR JANUARY COUNCIL MEETING
WE HAD A DISCUSSION ABOUT
REACHING AUDIENCES FOR FUNDING
OPPORTUNITIES AND ENCOURAGING
APPLICATIONS.
AND I SHARED IN MAY THAT WE
INCREASED OUR OUTREACH EFFORTS
TO BETTER PROMOTE OUR NINR-LED
FUNDING OPPORTUNITIES.
AND WE ARE REALLY ENCOURAGED BY
THE ROBUST INTEREST WE ARE
SEEING.
SO HERE ARE SOME OF THE RECENT
SUCCESSES.
VIEWS OF OUR FUNDING
OPPORTUNITIES ON OUR WEBSITE
HAVE INCREASED BY OVER 150%.
OUR FUNDING ANNOUNCEMENT E-MAILS
ARE AVERAGING 1,500 CLICKS PER
ANNOUNCEMENT, PARTICIPATION IN
TECHNICAL ASSISTANCE WEBINARS
FOR FUNDING OPPORTUNITIES IS
HIGH, AVERAGING OVER 500
REGISTRANTS, NEARLY 250 LIVE
VIEWS AND 400 YOUTUBE VIEWS PER
WEBINAR.
NINR'S DIRECTOR LECTURE
ATTENDANCE HAS INCREASED,
AVERAGING 925 REGISTRANTS AND
NEARLY 500 LIVE VIEWS, WITH
HUNDREDS MORE VIEWING THE
ARCHIVED RECORDINGS.
SO THESE EFFORTS RESULTED IN OUR
FUNDING OPPORTUNITIES HAVING THE
HIGHEST NUMBER OF APPLICATIONS.
FOUR OUT OF THE TOP FIVE IN
AVAILABLE NINR HISTORY GOING
BACK THE LAST 10 YEARS.
I WANT TO TELL YOU A LITTLE BIT
CONGRESSIONAL UPDATES OVER THE
PAST FEW MONTHS I HAVE HAD THE
OPPORTUNITY TO TALK WITH MEMBERS
OF CONGRESS AND CONGRESSIONAL
STAFF ABOUT IMPROVE.
ON JUNE 10th, I JOINED THE OTHER
IMPROVE CO-CHAIR, DR. DIANNA
BIANCI, AND DR. CLAYTON FROM
ORWH IN PROVIDING AN OVERVIEW TO
REPRESENTATIVE LAUREN UNDERWOOD
ON THE INITIATIVES CURRENT
ACTIVITIES AND ACCOMPLISHMENTS.
DR. GIBBONS PARTICIPATED AS
WELL.
I ALSO JOINED THE IMPROVE
CO-CHAIRS ON FRIDAY JULY 19th
DURING ONE OF NIH'S WEEKLY
VIRTUAL LUNCH AND LEARN
CONGRESSIONAL STAFF BRIEFINGS.
TO EDUCATE STAFF ON IMPROVE'S
CURRENT ACTIVITIES AND
ACCOMPLISHMENTS AND ON MAY 29th,
AN NINR FUNDED PROJECT WAS
FEATURED IN A CONGRESSIONAL
STAFF DELEGATION TRIP TO THE
MEDICAL COLLEGE OF WISCONSIN IN
MILWAUKEE.
THE VISIT WAS ORGANIZED BY THE
STAFF OF SENATOR TAMMY BALDWIN,
WHO SERVES AS THE CHAIR OF THE
SENATE LABOR HEALTH, AND HUMAN
SERVICES AND EDUCATION
APPROPRIATION SUBCOMMITTEE.
NIH SELECTIVE STUDY THAT IS
TESTING THE EFFICACY OF TWO
INTERVENTIONS TO IMPROVE HEALTH
OUTCOMES AND QUALITY OF LIVE
AMONG RURAL OLDER ADULTS LIVING
WITH HIV.
OTHER INSTITUTES HAD PROJECTS
HIGHLIGHTS, SO WE ARE PLEASED TO
SHARE THOSE UPDATES.
SO I'M GOING TO SKIP OUR
DISCUSSION.
BECAUSE WE ARE GOING TO TALK A
LOT LATER.
I'M GOING TO TRY TO KEEP GOING.
I WANT TO GIVE YOU SOME STAFF
UPDATES FROM NINR.
REALLY PLEASED TO WELCOME NEW
STAFF.
DR. NGUYEN'S ARRIVAL, TWO
FANTASTIC I.T. TECHNICIANS COME
ON BOARD, XAVIER GUTIERREZ AND
TYLER GUTMAN.
JANET OPUTA STARTED IN JULY AS A
HEALTH SCIENCE POLICY ANALYST.
THREE FELLOWS HAVE JOINED NINR'S
TEAM, ESTHER FREDERICK FROM THE
AAAS PROGRAM.
WE ALSO HAD TWO NEW FELLOWS JOIN
THE DIVISION OF INTRAMURAL
RESEARCH, AMARA, WHO I MENTIONED
AND JUSTIN ZHAO, SO WELCOME TO
ALL OF OUR NEW COLLEAGUES.
I WOULD LIKE TO RECOGNIZE THE
RETIREMENT OF ONE OF OUR
LONG-TIME MEMBERS OF OUR
INTRAMURAL DIVISION.
DR. MARY LIE RETIRED ON AUGUST
1.
SHE HAD 30 YEARS OF SERVICE THAT
BEGAN AT NIH NEUROSCIENCE
PROGRAM.
SHE BROUGHT THESE SKILLS TO NINR
IN 2014 WHERE SHE FIRST WORKED
AS A RESEARCH WORK SPECIALIST.
MOST RECENTLY MARY WORKED AS THE
CLINICAL OPERATIONS MANAGER.
MARY WAS A TERRIFIC COLLEAGUE
AND MENTOR TO SO MANY WHO CAME
THROUGH OUR INTRAMURAL PROGRAM
IN THE PAST 10 YEARS.
SHE WILL BE MISSED.
ON BEHALF OF NINR I WANT TO
CONGRATULATE HER AND WISH HER
THE BEST AS SHE MOVES ON TO HER
NEW ADVENTURES.
A FEW NIH-HHS UPDATES.
I'M SURE MANY OF YOU SAW THE
NEWS THAT ON JUNE 6, NIH
ANNOUNCED THE COMMUNITIES
ADVANCING RESEARCH EQUITY FOR
HEALTH OR CARE FOR HEALTH
INITIATIVE.
THIS WILL INVEST APPROXIMATELY
$30 MILLION OVER FISCAL YEARS 24
AND 25 TO PILOT A NATIONAL
PRIMARY CARE RESEARCH NETWORK.
LE SO THE NEW INITIATIVE IS THE
VISION OF OUR NIH DIRECTOR AND
SEEKS TO IMPROVE ACCESS TO
CLINICAL RESEARCH TO INFORM
MEDICAL CARE, PARTICULARLY FOR
THOSE COMMUNITIES HISTORICALLY
UNDERREPRESENTED IN CLINICAL
RESEARCH OR UNDERREPRESENTED IN
HEALTH CARE.
SO I'M ALSO PLEASED TO BE
SERVING ON THE SCIENTIFIC
COMMITTEE FOR THIS INITIATIVE
AND AM ALSO HAPPY TO BE
REPRESENTING NIH AS WELL ACROSS
HHS PRIMARY CARE RESEARCH LED BY
HRQ.
WE'RE ALSO ACTIVE IN THE PILOT
PHASE OF THE NEW NIH ENGAGEMENT
AND ACCESS FOR RESEARCH ACTIVE
INSTITUTIONS INITIATIVE.
THIS IS CONNECTING NIH
INSTITUTES AND CENTERS WITH
INSTITUTIONS THAT HAVE A
DOCUMENTED MISSION TO SERVE
POPULATIONS UNDERREPRESENTED IN
THE BIOMEDICAL AND BEHAVIORAL
RESEARCH.
HAVE LIMITED NIH FUNDING AND
AWARD DEGREES IN STEM AND
MEDICINE FIELDS.
SO PROGRAM DIRECTORS ARE
SUPPORTING FACT FROM FIVE OF THE
18 INSTITUTIONS SELECTED TO
PARTICIPATE IN THE FIRST PHASE.
CHARLES R DREW UNIVERSITY SCHOOL
OF MEDICINE AND SCIENCE, MAHARI
MEDICAL COLLEGE, MONTANA STATE
UNIVERSITY BOZEMAN, THE
UNIVERSITY OF SOUTH DAKOTA AND
UTAH STATE UNIVERSITY.
SO PROGRAM DIRECTORS WERE
MATCHED WITH FACULTY FROM EACH
OF THOSE INSTITUTIONS.
THEY MET, DISCUSSED THEIR
RESEARCH AIMS AND HAVE PROVIDED
GUIDANCE AND RESOURCES MOVING
FORWARD.
SO WE ARE VERY PROUD TO SUPPORT
THIS PROGRAM AND APPRECIATE THE
PARTNERSHIPS OF THE PROGRAM
STAFF WITH THESE RESEARCHERS.
SO BACK IN JUNE, THE SURGEON
GENERAL ISSUED A LANDMARK
ADVISORY ANNOUNCING FIREARM
VIOLENCE IS A PUBLIC HEALTH
CRISIS.
WE APPLAUD DR. MURTHY FOR USING
HIS PLATFORM TO BRING ATTENTION
TO THE DEVASTATING IMPACT IN
CONNECTION WITH OUR FIRMT
PREVEN --
FIREARM PREVENTION.
WE MADE IT.
I WANT TO ACKNOWLEDGE THE
AMAZING WORK ACROSS THE
INSTITUTE IN MOVING ALL OF THIS
SCIENCE FORWARD.
I WANT TO THANK ALL OF MY
COLLEAGUES TO HELP COMPILE THIS
INFORMATION TO SHARE WITH YOU
TODAY.
AND I WANT TO THANK YOU ALL FOR
LISTENING AND HELPING US MOVE
FORWARD FROM WHERE WE ARE TODAY.
SO WITH THAT, I WOULD LIKE TO
WELCOME COUNCIL MEMBER DR.
VINCENT GUILAMO RAMOS WHO IS
GOING TO PROVIDE US AN OVERVIEW
ON THE ENDING OF UNEQUAL
TREATMENT REPORT.
SO THANK YOU, DR. RAMOS.
>> SO GOOD MORNING.
IT IS A PLEASURE TO BE HERE AND
I'M GOING TO BE SPEAKING ABOUT
THE ENDING UNEQUAL TREATMENT
REPORT AS AN INDIVIDUAL
COMMITTEE MEMBER.
AT TIMES I MAY REFERENCE THINGS
THAT ARE MY OWN IDEAS, MOST OF
THE TIME I WILL BE SPEAKING ON
BEHALF OF THE COMMITTEE.
AND SO THANK YOU VERY MUCH FOR
THIS OPPORTUNITY.
HERE'S THE AGENDA OF WHAT WE ARE
GOING TO COVER.
I'M GOING TO START BY REALLY
RUNNING THROUGH SORT OF WHAT WAS
THE SCOPE, WHAT'S THE CHARGE,
WHAT WERE WE ASKED TO DO AND
PROVIDE OVERVIEW AND
IMPLICATIONS AT A HIGH LEVEL.
THE STRATEGY OPPORTUNITIES FOR
NURSING SCIENCE TO LEAD IN
ELIMINATING HEALTH EQUITIES.
I LOOK FORWARD TO HAVING A
CONVERSATION ABOUT THAT TOGETHER
WITH THE COUNCIL.
AND THEN AT THE END, MAYBE A FEW
MOMENTS TO REFLECT ON THE WORK
OF NINR FROM MY POINT OF VIEW,
REALLY ACKNOWLEDGING WHAT
PRECEDED ENDING UNEQUAL
TREATMENT, WHAT HAS BEEN THE
WORK OF THE INSTITUTE FOR SOME
TIME AND ALSO AN INVITATION FOR
EVERYONE TO HAVE A DISCUSSION ON
WHAT ARE SOME OF THE
OPPORTUNITIES AND SETTING THE
STAGE FOR OUR TWO SPEAKERS, OUR
TWO SCIENTISTS SPEAKING LATER
THIS AFTERNOON ABOUT WHAT THEY
SEE AS OPPORTUNITIES FROM THEIR
VANTAGE POINT.
LET ME JUMP RIGHT IN AND TALK
ABOUT THE REPORT.
SO THE REPORT WAS DEVELOPED BY
AN AD HOC COMMITTEE OF THE
NATIONAL ACADEMIES OF SCIENCE,
ENGINEERING AND MEDICINE.
OUR CHARGE WAS TO EXAMINE THE
CURRENT STATE OF HEALTH CARE
INEQUITIES.
I WILL DEFINE INEQUITIES AND HOW
WE MADE AN IMPORTANT DISTINCTION
BETWEEN THE HEALTH SYSTEM AND
HEALTH CARE SYSTEM.
IN THIS CASE OUR CHARGE WAS TO
LOOK AT THE HEALTH CARE SYSTEM
AND EXAMINE INEQUITIES IN THAT
SYSTEM.
WHAT IS REALLY CRITICAL IS WE
HAD A TIME INTERVAL INTERESTED
IN EXPLORING, 20 YEARS.
THE ORIGINAL REPORT WAS RELEASED
IN 2003.
I THINK MANY OF US REMEMBER IT
WAS A WATERSHED MOMENT.
IT WAS MET BY SOME COMMUNITIES
WITH A LOT OF OPPOSITION, I
WOULD SAY, A LOT OF TENSION, A
LOT OF DISAGREEMENT, DISBELIEF.
THERE WERE OTHER COMMUNITIES
THAT FINALLY THE ACKNOWLEDGEMENT
OF OUR EXPERIENCES.
THIS WAS ASKING THE FUNDAMENTAL
QUESTION, WHAT HAS HAPPENED IN
20 YEARS?
HAVE WE MADE PROGRESS?
HAVE THINGS STAYED THE SAME?
IF WE HAVE MADE PROGRESS, WHAT
EXACTLY HAS ACCOUNTED FOR THAT
PROGRESS IN TERMS OF POLICIES
AND PROGRAMS, IN TERMS OF
SCIENCES ADVANCES.
IF WE HAVEN'T, HOW DO WE START
TO UNDERSTAND WHAT WENT WRONG
AND WHAT DO WE DO TO MOVE
FORWARD.
A LITTLE MORE IN OUR STATEMENT
OF TASK.
WE WERE ASKED TO EXAMINE THE
MAJOR DRIVERS OF HEALTH CARE
INEQUITIES.
I MENTIONED WE EXPLORED WHAT WAS
SUCCESSFUL AND UNSUCCESSFUL IN
TERMS OF PROGRAMMATIC AND POLICY
INTERVENTIONS.
WHAT ARE THE GAPS?
WHAT ARE THE AREAS WE SHOULD BE
AS A NATION EXPLORING TO
STRENGTHEN OUR SCIENCE TO
RESPOND PROGRAMMATICALLY.
HOW DO WE SCALE INTERVENTIONS?
I THINK MANY OF US IN THE ROOM
IF NOT ALL OF US KNOW MANY
INTERVENTIONS ARE TERRIFIC THAT
NEVER GET SCALED.
THIS IS MY COMMENT, THIS IS TRUE
PARTICULARLY IN NURSING.
NURSES CONTRIBUTE A LOT OF
IMPORTANT BREAK THROUGHS AROUND
PROGRAMS AND POLICIES.
WOULDN'T IT BE TERRIFIC TO SCALE
THOSE TO HAVE A POPULATION
HEALTH EFFECT.
AND THEN THE LAST PART, BUT
PROBABLY THE MOST IMPORTANT, WE
WERE REALLY INTERESTED IN AS A
COMMITTEE HAVING A SECTION ON
ACCOUNTABILITY.
ONE OF THE SPECIFIC ACTIONS AND
ACTORS, WHAT WOULD WE DO
SPECIFIC AS A NATION TO ADDRESS
THE INEQUITIES THAT REMAIN IN
OUR NATION?
SO IMPORTANT TO TAKE A MOMENT
AND JUST SPEND TWO OR THREE
MINUTES ON THIS.
IT IS REALLY CRITICAL.
THESE ARE NOT IDEAS THAT ARE
NEW.
AND, IN FACT, I COULD HAVE GONE
FURTHER BACK EVEN PRIOR TO 1985,
BUT I'M STARTING IN 1985.
ONE OF THE THINGS I ENJOYED AS
PART OF THE RECENT NASEM
COMMITTEE IS WE WERE VERY
DELIBERATE OF TAKING THIS STEP
BACK WARD AND HEARING FROM THOSE
WHO HAD COME BEFORE US ABOUT
WHAT THEY HAD DONE AND WHAT THE
ISSUES WERE HISTORICALLY.
MOST OF US WILL REMEMBER IN 1985
THERE WAS A REPORT COMMONLY
REFERRED TO AS A HECKLER REPORT.
MARGARET HECKLER, THE HHS
SECRETARY.
AND IT WAS THE FIRST TIME WE HAD
A GROUP OF EMINENT SCIENTIST,
LEADERS, SCHOLARS WHO CAME
TOGETHER TO EXPLORE RACIAL AND
ETHNIC, AT THE TIME WHAT WERE
CALLED DISPARITIES AND TO TRY TO
MAKE SENSE OF IT.
THIS IS A VERY IMPORTANT POINT.
IN 1985 THE NATION WAS REPORTING
LIFE EXPECTANCY WAS AT AN
ALL-TIME HIGH, THAT WAS TRUE IN
AGGREGATE FORM.
WHAT WAS ALSO TRUE IS IN 1985
THE LIFE EXPECTANCY FOR
AFRICAN-AMERICANS, AS ONE
EXAMPLE, THE REPORT HAS MUCH
MORE OF IT, WAS THAT OF WHITES
IN 1950.
THERE WAS A 30-YEAR GAP BETWEEN
WHITES AND AFTERNOON AMERICANS
IN 1985.
I DON'T HAVE TIME TODAY TO TALK
ABOUT WHAT CAME OF THIS REPORT.
BUT THERE WERE MANY, MANY
IMPORTANT THINGS THAT CAME FROM
THE HECKLER REPORT INCLUDING THE
OFFICE OF MINORITY HEALTH,
ELEVATION OF NIMHD FROM A CENTER
TO AN INSTITUTE.
THERE WERE GREAT THINGS THAT
HAPPENED.
I WILL ALSO SAY IN 2003, AT THE
TIME WHAT WAS CALLED THE
INSTITUTE OF MEDICINE PURSUED
AND WAS INTERESTED IN THE TWEED
UNEQUAL TREATMENT REPORT.
AND THIS REPORT PROBABLY I WOULD
SAY, THESE ARE MY WORDS, ONE OF
THE MOST SIGNIFICANT REPORTS,
HEALTH POLICY THAT AT LEAST IN
MY LIFE TIME THAT I HAVE SEEN
THAT HAS REALLY CHANGED MY
UNDERSTANDING OF MY ROLE AS A
NURSE, AS A NURSE SCIENTIST, IS
UNEQUAL TREATMENT.
THIS REPORT DID, IN FACT,
REAFFIRM THAT WHAT WE CALL TODAY
SOCIAL DETERMINANTS OF HEALTH
MATTER.
I'M A BIG PROPONENT AND ADVOCATE
OF THAT.
WHAT IS ALSO TRUE THAT WAS CLEAR
IN THE REPORT, EVEN IF WE
CORRECTED FOR ALL OF THE SOCIAL
DETERMINANTS AS WE COMMONLY
THINK OF THEM, WE WOULD STILL
HAVE DISPARITIES.
AT THE TIME IN 2003 THEY WERE
STILL CALLED DISPARITIES.
THE REASON IS WE HAD SYSTEMIC
STRUCTURAL RACISM IN OUR HEALTH
AND HEALTH CARE SYSTEMS.
BOTH OF THOSE THINGS BEING
IMPORTANT, STRUCTURAL SYSTEMIC
RACISM AND ALSO SOCIAL
DETERMINANTS OF HEALTH.
SO I THINK I HAVE SET THE STAGE
FOR 2024.
AS A COMMUNITY MEMBER I REALLY
WANTED TO KNOW DID WE MAKE
PROGRESS?
I HAD A SENSE WE DID.
FOLKS IN THIS ROOM DID AS WELL.
I WANTED AN EMPIRICAL OVERVIEW
OF WHAT REALLY HAPPENED AND DID
WE MAKE PROGRESS?
SO HERE IS A SNAPSHOT OF THE
COMMITTEE.
THERE IS AN INTERPROFESSIONAL
COMMITTEE, REALLY FANTASTIC
FOLKS.
I WILL JUST MENTION A FEW, IN NO
WAY AM I DIMINISHING THOSE I
DIDN'T MENTION.
GEORGES BENJAMIN IS THE CEO OF
THE AMERICAN PUBLIC HEALTH
ASSOCIATION.
JENNIFER DEVOE.
JOHN AYENIAN BECAUSE OF HIS WORK
ON MEDICAID, HE IS A MEDICATE
SCHOLAR.
DARRYL GAS KINS AND THOMAS
LAVEIST ARE LEADER AROUND
INEQUITIES.
VALLEY BLUE BIRD JERNIGAN WHO
WAS A STRONG ADVOCATE IN
INDIGENOUS COMMUNITIES.
I WILL END BY SAYING FRANCIS
AMANKWAH WAS THE STUDY DIRECTOR
FROM THE NATIONAL ACADEMIES.
WITHOUT HIM WE COULDN'T HAVE
DONE THE REPORT.
YOU CAN SEE THE SPONSORS, NIH,
NINR.
THERE IS AN INTERACTIVE WEBSITE
AND SET OF RESOURCES THAT TAKE
THE REPORT AND MAKE IT MORE
DIGESTIBLE, SO I WILL TALK ABOUT
THAT LATER.
WE STARTED OFF WITH AN EXTENSIVE
LITERATURE REVIEW AND SPENT
MONTHS TRYING TO GET
CONCEPTUALLY CLEAR ON WHAT WE
MEAN.
TERMS THAT MAYBE SOUND LIKE ALL
OF US AGREE, TURNS OUT A LOT
MORE PEOPLE CAN COME INTO A ROOM
AND DISAGREE ABOUT TERMS.
SO WE HAD TO SPEND TIME REALLY
THINKING ABOUT WHAT THOSE TERMS
ARE.
WE ALSO HAD THE ABILITY TO
COMMISSION VERY SPECIFIC PAPERS.
WE COMMISSIONED ONE PAPER THAT
LOOKED AT 20 YEARS IN POLICY
ADVANCEMENTS THAT WERE
SUCCESSFUL OR NOT SUCCESSFUL.
I DON'T THINK IT IS SORT OF OUT
OF LINE TO RECOGNIZE PROFESSOR
DAWES WHO WAS THE LEAD IN
PERFORMING THAT OVERVIEW.
THERE WAS ALSO A SET OF ANALYSES
THAT WERE DONE AROUND HEALTH
EQUITIES BY CONDITION, BY RACE,
ETHNICITY, BY GEOGRAPHY.
SO THERE WAS A LOT IN ADDITION
TO THE REPORT THAT INFORMED THE
COMMITTEE'S DELIBERATIONS.
MANY PUBLIC WORKSHOPS, WE HAD
SOME INPUT FROM THE FORMAL
NURSING.
WE HAD DR. RUMAY ALEXANDER FROM
THE ANA AND EARNEST GRANT SERVED
AS A REVIEW FOR THE REPORT.
THERE WAS A LINK OPEN TO THE
PUBLIC AND WE RECEIVED COMMENTS
FROM MANY CONSTITUENCIES AND
DISCUSSED THOSE IN OUR MEETINGS.
IN A NUTSHELL, THE REPORT IS
JUST UNDER 400 PAGES.
IT'S GOT A LOT OF CONTENT.
SO I THINK PART OF WHAT IS
REALLY REFRESHING AND YOU CAN
SEE FROM THE QR CODE ON THE
SCREEN IF YOU FOLLOW THAT TO THE
WEBSITE, SINCE THE RELEASE OF
THE REPORT THERE HAVE BEEN A SET
OF MATERIALS DEVELOPED, AN
INTERACTIVE WEBSITE, VIDEO, FACT
SHEETS FOR POLICY MAKERS.
THERE IS A FRAMEWORK THAT LAYS
OUT THE MAIN CONCEPTUAL
UNDERPINNINGS OF THE REPORT.
NASEM CONTINUES TO ADD THINGS TO
THE WEBSITE.
THERE ARE EIGHT OVERARCHING
CONCLUSIONS THAT WE FOUND OVER
THE LAST 20 YEARS.
THERE ARE FIVE GOALS WITH AN EYE
TOWARD THE FUTURE AND 17
SPECIFIC ACTIONS THAT HAVE AN
ACTOR AND SPECIFIC
RECOMMENDATION OF WHAT SHOULD BE
DONE.
I ENCOURAGE FOLKS TO LOOK AT THE
REPORTS ORGANIZED IN THE WAY
THAT IS DEPICTED ON THE VEIN.
-- ON THE SCREEN.
THERE IS SOMETHING FOR ALL OF
US.
IF WE ARE DIRECTLY WORKING IN
HEALTH CARE, NURSING SCIENCE,
RESEARCH, ET CETERA, THERE ARE
PIECES FOR EVERY ASPECT OF OUR
NATION.
IF YOU CAN'T READ THE 400 PAGES
AND I KNOW THAT IS A BIG
COMMITMENT, THERE IS A NUMBER OF
PAPERS THAT HAVE COME OUT AND
THE COMMITTEE AND OTHERS ARE
WORKING FEVERISHLY ON OTHER
MANUSCRIPTS.
ONE OF THEM IS IN HEALTH
AFFAIRS, WHICH REALLY PROVIDES A
THREE TO FOUR-PAGE SUMMARY OF
WHAT IS IN 400 PAGES.
I WOULD UH CHECK IT OUT.
THE QR CODE IS THERE.
LAST WEEK THERE WAS A VIEWPOINT
RELEASED IN JAMA THAT WAS
CO-AUTHORED BY THE CHAIRS AND
FRANCIS.
AGAIN, ANOTHER GREAT SHORTER
VERSION OF WHAT IS IN THE
REPORT.
A COUPLE KEY TAKEAWAYS.
IT SOMETIMES TAKES TIME TO GET
CLEAR CONCEPTION OF WHAT WE
NEED.
OUR SCOPE AND CHARGE WAS LOOKING
AT THE HEALTH CARE SYSTEM,
UNDENI
UNDENIABLY, THE COMMITTEE NEW
AND STRUGGLED WITH RECOGNITION
THAT THERE IS A BROADER HEALTH
SYSTEM AND THE HEALTH CARE
SYSTEM IS EMBEDDED IN THAT
BROADER HEALTH SYSTEM.
THERE WILL BE TIMES I MAY
MENTION THE HEALTH SYSTEM IN MY
COMMENTS AND THERE ARE TIMES I
WILL MENTION THE HEALTH CARE
SYSTEM.
THE HEALTH CARE SYSTEM AS WE
KNOW IS WHERE THE ACTUAL
SERVICES, THE HEALTH SERVICES
ARE PROVIDED TO THE
ORGANIZATIONS.
IT'S THE RESOURCES, THE
INDIVIDUALS, THE WORK FORCE THAT
IS PROVIDING HEALTH CARE.
THE HEALTH SYSTEM IS MUCH
BROADER.
THE HEALTH CARE SYSTEM IS SHAPED
BY THE HEALTH SYSTEM AND THE
HEALTH SYSTEM INDEPENDENTLY
SHAPES OUTCOMES.
SO VERY, VERY IMPORTANT.
I MENTIONED HEALTH OUTCOMES I'M
TALKING ABOUT OR THE COMMITTEE
IS REFERRING TO HEALTH STATUS OF
INDIVIDUALS AND POPULATIONS.
THIS IS A POINT THAT WAS
IMPORTANT TO THE COMMITTEE AND
IT IS ACTUALLY IMPORTANT TO ME.
BY NO MEANS IS IT IN ANY WAY
SORT OF INTENDED TO REFLECT THAT
THE USE OF THE TERM DISPARITIES
ISN'T IN MANY SORT OF SECTORS
COMPLETELY APPROPRIATE.
BUT THE COMMITTEE FELT THAT WE
NEEDED TO MOVE AWAY FROM THE
TERM DISPARITIES.
AND THE REASON FOR THAT IS IN
OUR SORT OF DELIBERATIONS, WE
TALKED ABOUT DISPARITIES
REFLECTING A DIFFERENCE IN A
PARTICULAR OUTCOME.
AND FOR WHAT WE SAW OVER THE
PAST 20 CAREERS, WE SAW WHAT
MANY OF US ON THE COMMITTEE, THE
MAJORITY FELT WAS PREVENTIBLE,
WAS UNJUST, AND IT WAS UNFAIR.
FOR THAT MATTER OR IN THAT
SENSE, WE DECIDED THAT WE WERE
GOING TO ADOPT THE TERM HEALTH
INEQUITIES AND HEALTH CARE
INEQUITIES.
THAT WILL BE THE TERMINOLOGY I
WILL USE.
THEY ARE PREVENTIBLE, UNJUST AND
UNFAIR.
HERE IN A NUTSHELL IS SORT OF
THE MANY OF THE FINDINGS I HAVE
TAKEN FROM THE REPORT.
TO HELP US UNDERSTAND WHAT IS IN
THE 400 PAGES.
THE FIRST THING IS OVER THE PAST
TWO DECADES SINCE 2003, AS A
NATION, THERE HAS BEEN LIMITED
OVERALL PROGRESS IN THE
ELIMINATION OF HEALTH CARE
INEQUITIES.
SO I JUST WANT TO PAUSE FOR A
SECOND.
BECAUSE THAT WAS SOMETHING THAT
SURPRISED ME.
I SORT OF SENSED IT BEING A
NURSE, BUT SEEING 20 YEARS OF
DATA FOR OUR NATION AND SEEING
THERE HAD BEEN LIMITED PROGRESS,
I THINK THAT WAS SOMETHING THAT
WAS, IN MY VIEW, PRETTY
SURPRISING.
THESE INEQUITIES, THE HEALTH
CARE AND HEALTH INEQUITIES ARE
HIGHLY CONCENTRATED IN RACIAL,
ETHNIC MINORTIZED POPULATIONS.
HIGHLY CONCENTRATED.
IN ORDER TO MOVE FORWARD AS A
NATION, THERE IS A STRONG
SENTIMENT WE NEED TO ELIMINATE
HEALTH AND HEALTH CARE
INEQUIINEQUITY
S VERSUS SOLELY IMPROVING HEALTH
EQUITIES.
ADVANCING HEALTH EQUITY FELTLESS
COMMITTAL, LESS ABOUT MEASURABLE
PROGRESS AND CLEAR GOALS AND
REALLY THE ELIMINATION OF THE
HEALTH AND HEALTH CARE
INEQUITIES MEANS AS A NATION OUR
GOALS SHOULD BE TO ENSURE THAT
WE DO NOT HAVE THESE
PREVENTABLE, UNJUST AND UNFAIR
HEALTH OUTCOMES AND WE CAN DO
THIS AND THAT IS A CLEAR
BENCHMARK OF WHERE WE NEED TO
GO.
THE HEALTH CARE SYSTEM IS
EMBEDDED IN A LARGER HEALTH
SYSTEM.
THAT HEALTH SYSTEM DIRECTLY
SHAPES THE HEALTH CARE SYSTEM.
THE HELICOPALTH SYSTEM SHAPES T
HEALTH CARE SYSTEM.
NUMBER FIVE IS CRITICAL AND
SOMETHING AS A COMMITTEE WE WERE
VERY PROUD OF.
IT IS PROBABLY UNDENIABLE, I
WOULD IMAGINE MOST PEOPLE IN THE
ROOM WOULD AGREE WE ARE AT A
PARTICULAR SOCIAL-POLITICAL
MOMENT.
IT IS PROBABLY AN UNDERSTATEMENT
TO SAY WE HAVE DIFFERENT VIEWS
AS THE WAY WE SHOULD ADVANCE AS
A NATION.
SOME OF WHAT HAS BEEN OUR
DOMINANT PERSPECTIVE OR WHERE
THE TENSION HAS BEEN IN TERMS OF
WHERE EACH OF US MAY STAND IS IN
WHAT IS COMMONLY REFERRED TO AS
A ZERO SUM GAME.
IF WE MAKE INVESTMENTS IN THOSE
GROUPS THAT ARE FURTHEST FROM
ACHIEVING THE EQUITABLE OUTCOME,
SOMEHOW THAT MEANS ANOTHER GROUP
IS LOSING OUT.
SO IF WE MAKE INVESTMENTS IN
INDIGENOUS COMMUNITIES THEN SOME
OTHER GROUP IS MISSING OUT.
IF WE TARGET SPECIFICALLY LATINO
INDIVIDUALS AND ANOTHER GROUP IS
LOSING OUT.
I THINK FOLKS CAN APPRECIATE THE
ARGUMENT OF WHAT I'M SAYING.
WHAT WAS CLEAR IN OUR REVIEW OF
THE EVIDENCE WAS THAT THIS ZERO
SUM GAME IS A MYTH.
IT IS NOT TRUE.
IT IS THROUGH DIRECTLY FOCUSING
ON EFFORTS ON THE INEQUITIES AND
ELIMINATION OF THE HEALTH AND
HEALTH CARE INEQUITIES WE SEE
IMPROVEMENTS IN THE STATUS OF
THOSE GROUPS.
HERE IS THE PART THAT WAS REALLY
EXCITING, AND WE SEE BENEFITS TO
POPULATIONS OUTSIDE OF THOSE
GROUPS.
AND WE SEE THE SAME IS TRUE WHEN
WE CHOOSE AS A NATION TO NOT
ADDRESS THOSE INEQUITIES.
IT DOESN'T ONLY AFFECT THOSE
POPULATIONS THAT ARE
EXPERIENCING THE BURDEN OF THE
INEQUITY, BUT, IN FACT, IT HAS
IMPLICATIONS FOR US ALL.
THIS IS A MESSAGE OF WHY WE ARE
IN THIS TOGETHER.
WHY IT MATTERS WHEN WE SEE
INVESTMENTS FROM ALL OF THE
IMPORTANT INSTITUTIONS IN OUR
SOCIETY, INCLUDING NINR IN
SPECIFIC COMMUNITIES.
IT IS NOT JUST ABOUT THAT
COMMUNITY.
YES, IT WILL BENEFIT THEM, BUT
IT WILL HAVE IMPORTANT
IMPLICATIONS FOR COMMUNITIES FAR
REMOVED FROM THE COMMUNITY THAT
IS THE IMMEDIATE RECIPIENT OF
WHATEVER THAT IS THAT THE
PROGRAM OR POLICY IS INTENDED TO
ADDRESS.
WE KNOW WE HAVE A HEALTH CARE
SYSTEM.
THIS WAS QUITE PRONOUNCED AND
ROBUST IN THE REPORT AS WELL AS,
THAT OVERLY PRIORITIZED
DIAGNOSE, TREATMENT AND
MANAGEMENT OF DISEASE.
WE HAVE A SICK CARE MODEL IN OUR
COUNTRY THAT PLACES MOST OF ITS
RESOURCES ON ACUTE CARE.
ONE OF THE THINGS THAT WAS
APPARENT IN THE REPORT IS THE
SMALL INVESTMENTS WERE MADE IN
PRIMARY CARE, IN TERMS OF
WORKFORCE, ACTUAL RESOURCES TO
RUN PRIMARY CARE AND IN TERMS OF
RESEARCH TO STUDY PRIMARY CARE.
WE ARE A HEALTH MODEL THAT
FOCUSES ON VOLUME OF SERVICES,
OFTEN IN THE COSTLIEST SETTINGS
WITH THE COSTLIEST PROCEDURES.
WHERE ARE ALL THE PLACES WE CAN
DO MUCH MORE WORK AROUND KEEPING
THE POPULATION HEALTHY.
HEALTH PREVENTION, RESTORING
PEOPLE TO OPTIMAL HEALTH AND
SAVE MONEY BY HAVING GREATER
INVESTMENTS IN POPULATION
HEALTH.
THE ONLY KIND OF HEALTH CARE
THAT HAS THE BENEFIT OF A
POPULATION HEALTH EFFECT IS
PRIMARY CARE, YET IT IS, AS I
MENTIONED, THE SETTING WHERE WE
MAKE THE LEAST INVESTMENT.
THE THING THAT WAS REALLY
INTERESTING ALSO IN THE REPORT
THAT WE SPENT A LOT OF TIME ON
WAS REALLY LOOKING AT THE
EVIDENCE AROUND THE INTEGRATION
OF CLINICAL AND SOCIAL CARE.
WHAT IS IT EXACTLY THAT THE ROLE
OF THE HEALTH CARE SYSTEM IS IN
MOVING BEYOND THE TRADITIONAL
DOMAIN OF CLINICAL CARE AND
FORMALLY INTEGRATED SOCIAL CARE.
AND HOW DO WE MAKE OUR CARE LESS
CLINICIAN DRIVEN AND MORE
CENTERED DRIVEN, MORE WHOLE
PERSON FOCUSED, MORE
RELATIONSHIP BASED?
AND THAT FOCUSES MUCH MORE ON
WELLNESS, PREVENTION AND HEALTH
PROMOTION.
SO LOTS OF CONTENT AND QUESTIONS
IN TERMS OF NURSING SCIENCE AS
TO WHAT DOES INTEGRATED SOCIAL
AND CLINICAL CARE LOOK LIKE.
OUR WORKFORCE IS TOO NARROWLY
DEFINED.
WE NEED MORE PEOPLE.
WE NEED TO THINK ABOUT ROLES
THAT ARE CURRENTLY NOT WELL
DEFINED AND ALSO ACTORS THAT
NEED TO BE FORMALLY EMBRACED.
WE NEED TO REMOVE ARBITRARY AND
UNSCIENTIFIC RESTRICTIONS ON THE
ENTIRE WORKFORCE.
THIS IS QUITE PRONOUNCED IN
NURSING, BUT ALSO PHARMACY AND
PHYSICIAN ASSISTANTS AND OTHER
ACTORS.
EVERY SINGLE HEALTH CARE
PROFESSIONAL NEEDS TO BE ALL
HANDS ON DECK AND PERFORMING AT
THE HIGHEST LEVEL AND NEED NEW
PEOPLE AND NEW WAYS OF DOING
THING AND ORGANIZED IN
PROFESSIONAL TEAMS THAT ARE
WORKING TOGETHER TO ADDRESS OUR
NATION'S HEALTH.
WE DO NOT HAVE A REPRESENTATIVE
HEALTH CARE AND HEALTH
WORKFORCE.
SO THE WORKFORCE THAT WE HAVE IS
NOT ABLE TO RESPOND TO THE NEEDS
OF THE POPULATIONS THAT ARE
BEING SERVED.
THE STRONGEST EVIDENCE WE HAVE
AROUND SORT OF THE IMPORTANCE OF
HAVING A REPRESENTATIVE
WORKFORCE REALLY COMES FROM ALL
THE LITERATURE ON CONCORDANCE
BETWEEN PATIENTS AND PROVIDERS.
AND THOSE MECHANISMS ARE NOT
COMPLETELY UNDERSTOOD.
THEY ARE IN CHAPTER 5 OF THE
REPORT.
WHAT IS CLEAR IS AS A NATION WE
MUST HAVE A REPRESENTATIVE
WORKFORCE, THAT IS
REPRESENTATIVE OF THE
POPULATIONS RECEIVING CARE.
WE NEED TO EXAMINE CRITICALLY
OUR WORKFORCE IN TERMS OF
DECISION MAKING, THE KINDS OF
TOOLS AND ALGORITHMS.
THERE'S LOTS OF INTEREST IN
TECHNOLOGY AND AI, ET CETERA.
THOSE ARE THINGS THAT ARE GOOD,
BUT THE CHALLENGES THAT WE HAVE,
AND THIS IS WELL DOCUMENTED IN
THE REPORT, IS THAT MUCH OF THAT
TECHNOLOGY IS PLAGUED BY THE
SAME BIAS THAT WE HAVE IN SORT
OF THE HEALTH CARE WORKFORCE AS
IT CURRENTLY EXISTS IN TERMS OF
PEOPLE DELIVERING CARE.
WE NEED TO BE CAREFUL ABOUT THAT
IMPLICIT BIAS AND NOT
REPLICATING THAT THROUGH THE USE
OF TECHNOLOGY.
WE DON'T ROUTINELY COLLECT A
REPORT -- THIS WAS SURPRISING
ME, MAYBE OTHERS IN THE ROOM
KNOW THIS, I DID NOT KNOW.
WE DO NOT ROUTINELY COLLECT A
REPORT ACROSS ALL AGENCIES IN
OUR NATION SETTINGS, PATIENT
DATA ON RACE, ETHNICITY, TRIBAL
AFFILIATION, LANGUAGE
AFFILIA
AFFILIATION.
WE CERTAINLY DO NOT REPORT DATA
THAT HIGHLIGHTS THE INEQUITY.
WE MAY MAKE COMPARISONS THAT ARE
DESCRIPTIVE AND I CAN GIVE
EXAMPLES IN THE Q&A, BUT WE
RARELY ARE REPORTING ON
INEQUITIES.
WE DON'T ADEQUATELY INVEST IN
RESEARCH THAT IS FOCUSED ON
SOLUTIONS.
AND THOSE SOLUTIONS BEING TIED
TO THE ELIMINATION OF HEALTH AND
HEALTH CARE INEQUITIES.
THIS IS VERY IMPORTANT BECAUSE
THERE HAVE BEEN SORT OF, THERE'S
BEEN PROGRESS CERTAINLY.
ONE OF THE CHAPTERS IN THE
REPORT REALLY LOOKS AT FUNDING
IN NIH AND SHOW INCREASES IN
DOLLARS ALLOCATED TO HEALTH
EQUITY RESEARCH.
WHAT IS ALSO TRUE THERE,
SOMETHING I HAVE BEEN EXCITED TO
SHARE IS NINR AND NIMHD HAVE
BEEN ALLOCATIONS OF THEIR
OVERALL PORTFOLIO ADDRESSING
THIS WORK.
THE LION'S SHARE OF THE
RESOURCES ARE NOT FOCUSED AT ANY
OF THE INSTITUTES AT NIH ON WORK
THAT WOULD ELIMINATE HEALTH AND
HEALTH CARE INEQUITIES.
WE NEED TO DO MORE AND WE CAN DO
MORE.
AND THE LAST POINT I WILL MAKE
AROUND SORT OF HIGH-LEVEL
FINDINGS ARE THAT WE HAVE HAD
MANY POLICIES AND PROFESSOR
DAWES CAN TALK ABOUT THIS WHEN
WE GET INTO OUR Q&A.
BUT THESE POLICIES, BOY, WAS IT
INTERESTING SEEING POLICIES AND
PROGRAMS THAT, IN FACT, HAVE
HELPED AND HAVE BEEN SUCCESSFUL,
WHERE THERE IS EVIDENCE.
THINGS LIKE THE AFFORDABLE CARE
ACT OR MEDICAID EXPANSION.
AND ALSO POLICIES THAT HAVE
ACTUALLY NOT BEEN HELPFUL OR
HAVE THE POTENTIAL FOR
EXACERBATING INEQUITIES.
FOR EXAMPLE, WHAT WE ARE
EXPERIENCING NOW AROUND SOME OF
THE LIMITATIONS OF THE
CONSIDERATION OF RACE IN TERMS
OF HIGHER EDUCATION ADMISSIONS
DECISIONS AND WHAT THAT MEANS
FOR THE HEALTH CARE WORKFORCE
GIVEN WHAT WE KNOW ABOUT THE
IMPORTANCE OF
REPRESENTATIVENESS.
I THINK I WILL STOP THERE IN
TERMS OF HIGH-LEVEL OVERVIEW.
LET ME SHARE ON AUGUST 27th I
HAD A WONDERFUL INVITATION BY
NINR TO TALK ABOUT WHAT THIS
MEANS FOR NURSING SCIENCE.
SO I'M NOT GOING TO HAVE TIME
TODAY TO KIND OF REVIEW ALL OF
THAT, BUT MY LECTURE WAS FOCUSED
ON THESE SIX PIECES.
AT A HIGH LEVEL, I WILL
HIGHLIGHT SOME OF THE THINGS I
SAID.
THE RECORDING IS ON THE WEBSITE
AND AVAILABLE FOR FOLKS TO SEE
AND THERE'S LOTS MORE SPECIFICS
AROUND SOME OF THE IMPLICATIONS.
LET ME JUST GO THROUGH REALLY
QUICKLY AND HIGHLIGHT SOME OF
THE AREAS.
IN TERMS OF HEALTH AND HEALTH
CARE DELIVERY MODELS, I THINK I
HAVE ALREADY MENTIONED RESEARCH
THAT REALLY THINKS ABOUT NEW
WAYS OF MOVING AWAY FROM SICK
CARE AND PRIORITIZING THE
INTEGRATION OF SOCIAL AND
CLINICAL CARE.
MUCH MORE OF A FOCUS ON PRIMARY
CARE AS THE BACKBONE OF HEALTH
CARE.
HOW DO WE ENHANCE THE
PERSON-CENTEREDNESS AND THE
WHOLE-PERSON PERSPECTIVE IN
HEALTH CARE DELIVERY?
HOW DO WE THINK ABOUT
INTERVENTIONS THAT ARE DYNAMIC
AND THAT ARE MULTILEVEL AND CAN
EFFECTIVELY MITIGATE THE HARMFUL
SOCIAL DETERMINANTS OF HEALTH?
THESE ARE JUST SOME EXAMPLES.
AGAIN, THERE IS MORE IN THE
LECTURE.
SECOND AREA, IN TERMS OF
EVIDENCE GENERATION AND
METHODOLOGY.
HOW DO WE RESOLVE CONCEPTUAL
TENSIONS AND CLOSE GAPS IN THE
EMPIRICAL EVIDENCE?
ONE OF THE THINGS THAT HAS BEEN
CONCERNING TO ME IS THERE IS A
GROUP OF SCHOLARS WRITING
PAPERS, AS MANY OF YOU ARE
AWARE, THAT ARE QUESTIONING
WHETHER OR NOT IT IS WISE TO
MAKE INVESTMENTS IN SOCIAL
DETERMINANTS OF HEALTH.
SHOULD HEALTH DOLLARS BE USED
WITHIN PROGRAMS THAT ADDRESS
SOCIAL DETERMINANTS OF HEALTH.
PROBABLY ONE OF THE MOST RECENT
IS A REPORT THAT CAME OUT OF THE
MANHATTAN INSTITUTE BY A SENIOR
FELLOW WHO IS THERE, DR. CHRIS
POPE, WHO ARGUES THAT OUR
EMPHASIS ON SOCIAL DETERMINANTS
IS INFLATED AND WE SPEND TOO --
WE RUN THE RISK OF SPENDING TOO
MUCH OF OUR RESOURCES FOR HEALTH
DETERMINES ON ADDRESSING SERMOC
DETERMINANTS OF HEALTH.
I READ CHRIS' REPORT VERY
CLOSELY.
I FELT TREMENDOUS GRATITUDE TO
HIM.
I ACTUALLY REACHED OUT.
HE RAISES QUESTIONS FOR THOSE OF
US WHO BELIEVE THERE SHOULD BE
INTEGRATION OF CLINICAL AND
SOCIAL.
HIS QUESTIONS ARE LIKE SHINING
THE LIGHT ON HOW NURSING SCIENCE
CAN LEAD AND HOW WE CAN ACTUALLY
ADDRESS SOME OF THOSE STEPS.
I DON'T AGREE WITH EVERYTHING HE
SAYS, BUT BOY AM I HAPPY HE SORT
OF SAID, HEY, THERE IS ROOM HERE
TO GROW AND ROOM TO HAVE OUR
NURSING SCIENCE LEAD.
WE NEED NEW STUDY DESIGNS AND
MET
METHODS.
WE HAVE TO WORK ON MEASUREMENTS
THAT DRIP HEALTH INEQUITY, LARGE
SCALE MULTISITE DEMONSTRATIONS
OF NOVEL MODELS AND HOW DO WE
SCALE IS UP AND HAVE GREATER
IMPACT.
WORKFORCE ENHANCING TRAINING
OPPORTUNITIES FOR A SCIENCE
WORKFORCE COMMITTED TO SOLUTIONS
AND THE ELIMINATION OF HEALTH
AND HEALTH CARE INEQUITIES.
HOW DO WE IMPROVE THE
COMPETITIVE ACQUISITION OF
FUNDING FOR THE NURSING
WORKFORCE?
THIS IS NOW PART OF THE
APPLICATION OF THE FINDINGS FROM
THE REPORT, SORT OF MY THOUGHTS.
BUT US NURSE SCIENTISTS, WE'VE
GOT TO THINK ABOUT THE PIPELINE.
THERE ARE CLEARLY ISSUES IN
TERMS OF RETIREMENT AND PEOPLE
PURSUING A PH.D. IN NURSING AND
ALSO THE FUNDING RATES OF NURSE
SCIENTISTS AT NOT ONLY NINR, BUT
ACROSS NIH AND OTHER FEDERAL
FUNDERS.
WE'VE GOT TO GET OUR NURSE
SCIENTISTS SORT OF FUNDED AND
MAKE THEM MORE COMPETITIVE, MAKE
US MORE COMPETITIVE.
AND THEN ALSO THE ISSUES AROUND
THE REPRESENTATIVENESS.
DO WE HAVE THE RIGHT WORKFORCE?
DO WE HAVE THE RIGHT PEOPLE
ASKING THE RIGHT QUESTIONS?
AND DO WE HAVE THE RIGHT KINDS
OF INDIVIDUALS REPRESENTATIVE OF
THE COMMUNITIES WE ARE SEEKING
TO SERVE IN THAT RESEARCH.
IN TERMS OF MEANINGFUL COMMUNITY
ENGAGEMENT.
THE REPORT ELEVATES THE
COMMUNITY.
I'M LOOKING FORWARD TO HEARING
DR. McLEMORE'S TALK LATER THIS
AFTERNOON, BUT IT SAYS CLEARLY
THAT COMMUNITY NEEDS TO BE
ELEVATED TO THE SAME PLACE WHERE
THE HEALTH CARE SYSTEM IS.
IF WE ARE GOING TO ELIMINATE
HEALTH AND HEALTH CARE
INEQUITIES, WE NEED TO THINK
ABOUT WAYS TO MEANINGFULLY
ENGAGE COMMUNITIES THERE.
A SHOUT OUT FOR EVIDENCE-BASED
FRAMEWORKS AND COMMONLY REFERRED
TO AS MEANINGFUL COMMUNITY
ENGAGEMENT.
IT IS IMPORTANT TO INCORPORATE
MCE INTO SCIENTIFIC TRAINING AND
USING HEALTH CARE SYSTEMS FOR
THE DATA THEY ARE REQUIRED TO
COLLECT TO DO SOMETHING ABOUT
WHAT THEY ARE SEEING IN TERMS OF
THE INEQUITIES.
AND, YOU KNOW, I THINK ONE OF
THE PIECES THAT IS THIS LAST
POINT HERE IS THAT WE NEED
LEADERSHIP FROM ALL OF OUR
INSTITUTIONS IN SOCIETY TO
REALLY SEE THAT THERE ARE THESE
LARGER ISSUES OF CENTERING
HEALTH AND HEALTH CARE
INEQUITIES AND HOW DO WE MAKE
HEALTH AND HEALTH CARE MORE
AVAILABLE.
THE LAST IS EVIDENCE-BASED
POLICIES AND LEGAL PAYMENT
REFORM.
TWO POINTS.
I THINK THERE ARE LOTS OF
OPPORTUNITIES FOR NURSING
SCIENCE TO REALLY LOOK AT A
WHOLE SET OF NATURAL
EXPERIMENTS.
THERE ARE POLICIES THAT ARE
CHANGING THAT ARE REALLY
IMPORTANT WE SHOULD BE FOLLOWING
CLOSELY SEEING THE IMPACT OR
EFFECT OF NEW LAWS OR EXISTING
LAWS AND WHETHER OR NOT THESE
LAWS ARE RESULTS IN THINGS
CONSEQUENTIAL TO OUR NATION'S
HEALTH.
AND THEN ALL THE WORK AROUND
PAYMENT REFORM AND REALLY
THINKING ABOUT MOVEMENT AWAY
FROM A MODEL THAT
OVERPRIORITIZES PROCEDURES TO
REALLY A MODEL THAT EMPHASIZES
HOW WE CAN INCENTIVIZE HEALTH
OUTCOMES, BUT ENSURING WHEN WE
DO THAT WE ARE NOT DOING THAT IN
A WAY THAT WINDS UP BEING
UNINTENDED CONSEQUENCE.
THERE ARE MANY EXAMPLES WE CAN
TALK ABOUT DURING OUR Q&A.
LAST THING, I THOUGHT I WAS ON
THE LAST ONE.
ONE MORE.
PRIORITY NUMBER SIX.
SOLUTIONS AND MOVING BEYOND
CHARACTERIZATIONS OF INEQUITIES.
THE IMPORTANCE OF A CLEAR STAND
ON THE ELIMINATION OF HEALTH AND
HEALTH CARE INEQUITIES VERSUS A
MORE INCREMENTAL APPROACH TO
ADVANCE HEALTH EQUITY.
A DIRECT SHOUTOUT TO OUR NURSING
SCHOOLS AND PROFESSIONAL
ORGANIZATIONS TO REALLY CENTER
THE ELIMINATION OF HEALTH AND
HEALTH CARE INEQUITIES IN MY
EXPERIENCE HAS NOT BEEN IN A LOT
OF INSTITUTIONS IN THE WAY THAT
NURSING ORGANIZATIONS ARE
CURRENTLY SET UP.
THIS IS SOMETHING WE CAN CHANGE
AN SOMETHING WE SHOULD CHANGE.
SO JUST IN A NUTSHELL TO WRAP
UP, I WANT TO SPEND A MOMENT
ACKNOWLEDGING NINR.
I THINK DIRECTOR ZENK DID A
FANTASTIC JOB.
I WILL SAY ON BEHALF OF THE
COUNCIL, HOPEFULLY YOU DON'T SEE
ME BEING OUT OF TURN, BOY, WAS
THAT IMPRESSIVE THE OVERVIEW AND
REPORT.
IT SPEAKS TO WHAT PRECEDED
ENDING UNEQUAL TREATMENT IS THE
NINR STRATEGIC PLAN IN 2022.
YOU CAN SEE WHAT IS HERE NINR
HAS BEEN DOING THIS WORK.
THAT WAS SOMETHING THAT CAME OUT
IN THE REPORT.
THERE IS A SPECIAL SHOUTOUT IN
THE REPORT SPECIFICALLY TO NINR.
SOME EXAMPLES OF LEADERSHIP ARE
THE MECHANISMS, I WON'T REVIEW
THESE.
I THINK DIRECTOR ZENK DID A
GREAT JOB TALKING ABOUT THESE.
THERE'S LOTS OF EVIDENCE THAT
NINR IS REALLY LEADING AND
MAKING SERIOUS COMMITMENTS TO
ELIMINATE HEALTH AND HEALTH CARE
INEQUITIES.
THE SUMMER INSTITUTE WAS ANOTHER
GREAT EXAMPLE.
AGAIN, I THINK THAT WAS ALREADY
DISCUSSED, BUT THIS IS SOMETHING
WE ALL SHOULD BE PROUD OF.
WE SHOULD BE MAKING SURE WE ARE
SHARING AND LETTING PEOPLE KNOW
THE IMPORTANT WORK THAT NURSING
SCIENCE IS DOING LED BY THE
SUPPORT FROM ANYONE.
I'LL END BY SIMPLY SAYING WE ARE
IN THIS TOGETHER.
WE ARE IN A MOMENT WHERE THERE
IS GREAT SOCIAL AND POLITICAL
POLARIZATION.
IT POSES A RISK THAT AS A NATION
WE WON'T MOVE FORWARD AND IN 20
MORE YEARS THERE WILL BE SOMEONE
ELSE, NOT VINCENT GUILAMO RAMOS,
BUT WHOEVER IS COMING AFTER ME
WILL SAY THEY LOOK AT THE 2003
AND 2024 AND THE MOST RECENT
REPORT AND THAT WE STILL ARE A
NATION WITH HEALTH AND HEALTH
CARE INEQUITIES.
IN ORDER FOR THAT NOT TO HAPPEN,
WE HAVE TO REALIZE THERE IS NO
SUCH THING AS A ZERO SUM GAME.
THAT IS A MYTH AND WE NEED TO
FOCUS EFFORTS ON COMMUNITIES
THAT HAVE THE GREATEST
INEQUITIES AND IN DOING SO IT
BENEFITS ALL OF US.
IF WE DON'T RESPOND, THERE ARE
CONSEQUENCES FOR ALL OF US.
THANK YOU VERY MUCH AND I
CERTAINLY APPRECIATE THE TIME
TALKING TODAY.
THERE ARE SOME RESOURCES OF
THINGS THAT MY GROUP HAS BEEN
WRITING THAT MAY BE OF INTEREST.
SO IF THERE'S -- THEY ARE
OPEN-ACCESS MATERIALS.
TAKE A LOOK AT THOSE.
I WILL END BY SAYING THANK YOU
FOR THE OPPORTUNITY TO TALK
TODAY.
APPRECIATE IT.
>> THANK YOU SO VERY MUCH, DR.
GUILAMO-RAMOS FOR YOUR SERVICE
AND REPORTING ON THAT REPORT.
WE APPRECIATE YOU SHARING THAT
TODAY.
IT REALLY IS, I THINK FOR US,
REASSURING AND INSPIRING TO SEE
THE ALIGNMENT BETWEEN THE
STRATEGIC PLAN AND THE REPORT.
SO WE'RE GLAD FOR THAT, BUT AT
THE SAME TIME WE AGREE WITH THE
CONCLUSIONS OF F THE COMMITTEE
THAT THERE IS A LOT MORE TO DO
AND WE ARE COMMITTED TO
GENERATING THE SCIENCE TO GET
THERE.
I HAVE ASKED DR. BEKEMEIER AND
PROFESSOR DAWES TO OPEN THE
DISCUSSION BY SHARING YOUR
PERSPECTIVES ON OPPORTUNITIES
FOR NURSING SCIENCE TO RESPOND
TO THE REPORT AND THEN WE'LL
OPEN UP TO EVERYONE TO JUMP IN
AND SHARE YOUR IDEAS, TOO.
SO DR. BEKEMEIER, WOULD YOU LIKE
TO START?
>> OKAY.
SO THANKS FOR HAVING ME.
I LOVED HEARING YOU OVERVIEW AND
SEEING YOUR SLIDES AHEAD OF
TIME.
AND GETTING THE CHANCE TO SORT
OF DIG INTO THIS REPORT.
ALTHOUGH I WISH I WOULD HAVE
FOUND THE CLIFF NOTES FIRST.
I WAS ASKED TO REFLECT ON THIS
FROM MY PERSPECTIVE.
AND SO MY UNIQUE OR DIFFERENT
PERSPECTIVE.
AND MINE IS AS A NURSE
SCIENTIST, PUBLIC HEALTH SYSTEMS
RESEARCHER.
AND, YOU KNOW, THINKING FROM MY
LENS, NURSES ARE THE BACKBONE OF
THE PUBLIC HEALTH SYSTEM SO WE
CARRY A BIG BURDEN IN TERMS OF
OBLIGATION OF ENSURING
EFFECTIVENESS OF OUR PREVENTION
SYSTEM.
THAT IS MY LENS.
I WAS REALLY EXCITED BY SO MUCH
OF THIS REPORT.
I WILL JUST NOT REITERATE THE
THINGS YOU TALKED ABOUT
NECESSARILY, BUT FOCUS ON THIS
FROM MY LENS IN TERMS OF THE
FOCUS AND TYPES OF STUDIES AND
POPULATIONS THAT JUMP OUT TO ME
THAT WE SHOULD LOOK AT.
IN TERMS OF THE FOCUS, TO ME,
THIS SCREAMS WE'VE GOT TO BE --
OUR SCIENCE AND RESEARCH NEEDS
TO BE AT MULTIPLE LEVELS AND IT
TALKS ABOUT THAT, BUT INCLUSIVE
OF AND EMPHASIZING UPSTREAM LOOK
AT HOW WE DO OUR WORK AND OUR
SCIENCE.
BECAUSE I'M REALLY EXCITED ABOUT
THIS NOTION OF FOCUSING ON
ELIMINATING INEQUITIES AND NOT
JUST ADVANCING THEM.
BUT TO DO THAT, WE REALLY HAVE
TO GET BEYOND A NARROW LOOK AT
THE HOSPITAL WALLS, NECESSARILY,
AND THINK BIGGER IN TERMS OF THE
SYSTEMS WE ARE TALKING ABOUT.
IN CONNECTION WITH THAT, I
STRUGGLED A LITTLE BIT.
MAYBE DR. GUILAMO-RAMOS YOU CAN
TALK ABOUT THIS LATER.
I DID STRUGGLE WITH ABOUT WHAT
THE DEFINITION IS OR HOW BROADLY
FOLKS THOUGHT ABOUT IN TERMS OF
THE HEALTH CARE SYSTEM?
AND DID THAT HEALTH CARE SYSTEM
INCLUDE -- I KNOW IT SAID IT WAS
INCLUSIVE OF PUBLIC HEALTH.
HOW DO THOSE PUBLIC HEALTH
SYSTEMS PLAY INTO THE BROADER
SYSTEM?
I KNOW IT LOOKED AT CARE ACCESS,
USE AND QUALITY.
SO THINKING, TOO, IN TERMS OF
HOW BROADLY WE CAN THINK ABOUT
THAT.
LET'S SEE.
AND SOME OF THE FOCUS, TOO, IN H
ONE OF THE RECOMMENDATIONS OR IN
ONE AREA IT SAYS THAT WE --
THERE WAS A RECOMMENDATION ON
FUNDERS EXPANDING THEIR FUNDING
FOR ADDRESSING STRUCTURAL
RACISM, HEALTH RELATED SOCIAL
NEEDS TO ELIMINATE HEALTH
INEQUITIES.
THIS, TO ME, REINFORCES THIS
UPSTREAM THINKING.
IF WE ARE GOING TO BE REALLY
IMPACTING THESE AREAS.
IN TERMS OF TYPES OF STUDIES,
YOU SAID IMPLEMENTATION SCIENCE,
IMPLEMENTATION SCIENCE, ET
CETERA.
AND I, TOO, HAVE LONG THOUGHT
THAT IMPLEMENTATION SCIENCE IS
SO RIGHT FOR NURSING SCIENCE.
IT IS WHERE WE'RE AT.
IT IS WHERE WE LIVE.
WE HAVE SUCH A DEEP
UNDERSTANDING OF HOW THINGS WORK
OR DON'T WORK IN THE COMMUNITIES
WE SERVE.
IT IS A GREAT PLACE FOR NURSES
TO BE TESTING AND SCALING UP
PROMISING INTERVENTIONS.
AND INCLUSIVE OF POLICY
INTERVEN
INTERVENTIONS.
I LIKE THE EMPHASIS ON POLICY
INTERVENTIONS.
I DON'T THINK WE DO ENOUGH OF
THAT AND I LOVE THAT WAS
EMPHASIZED HERE.
AND THE NOTION THAT THERE ARE
LIMITED INTERVENTIONAL STUDIES
FOCUSING ON ELIMINATING RACIAL
AND ETHNIC INEQUITIES.
INTERVENTION STUDIES WE CAN BE
SCALING UP.
I LOVED YOUR COMMENT, TOO, OF
LOOKING AT THAT INTEGRATION OF
CLINICAL AND SOCIAL CARE.
THAT, TO ME, IS AN IMPORTANT
PLACE FOR US.
IN TERMS OF APPROACHES, I THINK
NURSING SCIENCE CAN REALLY EXCEL
IN AREAS THAT CAME OUT IN THE
REPORT AROUND COMMUNITY-BASED
PARTICIPATORY RESEARCH AND I
ALSO DO A LOT OF PRACTICE-BASED
RESEARCH, SO WITH PRACTICE
PARTNERS.
YOU TALKED ABOUT -- AND
MEANINGFUL COMMUNITY ENGAGEMENT
SLIDE, I REALLY LIKED THAT
NOTION OF THIS WORK BEING
COMMUNITY CENTERED.
IN THE REPORT IT HAS -- THERE IS
A MODEL THAT HAS A
PERSON-CENTERED.
MAYBE THIS IS SOMETHING TO TOUCH
ON LATER, TOO.
IT WAS A LITTLE -- THERE WAS A
LITTLE TENSION TO ME SOMETIMES
TO THE DEGREE WE ARE PERSON
CENTERED OR COMMUNITY CENTERS OR
COULD WE BE BOTH?
BUT -- AND ALSO YOU MENTIONED
NURSING SCIENCE HAVING A PLACE
IN LEADERSHIP IN ADDRESSING SOME
OF THESE SOCIETAL CHALLENGES
AROUND MISTRUST OF SCIENCE, ET
CETERA.
TO ME THAT IS A HUGE PLACE FOR
NURSING SCIENCE.
IN PART BECAUSE WE'RE ALWAYS
BROUGHT UP OVER AND OVER AS THE
MOST TRUSTED PROFESSION, BLAH,
BLAH, BLAH.
THAT IS AN OBLIGATION FOR US.
IF WE'RE GOING TO BE -- IF WE
ARE GOING TO HOLD OURSELVES UP
AS THE MOST TRUSTS PROFESSION,
WE HAVE AN OBLIGATION TO PROVIDE
LEADERSHIP IN THAT AREA SO I
WOULD SAY ABSOLUTELY.
JUST BRIEFLY, IN TERMS OF
SPECIFIC POPULATIONS, THE REPORT
KIND OF TALKS A LOT ABOUT RURAL
AREAS, THE DIGITAL AND DATA
DIVIDE, LACK OF WORKFORCE, LACK
OF ENOUGH WORKFORCE AS WELL AS
REPRESENTATIVE WORKFORCE IN
RURAL AREAS.
THAT IS AN AREA WE COULD AND
SHOULD BE DOING MORE IN.
AND DEFINITELY INDIGENOUS
POPULATIONS ARE TALKED ABOUT IN
THE REPORT QUITE A BIT AND THAT
IS A SPACE FOR US.
I WILL STOP THERE AND HAND IT
OFF TO DR. DAWES.
>> THANK YOU, DR. BEKEMEIER.
GOOD MORNING, EVERYONE.
GOOD MORNING.
IT IS SO GOOD TO BE HERE.
FIRST LET ME THANK YOU DR.
GUILAMO
GUILAMO-RAMOS FOR THAT GREAT
PRESENTATION.
I THOUGHT IT WAS INSIGHTFUL.
THANK YOU FOR YOUR WORK THAT THE
NURSING ASPECT WAS STRONG ON
ENDING UNEQUAL TREATMENT.
I WANT TO THANK OR DIRECTOR, DR.
ZENK, FOR HER COURAGEOUS
LEADERSHIP IN BROADENING
INCLUSIVITY AND GO AFTER THE
INSTIGATORS.
I HEARD YOU LOUD AND CLEAR, DR.
GUILAMO
GUILAMO-RAMOS.
WHERE SHOULD I START THE
TIMELINE?
I GO BACK TO -- AND I GO BACK TO
THAT TIME BECAUSE THERE WERE TWO
INSTANTS, 1865 UNDER THE LINCOLN
ADMINISTRATION WITH THE ENDING
OF THE CIVIL WAR, ENSURING THAT
NEWLY FREED BLACK PEOPLE AND
POOR WHITES WOULD HAVE ACCESS TO
THESE RESOURCES TO ADDRESS THEIR
SOCIAL DETERMINANTS OF HEALTH
AND DR. KING FOUGHT TO
ELIMINATE.
THERE WAS ANOTHER OPENING WHERE
THE FEDERAL GOVERNMENT AGAIN
PAID ATTENTION AND INVESTED
RESOURCES IN THE 1930s THEY
CREATED THE OFFICE OF NEGRO
HEALTH WORK, THEY FOCUSED ON
LOOKING AT DISPARATELY IMPACTED
POPULATION GROUPS.
BUT THEN WHAT HAPPENS?
BEFORE THOSE COULD BE SUSTAINED,
OPPONENTS OF ILL WILL WENT IN
AND ELIMINATED THOSE
OPPORTUNITIES WHERE WE WERE
SEEING IMPROVEMENTS IN LIFE
EXPECTANCY.
I WANT TO START WITH THE HECKLER
REPORT.
I'M SO GLAD YOU STARTED WITH
THAT ONE.
IT HAS BEEN OUR CHARGE.
I WANTED TO READ THIS BECAUSE I
THINK IT SPEAKS TO DR. ZENK AND
THE TEAM HERE AT NINR.
IT SAYS BASICALLY FOUR DECADES
AGO HHS SECRETARY MARGARET
HECKLER UNDER THE REAGAN
ADMINISTRATION DECLARED DESPITE
THE UNPRECEDENTED EXPLOSION IN
SCIENTIFIC KNOWLEDGE AND
MEDICINE TO DIAGNOSE, TREAT AND
CURE DISEASES, BLACKS,
HISPANICS, NATIVE AMERICANS AND
THOSE OF ASIAN AND PACIFIC
ISLANDER HERITAGE HAVE NOT
BENEFITED FULLY OR EQUITABLY
FROM THE FRUITS OF SCIENCE OR
THOSE SYSTEMS RESPONSIBLE FOR
TRANSLATING AND USING HEALTH
SCIENCES TECHNOLOGY.
THE TASK FORCE ON BLACK AND
MINORITY HEALTH WAS CONCEIVED IN
RESPONSE, A STEADY IMPROVEMENT
IN OVER ALL HEALTH STATUS WHILE
AT THE SAME TIME PERSISTENT
HEALTH INEQUITIES EXIST FOR
MINORITY AMERICANS.
THE TASK FORCE CAME INTO BEING
IT WAS EVIDENT TO BRING THE
HEALTH OF MINORITIES TO THE
LEVEL OF ALL AMERICANS, EFFORTS
OF MONUMENTAL PROPORTIONS WERE
NEEDED.
ARE WE THEN SURPRISED, RIGHT, AT
THE CONCLUSION YOU MADE EARLIER,
LIMITED OVERALL PROGRESS HAS
BEEN REALIZED.
WE HAVEN'T INVESTED TIME,
RESOURCES, HUMAN CAPITAL AT THE
LEVEL WE NEED TO, TO ADDRESS IT,
UNTIL NOW.
I'M EXCITED BY NINR'S FOCUS ON
THE SOCIAL DRIVERS OF THESE
INEQUITIES.
WHY IS THIS IMPORTANT?
AS WE ARE MOVING FORWARD, I'M
GLAD YOU ALSO MADE THE CASE WITH
OUR HEALTH ECONOMISTS AND WHILE
WE KNOW THAT THE MORAL ARGUMENT
SHOULD BE SUFFICIENT, WE KNOW
THAT IS NOT NECESSARILY TRUE.
IN A RECENT REPORT THAT MY TEAM
AND I FPUBLISHED, WE WERE WORKIG
AT DISEASES OF THE BRAIN AND
SYSTEMIC HEALTH, WHAT ARE THE
CURRENT AND PROJECTED INEQUITIES
BECAUSE OF OUR UNWILLINGNESS TO
INVEST.
THE NATION IS BECOMING A
RACIALLY PLURALISTIC SOCIETY,
THE DEATH RATES, LOSS OF LIFE
AND YEARS OF LIFE LOST AND SO
FORTH CONTINUES TO INCREASE
EXPONENTIALLY.
WHAT DOES THAT TRANSLATE
ECONOMICALLY AND FROM A NATIONAL
SECURITY STANDPOINT?
WHAT WE FOUND WAS QUITE
INTERESTING IN THIS YEAR, 2024,
WE ARE EXPECTED TO SPEND $477.5
BILLION, OWING TO THE
INEQUITIES, THE DIFFERENCES, IF
YOU WILL, OF PAPLATION GROUPS TO
THESE RELATIVE DISEASES AND BY
2040 WE WILL BE A MAJORITY
MINORITY COUNTRY THE NUMBER IS
$1.3 TRILLION.
VERY CONSERVATIVE NUMBER.
WHEN YOU COMPOUND THAT FROM NOW
UNTIL THEN, YOU ARE TALKING
ABOUT $14 TRILLION DOLLARS, WITH
A T.
HUGE.
SO I THINK ONE OF THE THINGS
THAT GETS ME REALLY EXCITED IS
THE WORK FOLKS HAVE BEEN DOING
WHERE YOU MENTIONED THE CRITICS
OFTEN QUESTION WHETHER SDOH
INTERVENTIONS TRULY WORK.
THE EVIDENCE SAYS THEY DO.
AND RESEARCH THAT WAS CONDUCTED
CONCLUDED THAT DOWNSTREAM
INTERVENTIONS, FOCUSED ON CHANGE
AT THE INDIVIDUAL LEVEL ARE MORE
LIKELY ININCREASE HEALTH
INEQUITY MORE THAN UPSTREAM THAT
FOCUS ON SOCIAL CHANGE OR POLICY
CHANGE.
THE DELAWARE HOUSING STUDY
REPORTED THAT COMMUNITY BASED
INTERVENTIONS RESULTED IN NOT
ONLY IMPROVED HEALTH OUTCOMES,
BUT SIGNIFICANT REDUCTIONS IN
HEALTH CARE COSTS.
PROGRAMS LIKE THAT SHOW
BASICALLY THAT ADDRESSING THE
SOCIAL DETERMINANTS OF HEALTH,
THE DRIVERS, CAN PREVENT THE
ONSET OF CHRONIC DISEASES,
REDUCE EMERGENCY ROOM VISITS AND
IMPROVE QUALITY OF LIFE FOR
INDIVIDUALS AND FAMILY.
TO IMPROVE ACROSS THE BOARD FOR
EVERY POPULATION GROUP WE NEED,
I HEARD YOU LOUD AND CLEAR AND
THE COMMITTEE'S RECOMMENDATIONS
LOUD AND CLEAR, WE NEED TO
CONTINUE TO ASSESS SOCIAL
CONSTRUCTS OF RACE, ETHNICITY
AND RESEARCH.
WE NEED TO ADDRESS RESEARCH GAPS
FROM INTERSECTIONAL, HOLIST CAL
APPROACH.
WE NEED THE EVIDENCE ON
STRUCTURAL LEVEL AND SOCIAL
DETERMINANTS OF HEALTH
INTERVENTIONS TO REDUCE HEALTH
INEQUITIES AND ADVANCE HEALTH
EQUITY.
WE NEED TO DO A BETTER JOB WITH
THOSE WHO ARE CRITICIZING THESE
INTERVENTIONS, EFFECTIVELY
DEMONSTRATED THE CAUSAL LINK AND
ULTIMATELY SECURE
ACTION-ORIENTED INTERVENTIONS IN
THESE UNDER ADDRESSED AND OFTEN
IGNORED AREAS OF IMPORTANCE.
SO I WILL STOP THERE AND JUST
SAY THAT I'M QUITE PLEASED THAT
YOU HAVE HIGHLIGHTED AREAS THAT
I THINK ARE HOLDING US BACK FROM
THE MYTH, IF YOU WILL, THE ZERO
SUM MYTH THAT HAS BEEN PLAGUING
US FOR DECADES.
I APPRECIATE WHEN YOU TALK ABOUT
EFFECTIVE HEALTH CARE DELIVERY
MODELS UTILIZING AN EQUITY LENS
THAT IS PART OF THE PROBLEM.
WE HAVE NOT MOVED WITH THE
EQUITY LENS IN THERE.
YOU ALSO MENTIONED AND THE WORK
I DID WITH THE COMMITTEE WITH
COMMISSION PAPER SUCCESSFUL AND
UNSUCCESSFUL INTERVENTIONS WHAT
WE FOUND WAS EXACTLY WHAT YOU
SAID.
MOST OF THE INTERVENTIONS WERE
UNSUCCESSFUL BECAUSE, AGAIN,
MOST OF THEM FOCUSED ON THE
INDIVIDUAL LEVEL.
THEY DID NOT BRIDGE THE CLINICAL
INTERVENTIONS WITH THOSE SOCIAL
DETERMINE NAANTS OF HEALTH.
WHAT YOU ARE DOING HERE AT NINR
IS GOING TO SCALE UP
INTERVENTIONS TO HELP US MOVE
THE NEEDLE.
I ALSO APPRECIATE YOU BROUGHT UP
THE CLINICAL TOOLS, THE
ALGORITHMS AND BIASED COGNITIVE
ASSESSMENT TOOLS, KIDNEY AND
HEART ASSESSMENT TOOLS.
I HAVE BEEN IN ROOMS FOLKS HAVE
SAID IT IS SO COMPLEX TO CHANGE
THESE.
I'M GLAD IT WAS RECOGNIZED.
IT IS SOME OF THE HIGHEST
HANGING FRUIT AND IF WE ARE
GOING TO MAKE A DENT IN THESE
INEQUITIES AN CLOSE THOSE GAPS,
WE HAVE TO OGO AFTER THAT.
I HOPE NINR WILL FOCUS ON THOSE
MORE CHALLENGING ISSUES.
IF THERE IS NO DATA, WHAT DO
FOLKS THINK, THERE IS NO
PROBLEM.
I'M GLAD YOU RECOGNIZED AND PUT
A SPOTLIGHT ON THE NEED FOR
PARTIAL RACE AND ETHNICITY DATA,
TRIBAL AFFILIATION, AND LAWS AND
POLICIES THAT REDUCE INEQUITIES
NOT BEING IMPLEMENTED TO THE DOE
DEBRIS THEY OUGHT TO.
THESE ARE AREAS WE HAVE FOUGHT
AND ADVOCATED FOR AND KNOW THEY
WORK.
THEY HAVE OFTENTIMES NOT BEEN
GIVEN THE TIME TO STAND ON THEIR
OWN LEGS TO SHOW THE
EFFECTIVENESS.
SO WITH THAT, I WILL CONCLUDE
AND JUST SAY THANK YOU AGAIN FOR
YOUR SERVICE ON THAT COMMITTEE.
THANK YOU FOR YOUR PRESENTATION
AND FOR OPENING UP OUR MINDING,
STRETCHING THE BOUNDARIES OF OUR
KNOWLEDGE.
>> SO, THANK YOU, DR. BEKEMEIER,
DR. DAWES.
JUST A COUPLE OF THOUGHTS AND
THEN I'M GOING TO SPEAK MORE AS
SORT OF VINCENT, A NURSE
SCIENTIST AND MY OWN
REFLECTIONS.
SO I AGREE THAT IF WE FOCUS ON
INDIVIDUAL LEVEL FACTORS,
PARTICULARLY AS HEALTH CARE IS
DESIGNED TODAY WE WILL WIND UP
WITH A LARGELY INEFFECTIVE
INTERVENTIONS FOR WHAT WE ARE
TRYING TO DO, ELIMINATION OF
HEALTH AND HEALTH CARE
INEQUITIES.
I THINK WHERE I GET CONCERNED
AND I WANT TO PUT THIS ON THE
TABLE FOR THE COUNCIL IS THAT A
LOT OF THE CURRENT EVIDENCE IS
ALSO BASED ON A FLAWED MODEL.
SO IF WE WERE TO REIMAGINE WHAT
IS REALLY A DIFFERENT KIND OF
HEALTH CARE SYSTEM THAT DOES
INTEGRATE CLINICAL AND SOCIAL
CARE AND WE FULLY EMBRACE THAT
THERE ARE GOING TO BE THINGS
THAT ARE NOT GOING TO BE
RESOLVED WITHIN THE HEALTH CARE
SYSTEM THAT NEED TO BE RESOLVED
AND NEED TO MAKE INTERVENTIONS
IN THE HEALTH SYSTEM, WHAT MIGHT
THEN THE EFFECTS BE?
MIGHT THERE BE MORE SYMMETRY
THERE?
IN MY MIND SOME OF THE MOST
COMPELLING QUESTIONS ARE AROUND
LEVERAGING THE NURSING WORKFORCE
AND OTHER HEALTH PROFESSIONS TO
BE TRAINED TO PROVIDE CLINICAL
AND SOCIAL CARE IN DIFFERENT
WAYS.
AND COULD WE GET AT MORE OF THE
EFFECTS THAT WE WANT, CERTAINLY
NOT IN ANY WAY DISCOUNTING WHAT
MANY CALL IN PUBLIC HEALTH --
FACTORS.
I AGREE WITH THAT, BUT I THINK
THAT SOMETIMES THERE IS THIS
DICHOTOMY THAT I THINK IS
TROUBLESOME BECAUSE I COULD ALSO
ARGUE THAT THERE'S EVIDENCE, AND
I DON'T NECESSARILY AGREE WITH
THIS, BUT I'M PUTTING ON THAT
OTHER CAP OF PEOPLE WITH THIS
OTHER VIEW, THAT WE DON'T FULLY
UNDERSTAND THE MECHANISMS ACROSS
DIFFERENT CONTEXTS, HOW
SOMETIMES UPSTREAM INTERVENTIONS
AFFECT DOWNSTREAM FAK FCFACTORS.
THERE IS AN OPPORTUNITY AS A
COUNTRY TO SAY HEY, THERE IS
THIS HEALTH CARE SYSTEM WE CAN
DO MORE.
TAKE A PROTOTYPICAL NURSE
GRADUATES IN 2030 AND IF HE OR
SHE WAS TRAINED IN INTEGRATED
CARE IN A WAY THAT WAS
FUNDAMENTALLY DIFFERENT, HOW FAR
WOULD THAT GET US?
IS ON TOP OF THAT, COULD WE MAKE
CHANGES IN THE BROADER HEALTH
SYSTEM AND WITH THAT, AMPLIFY
THE EFFECTS OF WHAT IS HAPPENING
IN BOTH?
TO ME, THAT IS WHAT WE NEED TO
FIGURE OUT AND SEE LOTS OF
OPPORTUNITY.
IT IS A NEW MODEL, INTEGRATES
SOCIAL AND CLINICAL CARE AND THE
BROADER CONTEXT IN TERMS OF
POLICIES AND STRUCTURAL FACTORS.
IT HIGHLIGHTS MECHANISMS AND IS
NOT A DICHOTOMY.
THERE IS A PAPER COMING OUT IN
THE AMERICAN JOURNAL OF PUBLIC
HEALTH THAT A NUMBER OF THE
COMMITTEE MEMBERS AUTHORED THAT
IS GETTING AT THIS POINT.
HOW DO WE THINK ABOUT IT
DIFFERENTLY?
>> VINCENT, THANK YOU FOR YOUR
PRESENTATION.
I WANT YOU THE PUT ON YOUR
FORMER NURSING DEAN HAT AND
THINK ABOUT, BECAUSE A LOT OF
THE CONVERSATION WAS AROUND
NURSING WORKFORCE AND WHAT YOU
SAID AS WELL.
WE KNOW OUR NURSING EDUCATION
SYSTEM WAS IN MANY WAYS
INHERITED FROM HOSPITALS AND
THEIR NEED FOR STAFFING.
THAT WAS FOCUSED INWARD, THIS
BEDSIDE NURSING CARE.
WE HAVE TO THINK OF UPSTREAM
SOCIAL DETERMINANTS OF HEALTH
AND WITHIN THIS NURSING
EDUCATION SYSTEM WE ARE HAVING
REAL CHALLENGES IN, ONE, IT IS
VERY EXPENSIVE AND NARROW
PIPELINE, NOT VERY INCLUSIVE.
WE WANT A MORE REPRESENTATIVE
WORKFORCE.
WE ARE TALKING TODAY ABOUT THE
CHALLENGES OF GETTING A DIVERSE
STUDENT POPULATION IN THERE.
WE HAVE ISSUES AROUND NURSE
PRACTICE READINESS, WE HAVE
NURSING BURNOUT.
WE ARE LOSING SOME NURSES IN THE
FIRST YEAR.
SOME ESTIMATES ARE 20%.
SO THOSE ARE, I THINK, AN
OPPORTUNITY FOR US TO REALLY
THINK ABOUT TURNING NURSING
SCIENCE AND LOOKING AT NURSING
EDUCATION, REIMAGINING WHAT
NURSING EDUCATION LOOKS LIKE.
DID THE REPORT PROVIDE
SUGGESTIONS HOW WE CAN SHAPE THE
ETCH-A-SKETCH OF HOW WE ARE
REDOING NURSING EDUCATION?
>> SO THE QUICK ANSWER IS YES.
THE REPORT DOES TALK ABOUT THAT.
IN CHAPTER 5 THERE WERE SPECIFIC
SUGGESTIONS FOR NURSING
ORGANIZATIONS, INCLUDING
SCHOOLS.
IT IS FRAMED AROUND HEALTH
PROFESSION EDUCATION, BUT IT
DOES LAY A BLUEPRINT FOR THE
CONTENT AND COMPETENCIES OUR
WORKFORCE IS GOING TO NEED,
PARTICULARLY WITH NEW ROLES,
WITH AN INTERPROFESSIONAL
REPORT, LOCATION FLEXIBILITY
WITH AN EMPHASIS ON
RELATIONSHIPS WITH REALLY
THINKING ABOUT MOVING AWAY FROM
BIAS CARE.
IT DIRECTLY COMMENTS ON SOME OF
THE THINGS THAT HAVE BEEN
DOMINANT IN MANY HEALTH
PROFESSION SCHOOLS AROUND
UNCONSCIOUS BIAS TRAINING AND IS
THERE EVIDENCE FOR THAT AND WHAT
WE SHOULD BE DOING, WHERE THERE
IS EVIDENCE, WHICH IS MORE
BEHAVIORAL FOCUSED AND MORE
SUSTAINABLE LONG TERM KINDS OF
INTERVENTIONS.
THERE IS A LOT IN THE REPORT
AROUND SCHOOLS.
I WILL SAY THAT I DEFINITELY
AGREE WITH YOU, I WOULD ARGUE IF
I THINK ABOUT NURSING, INITIALLY
WE, AS YOU KNOW BECAUSE I HAVE
READ PAPERS YOU HAVE WRITTEN
ABOUT THIS, WE INITIALLY WERE
NOT IN HOSPITALS.
WE ACTUALLY WERE TIED TO
COMMUNITIES AND BECAUSE OF THE
PROLIFERATION OF HOSPITALS AND
THE NEED FOR WORKFORCE, NURSES
OVER TIME BECAME SORT OF
CO-OPTED INTO THOSE SETTINGS AND
MORE AND MORE AN ACUTE CARE
WORKFORCE AND THAT SETTING THEN
DICTATED WHAT MANY OF THE
SCHOOLS DID.
THE COUNTRY NEEDS THE NURSING
WORKFORCE AND ALL HEALTH CARE
PROFESSIONALS TO ACHIEVE
POPULATION HEALTH FOR OUR
NATION.
THERE IS A CRITICAL MOMENT TO
TURN THINGS AROUND AND WE'VE GOT
TO BE WILLING TO GO WHERE THE
COUNTRY NEEDS US.
THE MOST CHALLENGING ISSUES WE
FACE AS A NATION, THAT IS OUR
OPPORTUNITY.
IT DOESN'T MEAN THAT ACUTE CARE
SETTINGS AREN'T STILL IMPORTANT,
BUT THERE'S A LOT THAT WE COULD
BE DOING THAT IS OUTSIDE OF
THOSE CONTEXTS.
>> THANK YOU SO MUCH, VINCENT.
I THINK YOU MADE IT REALLY
CRYSTAL CLEAR AND SIMPLE FOR
EVERYONE TO UNDERSTAND THE
MESSAGE FROM THE REPORT,
INCLUDING THE DIFFERENCES
BETWEEN THE DISPARITIES, THE
INEQUITIES, BUT ALSO THE IMPACT
OF ENDING UNEQUAL TREATMENT FOR
EVERYONE IN THIS SOCIETY.
I THINK THAT MESSAGE IS REALLY
IMPORTANT.
I REALLY LOVE THE COMPONENT
ABOUT EQUITABLE IMPLEMENTATION.
VERY KIND OF WIDE ADOPTION OF
IMPLEMENTATION SCIENCE, NURSES
ARE LEADING.
I THINK EVEN FOR PRACTICING
NURSES OR NURSING WORKFORCE IS
THAT EQUITABLE IMPLEMENTATION.
I THINK THAT IS ALSO CRITICAL
COMPONENT WHERE, YOU KNOW,
REFLECTING ABOUT ALL THE AMAZING
WORK NINR HAS ALREADY BEEN DOING
AN LEADING IN DIRECTOR ZENK'S
REPORT.
REFLECTING SOME OF THE QUESTIONS
THAT YOU ASKED, I THINK IT'S
CRITICALLY IMPORTANT THAT WE
EDUCATE THE NURSES WHEN THEY ARE
IN SCHOOLS SO THAT WHEN THEY GO
OUT AND PRACTICE, AND I'M
THINKING ABOUT THIS
INTERPROFESSIONAL, WE DON'T
REALLY NEED ALL THE NURSES TO
BECOME A SOCIAL WORKER OR TO
BECOME A PUBLIC HEALTH
PROFESSIONAL.
IT'S THAT TEAM-BASED AND WITH
YOUR RECOMMENDATION IN RELATED
HEALTH AND HEALTH CARE DELIVERY
MODELS THAT NURSES CAN LEAD OR
PARTICIPATE IN THESE
INTERPROFESSIONAL AND ALSO
THINKING BACK ABOUT
INTERPROFESSIONAL EDUCATION WHEN
THEY'RE IN SCHOOLS.
AND HOW CAN WE EDUCATE THEM WHEN
THEY ARE IN SCHOOL SO THAT WHEN
THEY GO OUT, ALL OF IT IS
CREATING JOBS THAT WILL BE
ATTRACTIVE IN HEALTH SYSTEMS OR
HEALTH CARE SYSTEMS.
THINK ABOUT THIS, YES, WE NEED
INTEGRATION OF SOCIAL AND
CLINICAL CARE MODELS, BUT WE
ALSO NEED EVIDENCE TO CONVINCE
HEALTH AND HEALTH SYSTEMS
LEADERS OR FUNDERS TO REALLY
LOOK AT WHERE IS THE GAIN WHEN
WE ARE DESIGNING, IMPLEMENTING
SUCH MODELS.
THERE ARE A LOT OF PILOT STUDIES
NINR HAVE FUNDED.
BUT IT IS CREATING MORE EVIDENCE
AND MAKE MESSAGES AS CLEAR AS
THE REPORT IS CREATING THE
EVIDENCE TO THE SOCIETY AND
THERE ARE A LOT OF BARRIERS AND
WE NEED TO THINK ABOUT AS WE ARE
ADVOCATING FOR THIS INTEGRATION,
THAT MAYBE WE ARE PUTTING BURDEN
ON THESE SOCIAL CARE AND
COMMUNITY-BASED ORGANIZATIONS
THAT HAVE NO INFRASTRUCTURE TO
SUPPORT A LOOP SOCIAL CARE
REFERRAL BACK TO LARGE HEALTH
CARE SYSTEMS THAT HAVE THESE
BILLION DOLLAR SPENDING ON
ELECTRONIC HEALTH WORKER
SYSTEMS.
TO CREATE THAT STREAMLINED
CLOSED LOOP REFERRAL TO THESE
COMMUNITY-BASED ORGANIZATIONS,
SOCIAL CARE ORGANIZATIONS WITH
THE HEALTH CARE SERVICES.
SO I THINK EVEN BEARING IN MIND
ABOUT AS WE ARE IMPLEMENTING AND
LEARNING FROM THIS REPORT, WAS
EQUITABLE IMPLEMENT TAKES, ARE
WE CREATING MORE BURDENS IN
THESE ORGANIZATIONS SUGGESTING
YET NOT GIVING THEM ADEQUATE
SUPPORT, BUT ASKING RESOURCES TO
PURSUE AND SEEK EVIDENCE IN
THESE AREAS.
AND I THINK THAT IS AN AREA
MAYBE WHAT NINR AND AS WE ARE
COLLABORATING WITH OTHER
INSTITUTES WE CAN ALSO THINK
ABOUT.
BUT, AGAIN, THANK YOU FOR THE
AMAZING REPORT AND REPRESENTING
THE NURSES COMMUNITY AND
DISSEMINATING ALL OF THIS TO A
WIDER AUDIENCE.
>> MAY I JUST MAYBE RESPOND TO
THAT, IF THAT IS OKAY.
SO I THINK YOU ARE RAISING SOME
REALLY GREAT POINTS.
MANY OF THE ARGUMENTS THAT A
NUMBER OF INDIVIDUALS HAVE
RAISED AROUND WHY THE
INTEGRATION OF CLINICAL AND
SOCIAL CARE MAY BE UNWISE ARE
SORT OF THE BASIC ARGUMENT IS
SIMILAR TO WHAT YOUR
ARTICULATING.
I SEE THIS AS -- I SEE THREE
WAYS I WOULD LIKE TO RESPOND.
THE FIRST IS I THINK PROFESSOR
DAWES AND DR. GASKINS HAVE
DOCUMENTED WHAT WE CURRENTLY
HAVE.
IF YOU LOOK AT THE DOLLAR
AMOUNT, FORGET ABOUT DOING THE
RIGHT THING WHICH OBVIOUSLY I
WANT TO DO, JUST LOOK AT THE
SHEER NUMBERS, IT IS
OVERWHELMING.
IT IS CLEAR WE CAN'T SUSTAIN
THAT COST AND WE NEED TO DO
SOMETHING DIFFERENT.
THAT IS KIND OF POINT NUMBER
ONE.
POINT NUMBER TWO IS WE DID
CRITICALLY ASK AS A COMMITTEE
WHAT DO WE HAVE?
THERE ARE MANY MODELS WE
REVIEWED.
THE MOST EXCITING WAS THE 1115
MEDICAID WAIVER PROJECT.
I WILL PICK ONE STATE LARGELY
BECAUSE I'M FAMILIAR WITH THAT
STATE, IT WAS THE FIRST STATE
THAT GOT THE WAIVER WHICH IS
NORTH CAROLINA.
SECRETARY KINGSLEY, WHO
PRESENTED ON THAT, HE PROVIDED A
NUMBER OF THINGS.
THIS IS PUBLIC INFORMATION THAT
IS IN THE PRESS RELEASE FROM
NORTH CAROLINA.
HE PROVIDED EVIDENCE THEY HAD
REDUCED THE COST OF CARE TO
PEOPLE WHO WERE IN RURAL
COMMUNITIES IN NORTH CAROLINA
THAT PRIOR TO THE INTEGRATION OF
MEDICAID DOLLARS HAD NOT HAD
ACCESS TO CARE.
THEIR PROGRAM LOOKED AT HOUSING
AND CRITICAL CARE AND FOOD.
NUMBER TWO, THEY WERE ABLE TO
SHOW THAT THE COMMUNITY-BASED
ORGANIZATIONS HAD BEEN
STRUGGLING, RIGHT?
MANY COMMUNITY-BASED
ORGANIZATIONS WERE STRUGGLING.
HAVING THE ABILITY TO GET
REIMBURSED THROUGH MEDICAID
DOLLARS PROVIDED A REVENUE
SOURCE THAT CREATES
SUSTAINABILITY FOR THOSE
ORGANIZATIONS AND ALLOWS THEM TO
ACTUALLY HIRE PEOPLE AND TO
BRING PEOPLE INTO THE WORK FORCE
THAT WERE NOT GETTING EMPLOYED
IN THE FORMAL HEALTH CARE
SYSTEM.
SO, AGAIN, IT IS ONE STATE AND
WE NEED TO BE CAREFUL, BUT THOSE
MEDICAID DEMONSTRATION PROJECTS
AND THIS IS SOMETHING I'M WORKS
ON NOW AT HOPKINS, CAREFULLY
EVALUATING WHAT ARE EACH OF THEM
DOING AND WHAT ARE THE RESULTS?
I THINK WE NEED TO TAKE
ADVANTAGE OF THESE KINDS OF
NATURAL EXPERIMENTS TO DESCRIBE
WHAT IS THE BIAS.
THAT WE ARE NOT MAKES STATEMENTS
THAT ARE NOT ROOTED IN THE
EVIDENCE.
THAT DID NOT PAN OUT IN NORTH
CAROLINA.
IN FACT, THE COMMUNITY-BASED
ORGANIZATIONS BENEFITED FROM
HAVING THOSE ADDITIONAL
RESOURCES.
>> WOW.
OKAY.
I WISH WE COULD KEEP GOING.
THE GOOD NEWS IS WE ARE GOING TO
HAVE A LARGE AMOUNT OF TIME THIS
AFTERNOON TO CONTINUE THE
CONVERSATION.
SO I'M GOING TO PAUSE US THERE.
SO I WANT TO THANK YOU,
PROFESSOR DAWES, YOU DR.
BEKEMEIER, THE COMMITTEE FOR
SHARING THEIR THOUGHTS AND AGAIN
TO YOU, DR. GUILAMO-RAMOS, DITTO
FOR YOUR COMMITMENT TO SHARING
THE COMMITTEE'S RECOMMENDATIONS
WITH ALL OF US.
SO WITH THAT, I'M GOING TO SAY
LET'S TAKE A BREAK.
AND WE'LL COME BACK AT 11:15.
SO WE'LL SEE YOU IN 12 MINUTES.
WELCOME BACK.
ONE HOUSE KEEPING ITEM BEFORE WE
MOVE FORWARD.
WHEN COUNCIL MEMBERS OR OTHERS
SPEAK, IF YOU DON'T MIND
SPEAKING CLOSER TO THE MIC TO
MAKE SURE THE RECORDING IS GOOD
SO EVERYONE FOREVER COULD HEAR
YOUR REMARKS.
THAT WOULD BE MUCH APPRECIATED.
WITH THAT, WE WILL HEAR FROM OUR
DEPUTY DIRECTOR, DR. COURTNEY
AKIN.
SHE IS GOING TO SHARE AN
OVERVIEW OF OUR WORK IN HEALTH
EQUITY.
SO THIS IS REALLY JUST TO GIVE
THE COMMITTEE, THE COUNCIL, A
SENSE OF WHERE WE'VE BEEN, WHAT
WE'RE CURRENTLY DOING AND A
LITTLE BIT MORE ABOUT HOW OUR
PERSPECTIVE HAS EVOLVED OVER THE
LAST FEW YEARS.
AND AGAIN, I'M REALLY PLEASED TO
HAVE AN NINR INVESTIGATOR WHO
DOES COMMUNITY WORK WHO IS GOING
TO TALK ABOUT WHAT SHE IS DOING
AND HOW HER WORK EXEMPLIFIES HOW
NURSING RESEARCH, NO PRESSURE,
CAN FOCUS ON HEALTH EQUITY.
>> THANK YOU FOR THAT
INTRODUCTION.
I UNDERSTAND THIS IS THE SESSION
BETWEEN ME AND MY LUNCH AND SO I
WILL BE BRIEF.
THANK YOU DR. RAMOS FOR
DESCRIBING THE ROLES OF NURSING
SCIENCE.
SOME OF THE GAPS ARE ADDRESSABLE
AND THE GOOD NEWS IS WE ARE
WALKING A PATHWAY AT NINR.
SO WHAT I'M HOPING TO DO IS SET
THE STAGE FOR COLLECTIVELY WHAT
WE HAVE BEEN DOING AND PROVIDE A
SUMMARY IN RELATION TO OUR NORTH
STAR.
IT IS SOBERING TO THINK ABOUT
THE WORK THAT NEEDS TO BE DONE
GIVEN THE ATTENTION OVER THE
YEARS TO FOCUS ON THESE
INEQUITIES.
I'M EXCITED ABOUT HOW WE PAINT A
PICTURE TO MOVE FORWARD TO
ACHIEVE HEALTH EQUITY.
AS YOU HEARD IN DR. ZENK'S
INTRODUCTION, HEALTH EQUITY IS
OUR GUIDING NORTH STAR, IT IS
ESSENTIAL TO THE WORK WE DO, THE
WORK WE SUPPORT AND AS YOU CAN
SEE FROM OUR MISSION STATEMENT,
CENTRAL TO OUR VISION.
OUR STRATEGIC PLAN IS A FOCUS ON
HEALTH EQUITY AS A PRIMARY
RESEARCH LENS AND SHAPED SO MANY
OF THE ACTIVITIES I WILL SHARE
IN A MOMENT.
THOUT MY TALK I WANT TO SHARE
OUR NORTH STAR PRESENTED A
STRONG VISION AND DRIVES EVERY
EFFORT FORWARD.
BY PRIORITIZING HEALTH EQUITY WE
ARE PURPOSEFULLY COMMITTING TO
ELEVATING ITS IMPORTANCE
THEREFORE CREATING
ACCOUNTABILITY FOR OURSELVES AND
OUR PARTNERS TO ASK THOSE
DIFFICULT QUESTIONS AND SEEK
SOLUTIONS TO THE MOST
CHALLENGING AND COMPLEX HEALTH
ISSUES SO THAT EVERYONE CAN
REACH OPTIMAL HEALTH.
BUT OUR PRIORITIZATION IN HEALTH
EQUITY HAS SHOWN UP IN SEVERAL
WAYS.
AND I'M GOING TO SPEND SOME TIME
SHARING THOSE, INCLUDING
LANDSCAPE OF OUR PORTFOLIO,
HEALTH OPPORTUNITIES AND
STRIVING, MOVING FORWARD TO
OBTAIN HEALTH EQUITY AND
COLLABORATING PARTNERSHIPS
FOCUSED ON ACHIEVING HEALTH
EQUITY.
NEXT SLIDE, PLEASE.
SO AS WE HEARD DR. GUILAMO-RAMOS
DESCRIBE, THERE ARE SEVERAL
CHALLENGES IN THE AASEM REPORT
THAT ARE CHALLENGING.
THAT THEY ARE NOT NEW TO NURSES
AS THEY HAVE BEEN ON THE FRONT
ROW SEAT TO HEALTH DISPARITIES
AND INEQUITIES.
WE ARE APPROACHING HOLISTICALLY
IN THE CONTEXT OF PEOPLE'S
LIVES.
ADDRESSING THESE NEEDS REQUIRE
WE SEEK OUT HEALTH EQUITY AND
FOLLOW OUR NORTH STAR.
PURPOSEFUL PRIORITIZATION LED TO
EXPANSION OF OUR PORTFOLIO THAT
REFLECTS BUDGET CHANGES STUDY
ENROLLMENTS AND THE WORK WE
SUSPECT.
-- SUSPEPPORT.
IT IS ONE THING TO TALK ABOUT
BEING PURPOSEFUL ABOUT THE
TRAJECTORY WE FOLLOW, IT IS
ANOTHER TO HIGHLIGHT AND
REITERATE THE EVIDENCE OF THE
CHANGES BECAUSE OF THE WORK
WE'VE ALREADY BEEN DOING.
THE WORK THAT WE'VE BEEN DOING
LED UP TO THE ESTABLISH OF
2022-2026 STRATEGIC PLAN AND NOW
THROUGH THE STRATEGIC PLAN WE
HAVE HAD THE ABILITY TO DESIGN
AND BE BOLD AND TO LEAN INTO
HISTORICAL POSITION NURSING HAS
HAD IN ADDRESSING THE
INTENSIFYING INEQUITIES IN
SOCIAL DETERMINANTS OF HEALTH.
WE'VE MADE GOOD PROGRESS TO
DATE.
NOT SAYING WE DON'T HAVE MUCH
MORE TO DO.
OUR FORT FOLIO HAS EXPANDED.
I WILL SAY THAT AGAIN.
OUR PORTFOLIO HAS EXPANDED TO
TRULY EXEMPLIFY SOME OF THE
THINGS YOU ARE SEEING HERE.
NEARLY 50% OF OUR ALLOCATED
BUDGET GOES TO SUPPORTING HEALTH
DISPARITIES RESEARCH.
65% OF OUR STUDIES HAVE A
BEHAVIORAL AND SOCIAL SCIENCE
BENT.
NINR THE INSTITUTE AT NIH WITH
THE LARGEST PORTION OF OUR
BUDGET BEING SPENT ON THIS TYPE
OF RESEARCH.
SOCIAL DETERMINANTS OF HEALTH
CLOSELY TIED TO INEQUITY, WE
HAVE TRIPLED OUR INVESTMENT
SINCE 2020, 47% OF OUR BUDGET
ATTRIBUTED TO SDOH WORK.
I WOULD BE REMISIF I DIDN'T TALK
ABOUT SHOWING UP IN RACIAL AND
ETHNIC MINORITY PARTICIPANTS.
INCLUSION OF BLACK AND
AFRICAN-AMERICAN PARTICIPANTS
ROSE FROM 20% IN 2020 TO 30% IN
2023.
IN FISCAL YEAR 2023 WE SAW THE
HIGHEST LEL OF ENROLLMENT FOR
HISPANIC AND LATINO
PARTICIPANTS.
WE HAVE AN INDIVIDUAL WITH US
NOW, OUR SCIENTIFIC DIVERSITY
OFFICER HELPING TO LEAN IN AND
THIS IS A HUGE FOCUS FOR US IN
TERMS OF OUR OUTREACH AND
PARTNERSHIPS WITH THE SCIENTIFIC
ORGANIZATIONS HELPING TO
WITHHOLD THIS.
SO THIS WAS MENTIONED, BUT I
WANT TO HIGHLIGHT THIS BECAUSE
IT IS IMPORTANT TO SEE.
OUR GRANT PORTFOLIO IS
REFLECTING OUR LONG STANDING
COMMITMENT TO HEALTH DISPAIRS
RESEARCH AND OUR EFFORTS
CONTINUE TO EXPAND THIS BECAUSE
IF YOU TAKE A LOOK AT OUR
COUNCIL AND THE DPRGRANTS THAT
COMING THROUGH YOU WILL SEE FOR
US THE INVESTMENT IN THIS AREA
SPECIFICALLY FOR FISCAL YEAR 23,
46% OF OUR BUDGET WERE
APPROXIMATELY $90 MILLION WENT
TO SUPPORTING PROJECTS WE
CATEGORIZE AS HEALTH DISPARITIES
RESEARCH.
NUMBER TWO AT NIH AS A PERCENT
OF OUR BUDGET.
I'M SURE YOU COULD TAKE A GUESS
WHAT THAT FIRST ONE IS.
AND DR. GUILAMO-RAMOS SAID IT,
NIMHD IS THE FIRST.
WE RECENTLY CONDUCTED A FORMAL
ANALYSIS TO OR GRANT PORT FOALO
TO DETERMINE HOW MANY PROJECTS
COULD BE CATEGORIZED AS HEALTH
EQUITY RESEARCH.
NIH DOES NOT HAVE A STANDARD
DEFINITION FOR HEALTH EQUITY
RESEARCH.
THERE IS NO OFFICIAL CATEGORY,
WE COULDN'T USE RCDC SO I WANT
TO GIVE MUCH APPLAUSE TO OUR
DIVISION THAT DID THIS LEGWORK
WITHOUT HAVING AN AUTOMATED WAY
OF DOING SO.
IT GIVES US AN OPPORTUNITY TO
TAKE A LOOK AT HEALTH EQUITY
RESEARCH AS THE RESEARCH THAT
ADDRESSES HEALTH DISPARITY,
EXAMINE STRUCTURAL FACTORS AND
IS COMMUNITY ENGAGED IN THIS
APPROACH.
IF YOU TAKE A LOOK AT NEWLY
FUNDED WORK, TYPE ONE GRANTS,
FOR EXAMPLE, NINR PROJECTS SINCE
2019 OUR FUNDING SUPPORT FOR
THIS AREA OF RESEARCH HAS
CONTINUED TO INCREASE
SUBSTAN
SUBSTANTIALLY.
THIS IS A PRELIMINARY ANALYSIS
WITH RELATIVELY SMALL NUMBERS.
SO I AM ENCOURAGED IF YOU TAKE A
LOOK AT THE TREND WE SEE HERE
AND THE INCREASE IN THE
APPLICATIONS TEND TO REFLECT
THIS TREND.
WE HAVE A WAYS TO GO, BUT WE'VE
GOT A DIRECTION AND A PATHWAY
FORWARD AND AS YOU CAN SEE WE
ARE MOVING ON THAT PATH.
NEXT SLIDE, PLEASE.
SO WHILE WE ARE PROUD OF THE
INVESTMENTS WE HAVE BEEN MAKING
SHOWING THE EXPANSION OF OUR
RESEARCH PORTFOLIO, WE ARE PROUD
OF OUR EXTRA MURAL PROGRAMMING
EVIDENTS TO LEAD NINR TO HEALTH
EQUITY ACTIVITIES THAT WE HAVE
ASSISTED IN DRIVING THE CHANGES.
SO I WANTED TO JUST POINT OUT A
FEW OF THEM TO YOU.
SPECIFICALLY OVER THE PAST TWO
YEARS WE HAVE ISSUED EIGHT
REQUESTS FOR APPLICATIONS,
CENTERED AROUND ACHIEVING HEALTH
EQUITY.
IMPRESSIVELY AS THESE RFAs, HALF
HAVE RESULTED IN THE HIGHEST
NUMBER OF APPLICATIONS TO OUR
RFAs IN NINR HISTORY GOING BACK
TO 2014.
THEY SCAN A BROAD RANGE OF FOCUS
ON HEALTH CARE SYSTEMS,
PARTICULARLY POPULATIONS OF
EMPHASIS THAT ARE MOST
VULNERABLE TO HEALTH INEQUITIES,
EXAMINING THESE CHALLENGES OF
MORE UPSTREAM SOLUTIONS AND
ULTIMATELY EXAMINING A ROLE OF
RESEARCH OUTCOMES THAT COULD
POTENTIALLY IMPACT POLICY.
SO AGAIN I WANTED TO HIGHLIGHT A
COUPLE OF OUR OPPORTUNITIES
SPECIFICALLY AND TALK MORE ABOUT
WHAT THEY ARE, HOW THEY WERE
DEVELOPED.
THE BRIDGE TO CARE INITIATIVE
FOCUSES ON INTEGRATED HEALTH
CARE AND COMMUNITY SERVICES TO
ADDRESS SOCIAL DETERMINANTS OF
HEALTH AND IMPROVE HEALTH
EQUITY.
RECOGNIZING THAT HEALTH CARE
ALONE CANNOT ADDRESS FACTORS
INFLUENCING HEALTH, THIS
INITIATIVE WAS DESIGNED TO
PROMOTE HEALTH CARE COMMUNITY
PARTNERSHIPS TO HANDLE UNMET
SOCIAL NEEDS SUCH AS HOUSING,
FOOD SECURITY AND ECONOMIC
STABILITY, WHICH OFTEN RESULT IN
POOR HEALTH OUTCOMES.
THIS INITIATIVE IS SUPPORTING
RESEARCH TO EVALUATE AND ENHANCE
THESE PARTNERSHIPS, EMPHASIZING
INTERVENTION AND EVALUATION
STUDIES TARGETING UNDERSERVED
POPULATIONS WHO ARE FACING THESE
HEALTH DISPARITIES, BUT THE GOAL
IS TO ENSURE EFFECTIVE AND
SUSTAINABLE PROGRAMS THAT CAN
ENHANCE HEALTH OUTCOMES BOTH AT
THE INDIVIDUAL, BUT ALSO AT THE
COMMUNITY LEVITT TO GET AT THE
CONVERSATION MAKING SURE WE ARE
MOVING BEYOND JUST INTERVENTIONS
TARGETED FOR INDIVIDUALS.
THROUGH OUR ORIGINAL RELEASE IN
2023, WE FUNDED PROJECTS LAST
YEAR THAT FOCUSED ON REVISING
THE CLINICAL CASCADE AS THE
SYSTEMS LEVEL TO IMPROVE ACCESS
TO THE TREATMENT OF OPIOID USE
DISORDERS, INCREASING SCHOOL
ATTENDANCE AND USING A
SCHOOL-BASED COMMUNITY HEALTH
CARE WORKER PROGRAM, IMPROVING
EARLY CHILDHOOD SPECIAL
EDUCATION SERVICES THROUGH OUR
PRESCHOOL PROGRAM AND A PROGRAM
FOR BLACK, HISPANIC AND LOW
INCOME CHILDREN WITH
DEVELOPMENTAL DELAYS AND
DISABILITIES.
AS WE'LL DISCUSS AND SEE LIVE
WITH DR. HORNING'S WORK IN HER
COMMUNITY ENGAGED FOCUS, IT IS
SO IMPORTANT TO HAVE COMMUNITY
PARTNERS AND REALLY EXEMPLIFY
AND SHOW NURSE-LED MODELS OF
CARE.
WE HEARD TODAY THE MENTION OF
JUST HOW IMPORTANT IT IS TO MOVE
AGAIN BEYOND INDIVIDUAL LEVEL
INTERVENTIONS AND TO CREATE
THOSE INTERVENTIONS AT A
STRUCTURAL LEVEL WITH AN EYE ON
THE OUTCOME THAT COULD DO MORE
THAN JUST THE INTERVENTION
THERE, BUT PERHAPS REALLY PUSH
POLICY CHANGE.
WE'RE IN A SPACE OF ALREADY
ENCOURAGING THAT MOVEMENT
FARTHER.
AS AN EXAMPLE TO PUSH THE
ENVELOPE FOR CHANGE AND HOW WE
ADDRESS HEALTH EQUITIES CAN BE
SEEN UNDER THE BRIDGE INITIATIVE
FOCUSED ON MATERNAL HEALTH
DISPARITIES, EVALUATING MEDICAID
SUPPORTED DOULA PROGRAMS.
THIS STUDY IS LEANING IN TO WORK
TO ENHANCE ACCESS TO RESPECTFUL
CULTURALLY CONGRUENT MATERNAL
SERVICES.
IT LEVERAGES RECENT POLICY
ADVANCEMENT LIKE MATERNITY AND
HOSPITAL EQUALLY IMPROVEMENT
NETWORKS AND TO PROVIDE LOW
INCOME MEDICAID ELIGIBLE
INDIVIDUALS TO DOULAS.
THE PILOT SEEKS THE OVERCOME THE
BARRIERS OF SUSTAINABLE POLICY
IMPLEMENTATION.
SO AGAIN, GETTING AT ONE OF THE
GAPS THAT HAVE BEEN EXPLAINED
AND EXPOEDED IN THE NAM REPORT.
IT IS OUR STRATEGIC GOAL TO MAKE
SURE WE ARE CREATING AN
OPPORTUNITY FOR COMMUNITY DRIVEN
INTERVENTION SUCH AS THESE TO
HAVE A PLACE SO WE WILL CONTINUE
TO MOVE FORWARD SUPPORTING WORK
LIKE THIS.
WE MUST CONTINUE DO PRESS
FORWARD IN MAKING SURE OUR
SOLICITATIONS FOR RESEARCH
CENTER ON INTERVENTION
STRATEGIES THAT ARE DESIGNED TO
GO BEYOND JUST IDENTIFYING
CHALLENGES.
WE NEED TO BE ABLE TO HAVE
STUDIES TO ADRES CONTEXTUAL
ISSUES DESCRIBED IN THE
DISCUSSION BRI DR. BEKEMEIER.
THROUGH OUR MOST RECENT RFA
LISTED HERE WE HAVE SOLICITED
RESEARCH ON INTERVENTION
STRATEGIES DESIGNED TO
SPECIFICALLY EVALUATE SERMON
DETERMINANTS OF HEALTH AND
ADDRESS OVERALL HEALTH EQUITY.
THIS FUNDING OPPORTUNITIES
SUPPORTS THE RESEARCH AND
DEVELOP AND ADAPT AND IMPLEMENT
STRATEGIES AND LEVERAGE POSITIVE
INFLUENCES ON HEALTH.
IT EMPHASIZES COMMUNITY
ENGAGEMENT TO ENSURE
INTERVENTIONS ALIGN WITH RURAL
COMMUNITY PRACTICES, NEEDS AND
STRENGTHS.
I'M GOING TO HIGHLIGHT STRAENTS
I THINK IT IS AN IMPORTANT
COMPONENT I HAVEN'T HEARD US
DISCUSS MUCH BEFORE THE
IMPORTANCE OF LEVERAGING
STRENGTH.
THE RESEARCH SUPPORTS VARIOUS
APPROACHES INCLUDING COMMUNITY
BASED PA TIS PA TERRY RESEARCH
TAILORED TO RURAL CONTACTS.
IN THIS PARTICULAR CASE WE ARE
GOING TO DISCUSS LATER THE
RESPONSES TO THIS RFA DURING OUR
CLOSED SESSION AS WE HAVE
APPLICATIONS IN HAND.
THE ACCESS INITIATIVE LOOKS TO
ADVANCE HEALTH DISPARITIES
THROUGH AN INTERSECTIONAL LENS
FOCUSING ON VARIOUS SOCIAL
STATUSES INTERSECT TO INFLUENCE
HEALTH OUTCOMES.
RECOGNIZING SYSTEM OF PRIVILEGE
AND OPPRESSION, RACISM AND
CLASSISM DRIVE HEALTH
INEQUITIES.
THE INITIATIVE WE PUT OUT IS
SEEKING RESEARCHERS TO UNCOVER
PATHWAYS AND MECHANISMS
UNDERLYING THESE DISPARITIES.
EMPHASIZING USE OF INNOVATIVE
METHODS TO IDENTIFY RACE,
ETHNICITY, GENDER AND OTHER
POSITIONS THAT AFFECT HEALTH,
ESPECIALLY IN MARGINALIZED
POPULATIONS.
AND I'M HAPPY TO SAY THAT WE ARE
EXPECTING ANTICIPATED AWARDS IN
OUR NEXT FISCAL YEAR.
AND LASTLY, AS YOU HAD HEARD
MENTIONED EARLIER TODAY, WE ARE
REALLY EXCITED TO ANNOUNCE AND
INTEND TO PUBLISH INITIATIVES TO
ADDRESS HOUSING INSTABILITY WITH
OUTCOME FOR OCTOBER WATCH.
SO KEEPING WITH THE SAME THEME
OF BUILDING THE EVIDENCE AND
PROVIDING OPPORTUNITIES TO
SUPPORT EXAMINING HEALTH EQUITY
WITH A FOCUS ON SOCIETAL IMPACT
I WANT TO SHARE ONE MORE EXAMPLE
OF A NURSE-LED INTERVENTION AND
RESPONSE TO A P.A.R. ON
COMMUNITY INTERVENTION TO
ADDRESS THE CONSEQUENCES OF
COVID-19, PANDEMIC AMONG HEALTH
DISPARITIES.
THIS PARTICULAR STUDY HAS
FOCUSED IN ON UNDERSERVED RACIAL
AND ETHNIC MINORITIES,
SPECIFICALLY AFRICAN-AMERICAN
ADULTS WITH CHRONIC ILLNESS
RECOVERS FROM COVID-19, ALONG
WITH INFORMAL CARE PARTNERS
RECOGNIZING THAT COMMUNITIES
FACE DISPROPORTIONATE IMPACT
FROM COVID-19 DUE TO SOCIAL AND
STRUCTURAL HEALTH DETERMINANTS
AND PREEXISTING CONDITIONS LIKE
DIABETES AND HYPERTENSION.
THE STUDY IS ADDRESSING RACIAL
AND PANDEMIC RELATED STRESSORS
AND SUGGESTS THIS DIAD IN THE
CHRONIC DISEASE MANAGEMENT.
BY ENHANCING THE EFFICACY OF
BOTH PATIENTS AND CAREGIVERS IN
MANAGING ILLNESS BEHAVIORS
THROUGH COACHING AND HEALTH
SYSTEM NAVIGATION.
SO, AGAIN, HAVING THE
OPPORTUNITY TO LOOK MORE BROADLY
THAN JUST INDIVIDUAL LEVEL
INTERVENTIONS.
THROUGH RIGOROUS EVALUATION AND
COMMUNITY INPUT THIS STUDY IS
WORKING TO REDUCE HEALTH
DISPARITIES TAILORING TO THE
UNIQUE CHALLENGES FACED BY THIS
POPULATION.
SO ALONG WITH OUR EFFORTS, OUR
RESEARCH PORTFOLIO TO EXPAND
THAT AND TO AGGRESSIVELY CREATE
OPPORTUNITIES FOR OUR
RESEARCHERS TO COME IN AND
SUPPORT THE EFFORT AND WORK WE
HAVE LAID THE GROUND FOR, WE ARE
ALSO IN A REALLY STRONG POSITION
TO LEAD BY COLLABORATING ACROSS
NIH TO HELP MAKE SURE WHEN WE
MOVE THESE NIH-WIDE EFFORTS
FORWARD THE OPPORTUNITY TO
EXPLORE SOCIAL DETERMINANTS OF
HEALTH AND TALK ABOUT HEALTH
EQUITY AND PARTNER WITH
COMMUNITIES REMAINS FRONT AND
CENTER.
SO YOU HEARD EARLIER FROM DR.
ZENK THE LATEST UPDATES, BUT I
WANTED TO UNDERSCORE THE
IMPORTANCE OF THIS PROGRAM
IMPROVE AS IT AIMS TO REDUCE
MATERNAL HEALTH DISPARITIES BY
TAILORING APPROACHES TO THOSE
MOST AFFECTED INCLUDING
AFRICAN-AMERICAN, AMERICAN
INDIAN, ALASKAN NATIVE
POPULATIONS AND INDIVIDUALS
LACKING ACCESS TO MATERNAL CARE.
WE HAVE ONE OF THE CO-CHAIRS
SITTING RIGHT NEXT TO ME.
AND WITH HER LEADERSHIP WE'VE
BEEN ABLE TO TRULY INFUSE AND
MAKE IT CLEAR WE NEED TO
UNDERSTAND THE IMPACT OF
SYSTEMATIC FACTORS DRIVING
DISPARITIES IN ORDER TO ADDRESS
HIGH RATES OF MATERNAL MORTALITY
AND MORBIDITY IN THE UNITED
STATES.
THEY ARE AWARDING $40 MILLION TO
ESTABLISH RESEARCH CENTERS OF
EXCELLENCE ACROSS D COUNTRY AND
THE CHANNEL AWARDS THAT WERE
GWYNN TO COMMUNITY ORGANIZATIONS
THAT DR. ZENK PRESENTED EARLIER,
IMPROVE SR. DEVELOPING A NETWORK
AND IDENTIFY RISK FACTORS FOR
MATERNAL MORTALITY AND MO BIDTY.
ANYONE THIN HAS BEEN INVOLVED IN
ALL STAGES OF THIS PROCESS AND
HELPED TO INFUSE THAT A FOCUS
REMAIN ON SERMON DETERMINANTS OF
HEALTH AND OVERCOMING STRUCTURAL
BARRIERS TO ADDRESS SOMETHING
YOU KNOW IS A PREVENTABLE HEALTH
DISPARITY.
AND I WON'T TALK MUCH ABOUT
CONGRESS, BUT I KNOW THERE WAS A
MEETING THAT JUST HAPPENED AND
YOU HEARD THE UPDATE EARLY.
I WANT TO REITERATE HOW TRULY
IMPACT THIS INITIATIVE WAS
DESIGNED AND AIMING TO ACHIEVE.
LAUNCHED IN 2023, MUCH WORK
BEGAN BEFORE THAT WITH LISTENING
SESSIONS AND O T A TO SET THE
STAGE TO MAKE SURE VOICES WERE
HEARD IN DEVELOPING AND
DEZINGING THIS INTERVENTION.
NINR PARTNERED THIS TIME WITH
NIMH, NIMHD, ORWS.
H AND THE OFFICER OF THE
DIRECTOR AS A FOUNDING CO-CHAIR
TO ESTABLISH A GROUNDBREAKING
PROGRAM NIH HAS NOT SEEN BEFORE
THAT I WAS INCREDIBLY EXCITED TO
SEE AS A BEHAVIORAL SCIENTIST
MYSELF.
YOU CAN'T INTERVENE IF YOU DON'T
UNDERSTAND THE COMMUNITY VOICE.
WE ARE PROVIDING $71 MILLION
APPROXIMATELY OVER FIVE YEARS TO
SUPPORT COMMUNITY ORGANIZATIONS
WITH NINR LEADING THE CHARGE AND
MANAGEMENT OF THE COORDINATING
CENTER OR CENTERS.
BUT THE PROGRAM AS YOU ALL MAY
KNOW EMPHASIZES THE ROLE OF
SOCIAL DETERMINANTS OF HEALTH BY
FOSTERING COLLABORATIONS BETWEEN
COMMUNITY LEADERS AND RESEARCH
PARTNERS FROM ACADEMIC
INSTITUTIONS.
THE RESEARCH FOCUSES ON
DEVELOPING, IMPLEMENTING AND
ASSESSING STRUCTURAL
INTERVENTIONS TO CREATE
SUSTAINABLE SOLUTIONS.
BY ADDRESSING SYSTEMATIC ISSUES
THAT LEAD TO HEALTH DISPARITIES
THE PROJECTS SUPPORTED BY
ComPASS ARE AIMING TO IMPROVE
HEALTH OUTCOMES IN COMMUNITIES
ACROSS THE NATION.
INITIATIVES TO ENHANCE ACCESS TO
HEALTHY FOOD, IMPROVE CHILD CARE
STRATEGIES, FACILITATE BETTER
HEALTH CARE ACCESS AND EXPAND
TELEHEALTH SERVICES IN RURAL
AREAS.
YOU CAN SEE THERE IS QUITE A LOT
OF ALIGNMENT IN WHAT WE HAVE SET
UP IN OUR STRATEGIC PLAN.
GIVE A HEAD NOT TO THE PERSON
SITTING NEXT TO BE AND THE
INVOLVEMENT IN IN INFUSING THE
IMPORTANCE OF NURSING SCIENCE.
SO ALL OF THIS IS TO SAY AND TO
SUMMARIZE AND HAVE THE
CONVERSATION THAT AFTER HEARING
THE UPDATES AND THE
ACCOMPLISHMENTS EARLIER THAT DR.
ZENK PRESENTED IN HER DIRECTOR'S
TALK AND THE NATURE OF THE GAPS
THAT WE STILL MUST ADDRESS, WE
HAVE RECOGNIZED THAT IT IS TIME
TO REVISIT OUR LENSES.
AND THAT WHAT WE INITIALLY
OUTLINED IN OUR STRATEGIC PLAN
DOES MATCH AND VERY MUCH
RELEVANT BUT JUST LIKE ANYTHING
ELSE IN SCIENCE EVOLVES SO WE
NEEDED TO CLARIFY AND IT WAS
TIME TO DO THAT.
IT GAVE US AN OPPORTUNITY TO
EXPLORE EMERGING AREAS OF
EMPHASIS AND THE APPROACHES TO
NURSING RESEARCH THAT HAVE THE
GREATEST POTENTIAL FOR PRODUCING
RESULTS WITH THE GREATEST IMPACT
BECAUSE NOW IS THE TIME TO DO
IT.
WE HAVE THE NOOR.
WE HAVE THE STAGE.
WE NOW HAVE EVIDENCE AND QUITE A
FEW SUGGESTIONS FOR AREAS TO GO
DO.
NEXT SLIDE, PLEASE.
AS WE'VE CONTINUED TO PRIORITIZE
HEALTH EQUITY AS OUR NORTH STAR
AND EXPAND OUR PORTFOLIO, THERE
ARE MANY IMPORTANT SCIENTIFIC
ADVANCEMENTS THAT PUSH THE NEED
FOR MORE CLARITY TO MOVE FORWARD
SUPPORTING OUR EFFORTS.
AS SHARED EARLIER, WE HAVE TAKEN
THE TIME AND SEVERAL DISCUSSIONS
AND A LOT OF INPUT AND
THOUGHTFULNESS AROUND MAKING
SURE AS WE WERE REFINING OUR
LENSES WE WERE STAYING TRUE TO
OUR NORTH STAR.
FOCUSING ON HEALTH EQUITY TODAY
IS OUR WAY OF DOING THAT.
DR. ZENK MENTIONED EARLIER WE
HAVE UPDATED OUR LANGUAGE AND IN
JULY AFTER MUCH DISCUSSION WE
RELEASED THAT.
YOU SHOULD BE ABLE TO SEE OUR
UPDATED LENSES ON OUR WEBSITE
AND WE'RE VERY PROUD OF WHERE WE
ARE WITH THIS BECAUSE NOW WE
HAVE AN OPPORTUNITY TO SHARE OUR
NORTH STAR WITH OUR
INVESTIGATORS.
WE'VE NOW PROVIDED ADDITIONAL
CLARITY OF THE TYPE OF RESEARCH
WE WOULD LIKE TO SEE WITH FULL
RECOGNITION THIS IS WHERE WE'RE
ABLE TO MAKE AN IMPACT.
NEXT SLIDE, PLEASE.
SO FOCUSING IN ON MAXIMIZING OUR
IMPACT AT NINR WE HAVE PUT REAL
EMPHASIS ON SUPPORTING RIGOROUS
SCIENCE THAT TRULY HAS THIS
POTENTIAL TO MAKE AN IMPACT.
WE WANT RESEARCH THAT GOES
BEYOND OBSERVING THE PROBLEM.
WE NEED TO INTERVENE AND WE NEED
TO MAKE A DIFFERENCE AND NOW IS
THE TIME TO DO THAT.
A VIEW OF OUR HEALTH EQUITY
RESEARCH IS HOW WE DESCRIBE IN
OUR HEALTH EQUITY PLAN.
AS DR. ZENK INDICATED EARLIER,
IT IS TIME TO MAKE THIS CHANGE.
THERE ARE CHARACTERISTICS OF
STUDIES THAT WE BELIEVE ARE
ESSENTIAL AND WE WANT STUDIES
THAT ARE SEEKING TO MAKE AN
IMPACT AND TO DO THAT AT A
FOUNDATIONAL LEVEL STUDIES MUST
INCORPORATE AND FOCUS ON HEALTH
DISPARITIES.
WE KNOW ADDRESSING HEALTH
DISPARITIES IS AN ESSENTIAL STEP
TO ACHIEVING HEALTH EQUITY.
WE'RE INTERESTED IN STUDIES, FOR
EXAMPLE, THAT EXAMINE
CONTRIBUTING FACTORS AND
PATHWAYS AND MECHANISMS
UNDERLYING HEALTH DISPARITIES,
BUT WE ARE INTERESTED IN TESTING
INTERVENTIONS AND OTHER
APPROACHES FOR THEIR IMPACT ON
HEALTH DISPARITIES.
IT IS BECAUSE WE ARE LOOKING FOR
THIS INTERSECTIONALTY WE WANTED
TO ALSO CLARIFY THIS PARTICULAR
LENS.
NEXT SLIDE, PLEASE.
BUT AS IT HAS BEEN POINTED OUT,
WE NEED TO PROVIDE MORE CLARITY
IN THE GOALS WE ARE TRYING TO
ACHIEVE AND OUR LENS IS A WAY TO
PROVIDE MORE CLARITY AND
GUIDANCE TO INVESTIGATORS WHO
ARE INTERESTED IN THIS WORK.
THROUGH IDENTIFICATION OF THESE
THREE KEYS WE ARE PURPOSEFULLY
HIGHLIGHTING WHAT WE ARE LOOKING
FOR.
RESEARCH THAT EXAMINES
INTERSECTIONS ON STRUCTURAL
FACTORS AND RESEARCH THAT IS
MEANINGFULLY INVOLVED,
MARGINALIZED AND MONETIZED
POPULATIONS AND WHAT I WOULD
LIKE TO POINT OUT HERE IS THE
IMPORTANCE OF EXAMINING HEALTH
QUIT AND LOOKING AT IT NOT AS A
DEFICIT MODEL BUT STRENGTH BASED
MODEL AND AMPLIFYING THE VOICES
OF THE COMMUNITY, THEIR
INFLUENCE AND MAKING SURE WE PAY
ATTENTION TO NOT JUST THE
DEFICITS IN THE HEALTH
DISPARITIES, BUT WHERE WE CAN
TAKE WHAT WE SEE IN TERMS OF
STRIDES AND APPLY THEM IN
DIFFERENT AREAS.
A STUDY THAT INCORPORATES ALL
THESE OF THESE KEYS STAND THE
BEST CHANCE OF HAVING AN IMPACT
ON HEALTH EQUITY.
WE ARE STRIVING FORWARD.
DON'T SEE US SLOWING DOWN AT ANY
POINT.
AS A MATTER OF FACT, IF YOU GO
TO THE DATA TABLES I SHOWED YOU
EVERYTHING IS.ING TO US MOVING
FORWARD.
CHASING THE NORTH STAR WE WANT
TO MAKE SURE WE ARE INCORPS
RATES ING ALL PRINCIPLES
PROVIDING ADDITIONAL
OPPORTUNITIES TO REALIZE THE
IMPACT NECESSARY TO END UNEQUAL
TREATMENT.
NINR IS IN THIS.
WE ARE IN IT NOW AND A LITTLE
LATER WE WILL TALK ABOUT WHERE
WE NEED TO GO AND I HOPE YOU
WILL LEAN IN TO THE NEXT STEPS
AS WE ALL HEAD UNDERNEATH OUR
NORTH STAR.
NEXT SLIDE, PLEASE.
AND WITH THAT, I'LL JUST SAY
THANK YOU FOR YOUR TIME AND
REALLY APPRECIATE HAVING THE
OPPORTUNITY TO BE PART OF THIS
CONVERSATION AS SOMETHING THAT
WE ALL HOLD NEAR AND DEAR.
>> THANK YOU SO MUCH, DR. AKIN.
I WELCOME NINR FUNDED
INVESTIGATOR MELISSA HORNING.
AN ASSOCIATE PROFESSOR AT THE
UNIVERSITY OF MINNESOTA SCHOOL
OF NURSING.
HER CURRENT RESEARCH FOCUSES ON
EVALUATING THE EFFECTIVENESS OF
A MOBILE FOOD MARKET AND
BRINGING AFFORDABLE AND
NUTRITIOUS FOOD TO UNDERSERVED
COMMUNITIES AND THE IMPACT ON
DIET QUALITY, FOOD PURCHASING
HABITS AND FOOD SECURITY.
DR. HORNING IS NOT JOINED
VIRTUALLY.
UNFORTUNATELY HER COMMUNITY
PARTNER WAS NOT ABLE TO MAKE IT
TODAY.
SO WE'LL CATCH UP WITH THAT
PARTNER LATER.
BUT, AGAIN, THANK YOU DR.
HORNING FOR JOINING US AND WE
ARE LOOKING FORWARD TO HEARING
MORE ABOUT YOUR PARTNERSHIP AND
RESEARCH.
>> THANK YOU.
STEPH SENDS HER DEEPEST REGRETS.
SHE IS TOO REMOTE TO CALL IN.
SO SHE IS SORRY SHE CAN'T BE
HERE.
BUT SHE TOLD ME I COULD PRESENT.
WITH THAT, I WILL GET STARTED.
I COME TO THIS WORK BY WAY OF
PUBLIC HEALTH NURSING.
AS A PUBLIC HEALTH NURSE ONE OF
THE GREATEST TOOLS IN MY TOOLKIT
WAS PARTNERSHIP WITH MY CLIENTS
AND THE COMMUNITY RESOURCES AND
ORGANIZATIONS THAT SUPPORTED
THEM.
BECAUSE WITHOUT PARTNERSHIP I
COULDN'T HAVE DONE MY JOB WELL.
THE FOCUS ON FOOD CAME FROM MY
CLIENTS BECAUSE THEY WERE
WORRIED ABOUT ACCESSING FOOD,
AFFORDING FOOD AND FOR SOME
PREPARING FOOD AND GETTING THEIR
KIDS TO EAT WELL.
NUTRITIOUS FOOD IS ESSENTIAL FOR
HEALTHY GROWTH AND DOCUMENT OF
OUR CHILDREN, MANAGEMENT OF
CHRONIC HEALTH CONDITIONS AND
AGING WELL.
NOT EVERYONE HAS ACCESS TO THE
FOOD THEY NEED AND FOOT
INSECURITY IS THE LIMITED ACCESS
TO FOOD AND THIS DOESN'T BEGIN
TO ADDRESS NUTRITIOUS FOOD.
FOOD INSECURITY IS CONTRIBUTING
TO HEALTH INEQUITIES RELATED TO
DIET, WEIGHT AND OTHER HEALTH
CONDITIONS.
RESEARCH HAS SHOWN IT IS
CONTRIBUTING TO A HOST OF POOR
OUTCOMES THAT MAKE IT IS A MAJOR
PUBLIC HEALTH CONCERN.
FOOD INSECURITY IMPACTS 1 IN 10
IN THE UNITED STATES.
UNFORTUNATELY, THIS IMPACT IS
NOT EQUITABLY DISTRIBUTED ACROSS
OUR COMMUNITIES.
FOOD INSECURITY
DISPROPORTIONATELY AFFECTS THOSE
FROM MINORTIZED RACIAL GROUPS.
IT IS JUMPING TWO SLIDE AT ONCE.
THOSE WHO ARE LOWER ECONOMIC
STATUS.
THE MAJOR FACTORS ARE THE
STRUCTURAL DETERMINANTS OF
HEALTH, SYSTEMS AND STRUCTURES
AND CONDITIONS WE LIVE, WORK AND
PLAY.
IN PARTICULAR STRUCTURAL RACISM
IS CONTRIBUTING TO FOOD
INSECURITY THROUGH CHRONIC
DISINVESTMENT IN COMMUNITIES
PREDOMINANTLY OF PEOPLE OF COLOR
AND OR LOW SOCIOECONOMIC STATUS.
STRUCTURAL RACISM IS
CONTRIBUTING TO FOOD INSECURITY
BASED ON WHERE FULL SERVICE
GROCERY STORES CHOOSE TO OPERATE
AND ARE ALLOWED TO OPERATE
THROUGH ZONING POLICIES AND
LAWS.
ECONOMIC INSTABILITY AND LIMITED
EMPLOYMENT OPPORTUNITIES ARE
CONTRIBUTING TO FOOD INSECURITY.
WHEN FACED WITH MULTIPLE NEEDS,
HOUSING, HEAT AND FOOD, FOOD IS
PRETTY FLEXIBLE.
WE HAVE ALL SEEN THE RISING COST
OF FOOD IN RECENT YEARS AND WE
ALSO KNOW THAT BASED ON THE
LOCATION AND TYPES OF STORES
AVAILABLE IN YOUR COMMUNITY,
PRICES VARY DRAMATICALLY,
SMALLER STORES HAVE HIGHER
PRICES AND LOWER QUALITY FOODS.
THIS IS A MAP OF THE TWIN CITIES
METROPOLITAN AREA IN MINNESOTA.
AND THE AREAS IN ORANGE ARE
CENSUS TRACKS EXPERIENCING LOW
INCOME AND LOW FOOD ACCESS.
AS YOU CAN SEE, LOW FOOD ACCESS
IS NOT EQUITABLY DISTRIBUTED
ACROSS OUR COMMUNITY, THIS IS
ACROSS THE COUNTRY.
AS A PUBLIC HEALTH NURSING
RESEARCHER I HAVE WRESTLED WITH,
WHAT DO WE DO?
HOW DO WE INTERVENE?
WHAT IS THE NEXT STEP?
SO I HAVE SEEN A LOT OF REALLY
AMAZING INNOVATIVE PROJECTS IN
RESEARCH AND COMMUNITY LIVE AND
DIE WITH GRANT FUNDING AND
CHANGES IN RESULTS IN FUNDING
PRIORITIES OR CHANGES IN
LEADERSHIP.
I WANTED TO BE SURE I WAS
CONTRIBUTING TO SOMETHING
POTENTIALLY SUSTAINABLE IN A
REALLY MEANINGFUL WAY TO ADVANCE
EQUITY AND I KNEW I HAD TO GO
BACK TO MY ROOTS AS A PUBLIC
HEALTH NURSE.
I KNEW IT NEEDED TO BE A
PARTNERED PROJECT.
THE TWIN CITYING MOBILE MARKET
WAS FOUNDED ON THE VALUES OF
EQUITY AND COMMUNITY ENGAGEMENT.
THE FOUNDING DIRECTOR LEAH
PORTER TALKED TO OVER 1,000
EMEMBERS OF THE COMMUNITY TO
MAKE SURE THE MOBILE MARKET
DESIGNED AND BUILT REFLECTED THE
NEEDS OF THE PEOPLE THAT WOULD
BE USING IT.
SHE WAS COMMITTED AND THE
COMMUNITY REALLY NEEDED THE
HIGHEST QUALITY CUSTOMER SERVICE
AND QUALITY AFFORDABLE FOODS.
THIS MOBILE MARKET GOES TO 25
SITES THAT ARE SPECIOUS LOW
INCOME AND LOW FOOD ACCESS AND
SELLS FOOD FROM ALL THE FOOD
GROUPS.
IT WAS INITIALLY OPERATED WITH
THE WILDER FOUNDATION.
THIS IS WHAT IT LOOKED LIKE IN
THE EARLY DAYS ON THE INSIDE
COMPLETE WITH SHOPPING CARTS.
THIS IS WHAT IT LOOKS LIKE NOW.
THE BUSES WERE JUST REFRESHED.
THEY INVESTED IN NEW BUSES
BECAUSE THE OLD BUSES HAS
SERIOUS MECHANICAL ISSUES THAT
RECUR.
THIS IS THE INSIDE OF THE BUS
NOW.
IT STILL HAS SHOPPING CARTS.
IN 2016 OUR ENGAGE RESEARCH
PROJECT BEGAN.
WHEN LEAH AND I MET FOR THE
FIRST TIME IT WAS BETTING TO
KNOW EACH OTHER AND DEVELOP A
PARTNERSHIP AND FIGURE OUT NEEDS
AND PRIORITIES.
I KNEW THAT INVOLVES TALKING TO
CUSTOMER.
LEAH SAID THIS MODEL ISN'T
INEXPENSIVE TO RUN, IT SOUNDS
GOOD, FEELS GOOD, WE NEED TO
KNOW IF IT IS HAVING IMPACT.
IS IT CHANGING FOOD INSECURITY?
IF IT IS NOT, WE NEED TO
RECONVENE AND FIGURE OUT WHAT WE
COULD DO INSTEAD.
LEAH REALLY WANTED TO KNOW THE
IMPACT OF THE MOBILE MARKET, SHE
DIDN'T WANT TO CREATE ANOTHER
BARRIER TO ACCESSING FOOD IN THE
AREAS SHE WAS TRYING TO IMPROVE
FOOD ACCESS.
BECAUSE OF HISTORICAL HARMS OF
RESEARCH SHE WAS LIKE IS THIS A
GOOD MOVE FOR US.
WE NEEDED TO BILL TRUST AND
RAPPORT.
I WORK ON A SALES DATA PROJECT
AND I WAS ABLE TO GET TO KNOW
HER OVER THE PROCESS OF DOING
JUST A DATA ANALYSIS PROJECT AND
VOLUNTEERING FOR HER WHEN SHE
NEEDED A VOLUNTEER.
AND THAT LED US TO THE POINT
WHERE WE WERE BEGINNING TO WEAVE
THE COMMUNITY ENGAGED RESEARCH
PARTNERSHIP WRITING RESEARCH
GRANTS AND PROGRAM
IMPLEMENTATION GRANTS.
WE EMPHASIZED SHARE DECISION
MAKING.
SHE READ EVERYTHING I WROTE, I
READ EVERYTHING SHE WROTE.
THAT LED TO THE FIRST STUDY THAT
WAS FUNDED WITH CUSTOMERS.
THAT WAS INTENTIONAL.
THE CUSTOMERS ARE THE EXPERTS OF
THEIR LIVES SO WE WANTED TO KNOW
FROM THEM FIRST WHAT WAS THE
LIVED EXPERIENCE OF SHOPPING AT
THE TWIN CITIES MOBILE MARKET?
MORE IMPORTANTLY WE WANTED TO
UNDERSTAND BETTER HOW DO WE DO
RESEARCH IN THE COMMUNITY AND DO
IT WELL AND CORRECTLY.
WE LEARNED A LOT OF WONDERFUL
THINGS FROM THE CUSTOMERS.
WE ALSO WERE FORTUNATE TO
RECEIVE A PROGRAM IMPLEMENTATION
GRANT FROM THE UNITED STATES
DEPARTMENT OF AGRICULTURE WITH A
RESEARCH IN IT.
WE GOT TO THE REMAIN IN FIELD
AND TALK WITH CUSTOMERS ABOUT
DAY-TO-DAY.
IT ALLOWS CUSTOMER INTERCEPT
SURVEYS AS WE WERE ABLE TO
DISCOVER THAT FOOD INSECURITY
WAS A NEARLY UNIVERSAL
EXPERIENCE.
AND THOSE PROJECTS THEN LED US
TO WHERE WE ARE AT THIS POINT,
SUBMITTED OUR FIRST RO1 AND
ENGAGING PARTNERS INVOLVED IN
THE WORK.
TRUE TO PROGRAMS IN THE
COMMUNITY, THEY ARE OPERATING IN
A SPACE WHERE THINGS ARE
CHANGING ALL THE TIME.
AS WE WERE WRITING OUR FIRST
RO1, THE MOBILE MARKET WAS
SWITCHING UMBRELLA
ORGANIZATIONS.
AS STEPH WOULD LIKE TO TELL YOU,
IT IS VERY, VERY CHALLENGING TO
TRANSITION A PROGRAM AT THE
START OF A PANDEMIC.
BUT THAT BEING SAID, MY INITIATE
PARTNER, LEAH, WAS TRARNS
SITUATIONING AWAY FROM THE
PROGRAM SO ALL OF THIS
HISTORICAL TRUST AND RAPPORT WE
BUILT UP HAD TO GET
RE-ESTABLISHED.
IT TOOK TIME TO GET THAT PART
DONE WHERE WE WERE LOOKING AT
WHAT ARE THE AIMS OF THIS STUDY
AND WHAT CAN WE DO TOGETHER AND
THE NEEDS OF THE ORGANIZATION
AND WHAT IS THE BENEFIT OR THE
POTENTIAL THINGS RESEARCH COULD
BRING TO THAT WORK?
WE WERE ABLE TO BE SUCCESSFUL IN
OUR GRANT RESUBMISSION AND WE
WERE FUNDED IN 2022 TO EVALUATE
THE IMPACT OF THIS FULL SERVICE
MOBILE MARKET ON DIETARY QUALITY
AND FOOD INSECURITY.
WE ARE SEEKING TO EXPLORE WHAT
IS THE EXPERIENCE OF THE MOBILE
MARKET AS THE INTERVENTION ARM.
TO UNDERSTAND WHAT IS WORKING,
WHAT CAN BE DO BETTER OR WHY
THEY CHOOSE TO SHOP OR DON'T
CHOOSE TO SHOP.
WE ARE AIMING TO DO 12 NEW
MOBILE MARKET SITES IN THE TWIN
CITIES TARGETING 264
PARTICIPANTS FOR POWER PURPOSES.
I'M PLEASED TO REPORT WE HAVE
JUST BEGUN BASELINE RECRUITMENT
AND DATA COLLECTION FOR OUR
THIRD WAVE OF THIS STUDY.
AND AFTER BASELINE DATA
COLLECTION RECRUITMENT IS DONE
FOR EACH OF THE WEAVES, THEY GET
RANDOMIZED TO RECEIVE THE MOBILE
MARKET OR HAVE TO WAIT UNTIL
FOLLOW-UP DATA COLLECTION IS
DONE.
HOPEFULLY BY NOW YOU SEE THE
COMMUNITY ENGAGEMENT WE ARE
DOING IN THIS WORK HAS BEEN
EMBEDDED IN THE PROJECT FROM THE
DEVELOPMENT OF THE AIM SO THE
DIVISION OF RESPONSIBILITIES
THEY ARE CLEARLY NEED TO BE
BREAKING DOWN THE BUSES.
THEY DON'T WANT ME IN THAT ROLE.
IT ALLOWED US TO OPENLY
COMMUNICATE HONESTLY WITH ONE
ANOTHER AS THIS PARTNERSHIP
CONTINUES TO DEVELOP OVER TIME
TO VALUE THE EXPERTISE OF
EVERYONE WHO COMES TO THE TABLE.
WE HAVE HAD TO NEGOTIATE
BUDGETS, AFTER BUDGET CUTS.
THINK ABOUT HOW DO WE SELECT
SITES FOR THE TRIAL.
THE MOBILE MARKET HAS CRITERIA.
THEY HAVE TO HAVE SOMEWHERE TO
PARK THE BUS.
IN ORDER TO MAKE IT THROUGH PEER
REVIEW WE HAD TO DECREASE THE
RISK OF DECON TAME NATION.
HOW DO WE INTERFACE WITH THE
COMMUNITY SITES THAT ARE
INTERESTED IN THE MOBILE MARKET,
SEEING IF THERE IS A GOOD FIT
BECAUSE AT THE END OF THE DAY
THE PEOPLE WHO LIVE IN THE
BUILDINGS THAT THE MOBIL MARKET
GOES TO NEED TO BE ABLE TO WANT
AND THINK THIS IS A GOOD IDEA
FOR THEM.
WE TRIED TO CREATE NICE FEEDBACK
LOOPS TO VALUE THE PARTICIPANT
EXPERIENCE AND THE MOBILE MARKET
STAFF ON THE GROUND EVERY SINGLE
DAY AND THEIR CUSTOMERS.
SO IN THE RESEARCH PROCESSES, WE
HAVE SOUGHT STAFF AND CUSTOMER
INPUT SO THEY ARE REVIEWING
EVERYTHING, TOO, TO MAKE SURE
OUR MEASUREMENT PROCESSES ARE IN
THE RIGHT SPACE, WE HAVE THE
RIGHT RECRUITMENT AND RETENTION
STRATEGIES.
AND THEY'VE HELPED US FIGURE OUT
HOW DO WE MAKE PARTICIPATION
WELCOMING AND EASY.
WE ARE IN THE COMMUNITY WITH
FOLKS.
WE TRY TO AIM FOR A REALLY
HOSPITABLE EXPERIENCE.
WE BUILT IN ACCOMMODATIONS FOR
EVERYONE.
FOR EXAMPLE, INSTEAD OF HAVING
SOMEONE BE LIKE, HERE IS YOUR
SURVEY, WHEN IT GETS TO THAT
POINT IN TIME EVERYONE IS
OFFERED, WOULD YOU LIKE HELP
READING YOUR SURVEY OR HELP WITH
THE iPAD OR WOULD YOU LIKE TO
TAKE THE SURVEY THEMSELVES.
WE WANT TO MAKE SURE THERE
AREN'T EXTRA BARRIERS FOR
RESEARCH PARTICIPATE.
RESEARCH ISN'T FOR EVERYONE.
THE WONDERFUL PART ABOUT OUR
TRIAL IS THE MOBILE MARKET IS
AVAILABLE TO EVERYONE.
RESEARCH PARTICIPANTS AND
BUILDING RESIDENTS ALIKE.
THE MOBILE MARKET STAFF DON'T
KNOW WHO IS A PARTICIPANT AND
WHO IS NOT.
WE HAVE LAUNCH EVENTS WHERE
EVERYBODY IN THE BUILDING COMES
TO LEARN ABOUT WHAT THE MOBILE
MARKET IS, HOW IT WORKS.
WE ARE SEEKING THAT EXPERIENCE
IN OUR PARTICIPANTS AND CLEARLY
GOING TO INFORM OUR PARTICIPANTS
OF THE TRIAL RESULTS.
SO WHEA WE KNOW IS THE DATA ARE
REALLY GOING TO SUPPORT THE FULL
SERVICE MOBILE MARKET MODEL OR
SUGGEST THAT CHANGES MIGHT BE
NEEDED TO PAVE THE WAY FOR
SERVICES THAT ARE TRULY
RESPONSIVE TO THE COMMUNITY
NEEDS AND INTEREST.
WE KNOW THE PARTICIPANTS IN OUR
STUDY ARE DEM GRAPHICALLY
REPRESENTED BY THE BUILDING
POPULATIONS AND WI HAVE HAD A
HIGH RETENTION RATE.
WE REGULARLY HEAR THAT
PARTICIPANTS LIKE PARTICIPATING
IN OUR STUDY AND I SOMETIMES GET
CUTE NOTES AND THEY ARE LIKE, DO
YOU HAVE ANY OTHER STUDIES WE
CAN PARTICIPATE IN?
WE KNOW CHALLENGES REMAIN.
NO COMMUNITY WANTS TO WAIT UNTIL
FOLLOW UP DATA COLLECTION TO
START THE SERVICE BECAUSE NEEDS
ARE IMMEDIATE.
NEEDS ARE NOW.
IF THE SITES ARE NEXT TO A
HIGH-END GROCERY STORE, THAT IS
OFF THE LIST EVEN THOUGH IT
WOULD POTENTIALLY BE A COMMUNITY
SITE THAT WOULD VERY MUCH NEED
THE TWIN CITIES MOESHL --
MOESHL MARKET.
THIS IS REAL WORLD
IMPLEMENTATION.
BUSES CAN BREAK DOUB.
THEY HAVE, THEY WILL, PROBABLY
WILL AGAIN.
SYSTEMS CAN FAIL, HICCUPS CAN
HAPPEN, BUT THE RESULTS TAKE
THAT INTO CONSIDERATION AND
HOPEFULLY THAT INCREASING
MEANINGFULNESS OF LOELGLY AND
BROADLY.
AND THAT INFLUENCES THE
SUSTAINABILITY.
IT ALSO COMES WITH THE CAVEAT
WHILE WE ARE DOING AIMING TO DO
REAL WORLD RESEARCH EVALUATION,
WE HAVE A SYNERGISTIC
PARTNERSHIP.
THERE ARE WAYS OUR TEAMS HAVE
WORKED TOGETHER AND THE MOBILE
MARKET ISN'T THE SAME AS IT WAS
BEFORE RESEARCH INVOLVEMENT.
FOR INSTANCE, THEY WANTED TO DO
A CUSTOMER LOYALTY PROGRAM AND
THEY DIDN'T HAVE THE PERSON
POWER TO GET IT FIGURED OUT.
WE HAD WRITTEN IT INTO OUR
GRANT.
SO WHEN THE GRANT WAS FUNDED MY
TEAM AND THEIR TEAM WORKED
TOGETHER AND THEY IMPLEMENTED
CUSTOMER LOYALTY PROGRAM.
IT IS REAL WORLD BUT WE HAVE A
PARTNERSHIP THAT IS SYNERGISTIC
SO IT IS PART OF WHAT WE ARE
MEAS
MEASURING.
WE TALK ABOUT HOW HEART THIS
WORK IS AND DEVELOPING
MEANINGFUL RELATIONSHIPS BECAUSE
PARTNERS ARE CHANGING,
COMMUNITIES NEED FOLLOW THROUGH
AND A LOT OF GRANTS AREN'T
FUNDED.
HOW DO WE DO THIS WORK AND DO IT
WELL?
TIMELINES TO FUNDING ARE LONG SO
WE NEED TO BE EFFICIENT IN THE
BUILDING OF PRELIMINARY DATA AND
DEVELOPMENT OF TEAMS SO IT IS
NOT ANTIQUATED BEFORE IT IS
FINISHED.
AND HOW DO WE LEVERAGE REAL
WORLD IMPLEMENTATION.
HOW DO WE DO THAT WELL WHILE
CONDUCTING RIGOROUS RESEARCH?
CAN WE LOOK AT OTHER TYPES OF
DESIGNS.
A CLUSTER RANDOMIZED TRIAL, NOT
ALL REAL WORLD RESEARCH CAN
ATTAIN THAT SO OTHER OPTIONS ARE
PORNTS TO CONSIDER.
HOW DO WE EMBED COMMUNITY
ENGAGEMENT IN PROJECTS IN A WAY
THAT IS REAL.
IT IS NOT A ONE SIZE FITS ALL
APPROACH.
WHAT I AND OTHERS DO IS GOING TO
LOOK DIFFERENT, WAS WE NEED TO
MAKE SURE WE'RE BEING TRUE TO
THE COMMUNITIES WE ARE WORKING
WITH AND DOING IT THE RIGHT WAY
FOR EACH STUDY BECAUSE IT IS NOT
A SERIES OF CHECK BOXES AND ARE
WE HITTING EACH ONE.
THOSE ARE QUESTIONS WE TALK
ABOUT AND FOOD FOR THOUGHT,
LITERALLY AS WE ARE PREPARING
FOR LUNCH.
I JUST WANT TO SAY THANK YOU FOR
YOUR TIME.
>> THAT WAS GREAT.
THANK YOU SO MUCH.
DR. AYALA, KICK US OFF.
>> THANK YOU.
TWO WONDERFUL PRESENTATIONS AND
THANK YOU FOR GIVING US TIME TO
HAVE A LITTLE DISCUSSION BEFORE
LUNCH.
REALLY APPRECIATED YOUR
PRESENTATION, DR. AKIN,
ESPECIALLY THE FIRST PART WITH
THE DATA.
IT IS SOMETHING I HAVE BEEN
WONDERING ABOUT FOR A WHILE.
I APPRECIATE GETTING IT.
BUT IT ALSO RAISED SOME OTHER
QUESTIONS FOR ME, AMONG THEM CAN
THESE, FOR EXAMPLE, THE
ENROLLMENT, THE INCREASES IN
ENROLLMENT, CAN THIS BE
EXPLAINED BY WHO YOU ARE
FUNDING?
INSTITUTIONS AND/OR
INVESTIGATORS?
I'M CURIOUS WHEN YOU THINK BACK
TO THE SOCIAL DETERMINANTS OF
HEALTH TRAINING, I WONDER TO
WHAT EXTENT WE ARE TRACKING.
ARE THOSE FOLKS LEADING SOME OF
THESE GRANTS AND WONDERING ABOUT
THE SYNERGY OF THAT CAPACITY
BUILDING ESPECIALLY WITH FACULTY
AND PARTNERS OF DIVERSE RACIAL
ETHNIC BACKGROUNDS AND ARE THOSE
INVESTMENTS THEN LEADING TO
THESE INCREASING IN ENROLLMENT
AND WHAT NOT?
WHAT KIND OF EXPLAINS THOSE
CHANGES THAT WE ARE SEEING,
WHICH IS FANTASTIC?
THE SECOND QUESTION THAT RAISED
RELATED TO CLARIFYING THE HEALTH
EQUITY LENS.
THE NATURAL EXPERIMENTS AND
DEMONSTRATION STUDIES AND THIS
RELATES TO SOMETHING YOU SAID
DR. HORNING, HOW ARE WE CHANGING
OR EDUCATING.
YOUR DESIGN IS RIGOROUS WHICH IS
PROBABLY ONE OF THE REASONS WHY
IT WAS FUNDED, BUT NOT ALL
STUDIES CAN FIT THOSE DESIGNS.
I'M CURIOUS WHAT MORE CAN WE DO
TO IMPROVE THAT PROCESS, THE
REVIEW PROCESS SO WE DON'T
DISCOURAGE PEOPLE FROM TESTING
OUT DIFFERENT DESIGNS?
AND THEN FINALLY, YOUR COMMENT
REGARDING STRENGTH-BASED MODELS.
THAT WAS CLEAR DURING THE
ComPASS DISCUSSIONS.
I THINK EVERY SINGLE INDIVIDUAL
WHO SPOKE UP THEN SAID WE NEED
TO HAVE A MORE ASSETS BASED
APPROACH AND NOT A DEFICITS
APPROACH.
WE ARE TRYING TO BUILD ON
COMMUNITY STRENGTHS AS OPPOSED
TO THINKING ABOUT THEM NOT
COMING WITH STRENGTHS, INCLUDING
THE ORGANIZATIONS THEMSELVES,
BECAUSE I THINK THERE WAS A
SENSE THAT THE ORGANIZATIONS DID
NOT HAVE NECESSARILY THE
CAPACITY TO BE ABLE TO DO THIS,
BUT IT IS CLEAR THEY HAVE BEEN
DOING IT FOR A WHILE, MAYBE NOT
WITH A RESEARCH LENS.
DR. HORNING, I REALLY APPRECIATE
YOUR FOCUS ON LAWS AND POLICIES.
IT REMINDED ME OF ONE OF THE
ComPASS PROJECTS.
THIS IS LED BY A GROUP CALLED
GUNNA IN SAN FRANCISCO.
WHAT THEY ARE TRYING TO DO IS
TAKE STREET VENDORS AND START TO
HAVE THEM BUILD THEIR CAPACITY
TO HAVE A STORE FRONT IN ALL THE
VACANT BUILDINGS NOW IN SAN
FRANCISCO.
REALLY TALKED ABOUT THE LAWS
THAT ARE NEEDED AND POLICIES
AROUND THAT TO MAKE THAT HAPPEN.
THE OTHER THING THAT STRUCK ME
ABOUT YOUR PRESENTATION AND WE
ALL KNOW THIS, BUT HOW MUCH TIME
IT TAKES.
AND IT IS A STRUGGLE I HAVE AS A
MENTOR OF A LOT OF JUNIOR
FACULTY OF COLOR WHO REALLY WANT
TO BE SUCCESSFUL IN THE R T P
PROCESS, BUT HAVE SUCH A VISION
FOR THEIR RESEARCH LIKE YOURS,
BUT ARE WORRIED ABOUT THE TIME
IT WILL TAKE AND WONDERING HOW
IT IS GOING TO IMPACT THEIR
CAREER.
SO IT IS BALANCE THAT I'M TRYING
TO FIGURE OUT, ESPECIALLY AS A
MENTOR, HOW TO SUPPORT THEM TO
BE ABLE TO ADVANCE.
ONE QUESTION I HAVE FOR YOU,
THOUGH, IS I MISSED, HOW DID YOU
KIND OF TURN THE CORNER WITH
YOUR PARTNER IN TERMS OF HER
INTEREST IN RESEARCH?
>> SO LEAH AND I WERE LITERALLY
JUST MEETING ON THIS OTHER
PROJECT.
SO I WAS TRYING TO HELP HER OUT
AND JUST BY BEING HUMAN, RIGHT?
DEVELOPING A RELATIONSHIP,
GETTING TO KNOW ONE ANOTHER,
BEING ABLE TO TALK ABOUT HOW CAN
WE DO THIS AND DO THIS WELL AND
HOW DO WE GET THE CUSTOMERS TO
INFORM WHAT WE ARE DOING?
TO MAKE SURE WE ARE CREATING A
SPACE THAT IS SAFE.
IT REALLY WAS DEVELOPING A
RELATIONSHIP WITH TIME.
I THINK THAT IS THE TRICK FOR
INVESTIGATORS, RIGHT?
AND IT IS THE TRICK FOR
COMMUNITY.
THIS WORK TAKES TIME AND
INVESTMENT OF RESOURCES BOTH OF
WHICH ARE LIMITED.
AND SO IT IS PRETTY HIGH RISK,
HIGH REWARD BECAUSE PARTNERS ARE
CHANGING AND EVOLVING AND UNLESS
YOUR PARTNER IS ABLE TO WEATHER
THOSE STORMS, YOU CAN END UP
FINDI IING REALLY WONDERFUL
INVESTIGATORS FACING TENURE
CLOCKS AND HAVING THAT STRUGGLE.
>> YOU ASKED SOME INCREDIBLY
GREAT QUESTIONS AND THE FIRST
ONE IS THE IT UNIVERSITIES WE
ARE FUNDING AND LOOKING TO
LEVERAGE?
WE ARE HAVING THAT CONVERSATION
NOW ABOUT THE PARTNERSHIPS.
SO WE DON'T KNOWSLY HAVE THE
DATA, ALTHOUGH, DR. GRAYSON, YOU
CAN CORRECT ME IF I'M WRONG ON
JUST YET.
IT IS IN FULL RECOGNITION WE
NEED TO SUPPORT SOME OF THE
UNIVERSITIES TO HAVE THE
INFRASTRUCTURE TO DO THE WORK WE
ARE TALKING ABOUT DOING.
SO CONVERSATIONS ARE COMING.
>> ONE REALLY MIGHT BE A SILLY
QUESTION, BUT IT WAS ONE OF YOUR
FIRST SLIDES.
AND DR. AKIN, THANK YOU FOR ALL
THE WORK.
HOW YOU DIFFERENTIATED BETWEEN
HEALTH DISPARITIES RESEARCH AND
SOCIAL DETERMINANTS OF HEALTH
RESEARCH?
TO ME, IF YOU ARE LOOKING AT
HEALTH DISPARITIES, YOU SHOULD
BE LOOKING AT SOCIAL
DETERMINANTS OF HEALTH.
I WAS JUST WRAPPING MY MIND
AROUND IT.
HOW COULD ONE FALL INTO ONE AND
NOT THE OTHER, YOU KNOW?
>> YEAH.
I'LL START BY SAYING NOT ALL
SOCIAL DETERMINANTS OF HEALTH IS
FOCUSED ON HEALTH DISPARITIES.
LIKEWISE NOT ALL HEALTH
DISPARITIES RESEARCH ADDRESSES
SOCIAL DETERMINANTS.
A QUESTION IS WHETHER THEY
SHOULD, BUT THAT IS TRUE, RIGHT?
SOME PEOPLE ARE TRYING TO
ADDRESS DISPARITIES OTHER THAN
SOCIAL DETERMINANTS OF HEALTH
LENS.
THEN IT IS THE COATING.
WHICH IS DR. GRAYSON'S
DEPARTMENT SO I WILL LET HIM
ADD.
>> SO BOTH OF THOSE TOPICS,
HEALTH DISPARITIES RESEARCH AND
SOCIAL DETERMINANTS OF HEALTH
RESEARCH ARE OFFICIAL NIH
CATEGORIES DONE THROUGH RCDC
FINGERPRINTS.
I WENT INTO IT AT THE LAST
MEETING.
THE NUMBERS THAT YOU SAW THERE
SIMPLY COME FROM THOSE.
THERE CERTAINLY IS, OF COURSE,
OVERLAP BETWEEN THOSE TWO LISTS
AND ONE COULD ASK HOW WELL DO
THOSE FINGERPRINTS DISTINGUISH
BETWEEN THOSE TWO CATEGORIES
>> THEY ARE NOT MUTUALLY
EXCLUSIVE?
>> NO, THEY ARE NOT.
THERE IS SIGNIFICANT OVERLAP
BETWEEN THOSE TWO LISTS.
>> THERE'S BEEN A LOT.
ANY OTHER QUESTIONS OR THOUGHTS
BEFORE WE --
>> DR. HORNING, THANK YOU SO
MUCH FOR YOUR PRESENTATION.
I CAN'T IMAGINE YOU START A
STUDY WITH A MOBILE MARKET IN
CLOSE SPACE DURING COVID TIME.
I AM CURIOUS AND I APPRECIATE
YOU PRESENTING THE CHALLENGES
BETWEEN THE REAL WORLD
IMPLEMENTATION VERSUS RIGOROUS
RESEARCH.
AND I WONDER IF YOU COULD
ELABORATE MORE ABOUT YOUR
CHALLENGES WITH THESE KPUNTS --
COMMUNITIES BENEFITING FROM THE
FOOD AND INCREASED FOOD
SECURITY, BUT IN THE MEANTIME
DURING A TIME, DID PARTICIPANTS
WANT YOU TO MOVE THE FOOD
OUTSIDE THE MOBILE MARKET
BECAUSE OF COVID?
I'M JUST CURIOUS, I GUESS, THE
CHALLENGES YOU HAVE ENCOUNTERED
IN THIS APPROACH.
>> YEAH, SO TRIAL WAS FUNDED
ACTUALLY AFTER NORMAL SERVICE
HAS RESUMED.
IN THE PERIOD BETWEEN MARCH 2020
AND IT WASN'T UNTIL SORT OF --
I'M GOING TO GET THE DATES
WRONG, BUT IT WASN'T UNTIL MUCH
MUCH LATER THE SERVICE RESUMED.
THEY WERE DOING BOXES TO
EVERYONE IN THE BUILDING.
IT WASN'T PICK OUT YOUR OWN
STUFF AND PAY FOR IT.
THEY WERE STILL TRYING TO
RECOGNIZE THESE COMMUNITIES WERE
HIGHEST RISK FOR COVID OUTCOMES
FOR A VARIETY OF INTERSECTIONAL
REASONS.
HOW TO DO THIS SAFELY, IN A BUS
IN ENCLOSED SPACE.
IN THE WINTER THE BUS HAS TO BE
SHUT AND IN THE SUMMER IT IS HOT
AND YOU CAN'T HAVE THE FOOD
SPOILING.
THEY HAVE TO KEEP IT SOMEWHAT
CLOSED SO IT WASN'T POSSIBLE TO
DO IT WELL ON THE BUS IN THAT
TIME.
THEY HAD TO CHANGE THE PROGRAM
IN THE INTERIM.
THEN THEY WERE WATCHING THE
PROGRAM AS IT WAS ORIGINALLY FOR
THE FIRST TIME.
SO IT WAS -- IT IS LIKE THE REAL
WORLD MESSY NATURE OF BEING IN
COMMUNITY AND THEN BEING
FLEXIBLE LIKE THAT.
>> GREAT.
THANK YOU.
I AM ALSO CURIOUS ABOUT THE
SCIENCE BEHIND IT THAT WE ARE
MARRYING THE IMPLEMENTATION
SCIENCE WITH REAL WORLD AND
PARTNERSHIP WITH COMMUNITY
PARTNERS.
I'M ALSO CURIOUS ABOUT YOUR KIND
OF VIEWS, THE ACTUAL LEVERAGING
THE REAL WORLD EVIDENCE THAT IS
NATURALLY OCCURRING LEARNING AND
DEVELOPING OR ADVANCING THE
SCIENCE USED REAL-WORLD DATA
VERSUS IMPLEMENTING STRATEGIES
AND KIND OF LEARNING WHAT IS THE
SCIENCE BEHIND THIS COMMUNITY
PARTNERSHIP.
DO YOU SEE A DIFFERENCE BETWEEN
THE TWO?
AND HOW DO WE BALANCE?
>> I THINK THAT IS A REALLY GOOD
QUESTION.
WITH THIS STUDY, LIKE, WE ARE
RECRUITING RESEARCH PARTICIPANTS
TO BE ABLE TO HAVE THIS RIGOROUS
RESULTS WE CAN TRUST.
BUT WE ARE ALSO COLLECTING POINT
OF SALES DATA SO WE ARE ABLE TO
GET THAT SYSTEMS LEVEL SORT OF
LOOK AS WELL TO LOOK AT
PURCHASING TRENDS OVER TIME.
SO I THINK THAT THERE'S WAYS IN
WHICH YOU CAN DO BOTH, RIGHT?
SO I THINK IT IS FIGURING OUT A
NEW POLICY CHANGES, CMS IS
ALLOWING MEDICARE TO PROVIDE
PROVISIONS OF FOOD.
WE ARE SEEING A LOT IN THE FOOD
IS MEDICINE WORLD.
HOW DO WE CAPTURE THE DATA THAT
EXISTS ON THESE PROGRAMS AND
HEALTH SYSTEMS THAT ARE
IMPLEMENTING THEM?
HOW DO WE TAKE THAT AND EVALUATE
IT TO UNDERSTAND HOW IS THIS
CHANGE IN POLICY CONTRIBUTING TO
EQUITABLE OUTCOMES OR NOT IN
COMMUNITY?
SO IT IS A BOTH/AND.
SO WE CAN'T TOSS OUR C Ts OUT
AND WE CAN'T TOSS OUT OTHER
STUDIES, BUT HOW DO WE GET THOSE
STUDIES FUNDED.
YOU PUT AN RCT, THERE IS AN
INHERENT BIAS TO THE NATURAL
EXPERIMENT.
IS ATTENTION THERE?
SO THOSE ARE BIG QUESTIONS THAT
DON'T HAVE EASY ANSWERS.
>> THANK YOU.
>> SO WE'RE AT TIME, BUT I
DON'T -- JUST IN CASE, I'M GOING
TO LOOK AROUND TO MAKE SURE.
I KNOW.
ALL RIGHT.
I KNOW.
I'M GLAD I LOOKED.
>> I APPRECIATE THAT.
BECAUSE I WAS TRYING TO FIGURE
OUT HOW I WANTED TO SAY THIS.
THANK YOU FOR YOUR PRESENTATION.
I WAS EXCITED BY WHAT I HEARD
AND WHAT I LEARNED.
I'M CURIOUS, WHETHER YOU ALL
HAVE, YOU KNOW, PLANNED TO LINK
THE DATA THAT YOU HAVE FOUND
WITH HEALTH CARE SYSTEMS, SOCIAL
SERVICES SYSTEMS?
HAVE YOU ENGAGED THOSE PARTNERS
IN THAT WORK TO ADDRESS OTHER,
YOU KNOW, ISSUES?
IS
>> YEAH.
AT THIS POINT WE DON'T HAVE
PLANS TO SORT OF LINK THIS STUDY
WITH HEALTH SYSTEMS OR HEALTH
CARE PARTNERS.
THE MOBILE MARKET HAS
PARTNERSHIPS WITH THE MEDICAL
HEALTH CARE SYSTEMS.
AND SO LIKE THEY DO SORT OF
ENTERTAIN AND TALK TO THEM
SOMEWHAT REGULARLY, BUT THIS IS
VAT THERE THAT.
THEY HAVE TRIALED SITES AT
CLINICS AND HEALTH SYSTEMS TO
VARYING DEGREES OF SUCCESS JUST
BECAUSE IT IS A STOP ONCE A
WEEK.
SO YOU ARE CATCHING PEOPLE WHO
COME TO APPOINTMENTS THURSDAYS
1:00 TO 4:00.
THERE IS STILL A LOT TO THINK
ABOUT WHEN YOU THINK ABOUT HOW
WE REFER TO TWIN CITIES MOBILE
MARKET.
SOME COMMUNITIES HAVE VOUCHERS
IT IS PART OF FOOD PRESCRIPTION
PROGRAM.
WE DON'T HAVE LINKAGES TO THE
BROADER HEALTH SYSTEMS AT THIS
TIME.
IF I COULD ADD ONE THING.
I REALIZE I DIDN'T ACKNOWLEDGE
MY PARTNERS AND FUNDERS.
I WANT TO ACKNOWLEDGE OUR WORK
IS FUNDED BY NINR AND STEPH AND
HER TEAM AND THE SHOPPERS AND
CUSTOMERS ARE RESEARCH PARTNERS.
MY APOLOGIES FOR THAT SERIOUS
OMISSION AND THANK YOU FOR THOSE
TWO MINUTES TO SAY IT.
>> WELL, DR. HORNING, THANK YOU
SO MUCH FOR JOINING US AND
SHARING YOUR SCIENCE AND
EXEMPLIFYING COMMUNITY
PARTNERSHIP AND HOW THAT CAN BE
INTEGRATED CLOSELY INTO
RESEARCH.
I WANT TO NOTE TO COUNCIL, ALL
YOUR COMMENTS WE TRACK THEM OVER
TIME.
HOPEFULLY YOU SEE THAT WE ARE IN
BRINGING RESPONSES BACK TO YOU.
SO KNOW THAT IF WE DIDN'T
DIRECTLY ADDRESS ALL YOUR
QUESTIONS TODAY, WE ARE KEEPING
TRACK AND WILL BE CIRCLING BACK.
IF EVER YOU FIND WE HAVE NOT
ANSWERED YOUR QUESTIONS, PLEASE
LET US KNOW AND WE'LL BE SURE TO
DO THAT.
WITH THAT, WE ARE ALMOST
PERFECTLY ON TIME.
THANK YOU AGAIN, DR. HORNING AND
IT IS LUNCHTIME AND ALL RIGHT.
SO 12:45.
CAN WE GET TOGETHER AT 12:45?
23 MINUTES?
I CAN'T DO MATH.
YOU ALL HAVE 27 MINUTES OR
SOMETHING.
IT IS FINE.
SO ENJOY.
>> OKAY.
WELCOME BACK, EVERYONE.
SO AS WE INTRODUCED THIS
MORNING, WE HAVE ALLOCATED THE
NEXT COUPLE OF HOURS TO TALKING
ABOUT THE FUTURE OF HEALTH
EQUITY RESEARCH AT NINR.
SO AS DR. AKIN MENTIONED NINR
AND NURSING RESEARCH WE BELIEVE
HAS A REALLY IMPORTANT ROLE TO
PLAY IN HEALTH EQUITY AND THIS
SHOWS UP IN VARIOUS WAYS.
SO TO -- TWO OF THOSE
INDIVIDUALS WHO CAN HELP US
THINK ABOUT HOW WE CAN MAXIMIZE
IMPACT AND LEVERAGE NURSING
RESEARCH ARE HERE WITH US TODAY.
SO WE'RE GOING TO BE TALKING
ABOUT STRUCTURAL INTERVENTIONS,
MEANINGFUL COMMUNITY ENGAGEMENT
AND SO I'M PLEASED TO INTRODUCE
OUR FIRST SPEAKER.
SO WELCOME TO DR. MONICA
McLEMORE.
OF THE UNIVERSITY OF WASHINGTON
SCHOOL OF NURSING.
DR. McLEMORE IS A PROFESSOR IN
THE DEPARTMENT OF CHILD, FAMILY
AND POPULATION HEALTH NURSING.
ADJUNCT PROFESSOR IN THE SCHOOL
OF PUBLIC HEALTH AND THE
DEPARTMENT OF WOMEN AND GENDER
STUDIES AND IS THE DIRECTOR OF
THE MANNING PRICE SPRATLAN
CENTER OF ANTI-RACISM AND
EQUITY.
DR. McLEMORE'S EXTENSIONIVE AND
CLINICAL RESEARCH CAREER HAVE
FOCUSED ON REPRODUCTIVE RIGHTS
AND JUSTICE.
SHE IS A MEMBER OF THE HONOR
SOCIETY OF NURSING.
WITH THIS SESSION DR. McLEMORE
HOPES TO EDUCATE AND INSPIRE ALL
OF US TO RETROFIT TO RIGHT
HISTORICAL HARMS, PARTNER WITH
PEOPLE AND ADVANCE HEALTH
EQUITY.
SO WELCOME TO YOU.
>> THANK YOU, DR. ZENK.
IT IS SO GREAT TO BE HERE TODAY.
IT IS SUCH AN HONOR.
I DON'T KNOW HOW YOU ALL ARE
FEELING, BUT I HAVE A REALLY BIG
TASK, RIGHT?
I'M RIGHT AFTER LUNCH.
SO I'M GOING TO MAKE SURE WE
DON'T HAVE POST LUNCH NARCOLEPS.
ANYONE WHO KNOWS ME KNOWS I'M
NOT A TRADITIONAL RESEARCHER.
I DON'T KNOW ABOUT YOU, MY BRAIN
IS BLOWING UP.
THERE ARE MILLION THINGS OF I
WOULD LIKE TO SAY.
PART OF ME WANTS TO DITCH MY
SLIDE SET.
BUT I'M NOT GOING TO THAT.
I'M GOING TO WALK YOU THROUGH
SOME SLIDE AND TRY TO REALLY GET
US TO REIMAGINE NOT JUST HEALTH
EQUITY, AND DISRUPT THE IDEA OF
COMMUNITIES, I HAVE STARTED TO
USE THE WORD PLURAL.
THERE ARE GROUPS OF INDIVIDUALS
AND INTERESTED PARTYIES,
INSTITUTIONS AND I WILL USE A
LOT OF EXEMPLARS FROM MY OWN
LIFE, MY OWN WORK.
WE HAVE APOLOGIES TO MAKE.
WE HAVE TRUTH AND RECONCILIATION
TO DO.
THERE IS SOME OF THAT
FOUNDATIONAL WORK SUSPECT JUST
CREATING TRUST IN PARTNERSHIP.
SOME OF IT IS ACTUALLY LAYING
THE GROUNDWORK FOR FUTURE WORK.
THAT IN AND OF ITSELF IS
VALUABLE.
I ALWAYS DO A LAND RECOGNITION.
WE DO IT AT THE UNIVERSITY OF
WASHINGTON.
THIS IS WHERE WE CURRENTLY ARE.
I AM NOT NAIVE ENOUGH TO ATTEMPT
TO PRONOUNCE THESE, BUT I WILL
GO TO THE LAND
ACKNOWLEDGEMENT.ORG IF YOU DON'T
KNOW IT TO BE ABLE TO UNDERSTAND
HOW TO SPEAK THESE NAMES.
AS A BLACK IDENTIFIED AMERICAN,
I ALSO NEED TO MAKE A LABOR
ACKNOWLEDGEMENT BECAUSE I THINK
IT'S REALLY IMPORTANT FOR US TO
ACKNOWLEDGE, AND THIS COMES FROM
SEATTLE-KING COUNTY PUBLIC
HEALTH, THAT IT IS VERY
IMPORTANT WE UNDERSTAND HOW WE
GOT WHERE WE ARE.
WE ARE LUCKY THAT PROUFR D --
PROFESSOR DAWES AND PROFESSOR
RAMOS, THE LABOR OF THE PEOPLE
WORK.
THROUGHOUT THE NATION.
I DON'T THINK WE'RE GOING TO GET
ANYWHERE IN TERMS OF WANTING TO
IMPROVE ANY KIND OF OUT COME.
I ALSO STAND ON THE SHOULDER OF
GIANTS.
I CAME IN ON TUESDAY, I'VE BEEN
ATTENDING THE CONGRESSIONAL
BLACK CAUCUS FOUNDATION MEETING
IN ADDITION TO STOPPING HERE.
IF YOU DON'T KNOW FRANKIE
MANNING AND IF YOU DON'T KNOW
DR. BETTY SMITH WILLIAMS, I
HIGHLY RECOMMEND THAT YOU LOOK
UP THEIR WORK BECAUSE THE TWO OF
THEM ARE TWO PEOPLE WHO BOTH ARE
LIVING, WHO INSPIRE ME TO DO THE
WORK THAT I DO.
SO SOME OF YOU MAY NOT KNOW ME,
AND I WANTED TO MAKE SURE THAT
YOU HAD A CLEAR UNDERSTANDING
WHETHER YOU'RE WATCHING
VIRTUALLY OR YOU'RE HERE IN THE
ROOM, THAT IT'S QUITE POSSIBLE
TO HAVE A VERY SUCCESSFUL
RESEARCH PROGRAM AND TRAJECTORY
WITHOUT EVER RECEIVING FEDERAL
DOLLARS.
AND THIS IS REALLY IMPORTANT, I
SAY THIS NOT AS A SLIGHT OR A
DING, BUT YOU RECOGNIZING FROM
THE PREVIOUS PRESENTATION OF
RESEARCH, FOUNDATION GRANTS,
INTRAMURAL PROJECTS, SMALL
GRANTS, PROFESSIONAL
ORGANIZATION GRANTS HAVE
HISTORICALLY SERVED AS THE
FOUNDATION FOR PEOPLE TO GET TO
THEIR FIRST R01 OR THEIR FIRST
R21.
SO I WANT US TO START THINKING
REALLY CREATIVELY AROUND THE
FACT THAT WE CAN ALSO BE
THINKING ABOUT WHO ARE THOSE
OTHER COMMUNITIES, WHO ARE THOSE
OTHER FUNDERS, WHO ARE THOSE
OTHER STAKEHOLDERS THAT WE NEED
TO BE THINKING ABOUT IN
PARTNERING TO REALLY DEVELOP
NURSE SCIENCE SCHOLARSHIP IN
HEALTH EQUITY BECAUSE THOSE HAVE
BEEN VERY, VERY CRUCIAL TO MY
CAREER, AND PROBABLY TO MANY
OTHER EARLY CAREER FOLKS AS
WELL.
I HAVE BEEN A HIGHLY SUCCESSFUL
AND PROLIFIC PERSON BECAUSE OF
THE COMMUNITIES THAT LIFT ME UP
AND THAT I AM IN, WITH, AND
FROM.
AND I WANT US TO START USING
THAT LANGUAGE WHEN WE TALK ABOUT
COMMUNITY ENGAGEMENT, RIGHT?
BECAUSE IT'S ONE THING TO BE IN
COMMUNITY.
IT'S ANOTHER THING TO BE FROM A
COMMUNITY.
IT ANOTHER THING TO WORK WITH
COMMUNITY, AND IT'S ANOTHER
THING TO BE OF COMMUNITY.
AND THOSE THINGS MATTER IN TERMS
OF WHEN YOU'RE BUILDING OUT
PROGRAMS OF RESEARCH AND TRYING
TO DESIGN INTERVENTIONS.
DR. ELLE LETT IS A BLACK TRANS
WOMAN WHO IS A STATISTICIAN BY
TRAINING FINISHING UP HER DEGREE
AT THE PENNSYLVANIA.
UNIVERSITY OF
PENNSYLVANIA.
I ALSO LIKE TO GIVE PEOPLE
DEFINITIONS OF ANTI-RACISM AND
THERE ARE MORE THAN THIS ONE BUT
I THINK THIS ONE IS REALLY,
REALLY POS IMPORTANT, AND WE'VE
TALKED ABOUT THE RELATIONSHIP
BETWEEN HEALTH DISPARITIES AND
HEALTH INEQUITIES AND HEALTH
EQUITY.
AND I WANT TO INTRODUCE
ANTI-RACISM DEFINITION BECAUSE
YOU WILL SEE IT ACTUALLY IS VERY
ALIGNED AND CONGRUENT WITH WHAT
WE'RE THINKING ABOUT.
THE WAY THAT DR. LETT DESCRIBES
THIS, SHE SAYS IT'S THE
CONTINUAL PRACTICE OF UNLEARNING
INTERNALIZED BELIEF SYSTEMS
DICTATED BY WHITE SUPREMACY,
REDISTRIBUTING POWER, RESOURCES,
AND PRIVILEGE TO POPULATIONS
DIRECTLY AND DISPROPORTIONATELY
HARMED BY WHITE SUPREMACY, AND
REDRESSING HISTORICAL AND
CONTEMPORARY BIOLOGICAL, MEN
ACTUAL SPIRITUAL AND SOCIAL
INJUSTICES ENACTED UNDER WHITE
SUPREMACY.
I LOVE THIS DEFINITION BECAUSE
IT'S ACTION-ORIENTED, IT'S NOT
LIKE THEORETICAL, AND IT'S NOT
ASPIRATIONAL.
IT ACTUALLY SPEAKS TRUTHS AND IS
VERY DIRECTIVE, WHICH I THINK IS
SOMETHING WE MIGHT WANT TO START
THINKING ABOUT WHEN WE'RE
TALKING ABOUT WHAT I THINK IS
THE UNETHICAL CONTINUATION OF
CONTRIBUTORS TO PREMATURE BLACK,
BROWN, INDIGENOUS AND OTHER
PEOPLE'S DEATHS IN THIS COUNTRY.
I ALREADY TALKED ABOUT ONE
DEFINITION OF HEALTH EQUITY IS
DR. CAMARA JONES'.
THE SECOND ONE, WHAT IF HEALTH
EQUITY IS NOT EXPERIENCED, WHAT
IF IT'S NOT ACHIEVED?
WHAT IF IT'S A CONTINUAL
EXPERIENCE OF THE PEOPLE THAT WE
SERVE, OR THE POPULATIONS IN
COMMUNITIES WITH WHOM, FROM
WHOM, OF WHOM WE WORK?
HOW WOULD WE MEASURE IT, HOW
WOULD WE REALLY START TO
UNDERSTAND SOMEBODY'S EXPERIENCE
AS CHANGED?
I LOVE THE PREVIOUS PRESENTATION
AROUND THE FOOD TRUCKS, BECAUSE
THEY ARE CONSTANTLY LOOKING AT
NOT ONLY CONSUMER DATA, BUT
THEY'RE ALSO LOOKING AT
UTILIZATION DATA.
HOW DOES THAT CHANGE OVER TIME.
BECAUSE AT SOME POINT, IF THOSE
PEOPLE ARE ABLE TO GET
MEANINGFUL WORK AT A LIVING
WAGE, AND THEY GET EMPLOYEE
SPONSORED HEALTH INSURANCE, AT
SOME POINT YOU WOULD THINK OF
THE RESIDENTS USING THE FOOD
TRUCKS, RIGHT?
IS THAT HOW WE'RE THINKING ABOUT
THIS?
BECAUSE THAT'S WHAT -- SO WHAT
IF HEALTH EQUITY IS EXPERIENCED
AND WHAT WILL IT TAKE FOR PEOPLE
TO HAVE AN EXPERIENCE THEY WOULD
ACTUALLY RECOGNIZE?
I WANT US TO BE THINKING
DIFFERENTLY WHEN WE START TO
THINK ABOUT OUR WORK.
SO LET'S DEAL WITH THE ELEPHANT
IN THE ROOM.
WE'VE HAD SEVERAL PUBLICATIONS
AROUND THE SHIFTS IN NURSING
SCIENCE.
WE'RE AT A PRECIPICE, RIGHT?
WE HAVE A SITUATION WHERE WE
HAVE MULTIPLE PATHWAYS FOR
ADVANCED EDUCATION IN NURSING.
AND THAT WE SEE A HUGE BRAIN
TRUST IN OUR DOCTORATE OF
NURSING PRACTICE INDIVIDUALS,
RIGHT?
AND WE'RE STARTING TO SEE A --
THEY JUST HAD A PIECE IN NURSING
OUTLOOK ABOUT THIS, ABOUT WHERE
IS THE FUTURE OF THE PH.D.
RESEARCHERS, THE RESEARCHERS AND
MILEAGE PRODUCERS, RIGHT?
WE NEED TO WRESTLE WITH THESE
THINGS BECAUSE THAT'S OUR FUTURE
BRAIN TRUST.
SO UNTIL WE CAN CLARIFY THAT,
WHEN WE COME INTO COMMUNITIES,
IT IS CONFUSING TO THEM WHEN WE
HAVE SHARED CREDENTIALS AND
DIFFERENT SKILLSETS.
SO MAYBE WE NEED MORE DATA
VISUALIZATION PROGRESS.
I LOVE THE FACT THAT THE REPORT
HAS INFO GRAPHICS AND A WHOLE
VARIETY OF OTHER THINGS.
MAYBE WE NEED MORE INTERACTIVE
TOOLS TO ENGENDER OR GARNER THAT
TRUST THAT WE'RE LOOKING TO
RESTORE.
I WON'T EVEN SAY BUILD, BUT TO
RESTORE.
SO WE NEED TO HAVE THESE
CONVERSATIONS, AND I'M ACTUALLY
REALLY GLAD -- I WOULD LIKE TO
SEE MORE PUBLICATIONS AND
CONVERSATION ABOUT THIS.
I WILL PUT MY HAT ON AS THE
EDITOR-IN-CHIEF OF HEALTH
EQUITY, THAT YOU ARE GOING TO
START TO SEE SOME REALLY FUN AND
INTERESTING PRODUCT OFFERINGS.
WE NEED TO BE THINKING MORE
ABOUT OUR COMMUNITIES, NOT JUST
FACULTY.
I'VE HEARD SCHOOLS OF NURSING,
MAYBE WE NEED TO TALK TO OUR
PROFESSIONAL ORGANIZATION, OH,
AND OUR PUBLISHERS OF SCIENCE.
TO ALSO THINK ABOUT THEIR ROLE
IN BUILDING MOMENTUM AROUND
UPSTREAM SOLUTIONS THAT WE NEED
AND THE EXCITEMENT THAT'S
NECESSARY FOR US TO DO AUTHENTIC
COMMUNITY ENGAGED WORK.
SO IN THE HOTEL THIS MORNING,
YOU MAY OR MAY NOT HAVE HEARD ME
SAY THIS BUT I'M GOING TO
CONTINUE TO SAY THIS, WE'RE
EITHER GOING TO APPLY INTERNAL
PRESSURE TO OURSELVES AROUND
COMMUNITY ENGAGEMENT AND
AUTHENTICITY OR IT'S EXTERNALLY
GOING TO BE IMPOSED ON US.
I WOULD LIKE FOR US TO BE BOLD
AND COURAGEOUS ENOUGH TO BE ABLE
TO MAKE THE DECISION THAT WE'RE
FINALLY GOING TO SPEND SOME OF
THE MOST TRUSTED OF THE HEALTH
PROFESSIONS' CURRENCY IN
NURSING.
THIS IS FROM MY FORMER HOME
STATE, THAT'S GOVERNOR GAVIN
NEWSOM.
THERE WERE ALMOST 20 BIDS THAT
WERE SIGNED INTO LAW, SO WE'RE
IN THE DOBBS WORLD NOW, POST
ROE, WE HAVE STATES PICKING UP
THE MANTLE OF TRAINING THE
NEXT -- BASED IN RESPONSE TO
STATE LEGISLATURES.
SO THAT MEANS ARE WE GOING TO
ENGAGE WITH AND DECIDE HOW
THEY'RE GOING TO BE UTILIZED AND
MY ANSWER IS ABSOLUTELY.
WE HAD PH.D. PREPARED MIDWIVES
FUNCTIONING TO HELP CRAFT SOME
OF THIS LEGISLATION TO ALLOW US
TO BRING NURSING LEADERSHIP AND
WORK FORWARD TO BE ABLE TO
DEVELOP THE WORKFORCE OF THE
FUTURE, GROUNDED IN COMMUNITIES
AND CENTERING COMMUNITIES WHERE
THEY HAVE NOT HAD ACCESS OR
PATHWAYS BUILT TO THE HEALTH
PROFESSIONS.
THEY ARE INCLUDING NOT ONLY
COMMUNITY COLLEGE, THEY ARE
INCLUDING HIGH SCHOOL INTERNS,
THEY ARE INTERGENERATIONAL
COHORTS OF PEOPLE SO THAT WE CAN
HAVE THAT REPRESENTATIVE
WORKFORCE.
WHEN WE THINK ABOUT ARPA, I'M SO
GLAD TO SEE OUR OFFICE OF
WOMEN'S HEALTH RESEARCH SITTING
HERE, RIGHT, WHEN WE THINK ABOUT
ALL THE ATTENTION AND THE
INVESTMENTS, HOW ARE WE
INCLUDING COMMUNITIES IN THESE
OPPORTUNITIES?
WE HAD A WATCH PARTY WITH THE
DOULAS WHEN GENDER POLICY
COUNCIL -- I MEET WITH THEM
EVERY TIME I'M EA HERE IN D.C. O
SAY THIS IS WHAT THE FEDERAL
GOVERNMENT IS DOING TO HELP
IMPROVE OUR HEALTH.
MAYBE IT'S TIME FOR US TO DO
MORE COMMUNITY WORK.
OUTSIDE OF BABY SHOWERS.
RIGHT?
MAYBE IT'S TIME FOR US TO HAVE
WATCH PARTIES AROUND WHAT THE
PEOPLE THAT WORK FOR US ARE
ACTUALLY DOING.
THIS IS GOING TO BE VERY
FASCINATING.
SO I DON'T KNOW HOW MANY PEOPLE
SAW MELINDA GATES' OP-ED RIGHT
AFTER MEMORIAL DAY, HOW SHE'S
GOING TO INVEST A BILLION
DOLLARS INTO REPRODUCTIVE
WOMEN'S HEALTH?
SO SHE DECIDED TO GIVE
$240 MILLION TO 18
ORGANIZATIONS.
THOSE 18 ORGANIZATIONS ARE
LISTED ON THE RIGHT.
THE PURPLE ARROWS ARE PEOPLE
MYSELF AND A WHOLE LOT OF OTHER
PEOPLE KNOW, WORK WITH, HAVE ON
TEXT OR ARE FRIENDS, RIGHT?
WHO IN THIS ROOM IS PREPARED TO
GO TO THOSE ORGANIZATIONS WITH
YOUR UNRESTRICTED MONEY AND PUT
THOSE IDEAS IN FRONT OF THEM
ABOUT PARTNERSHIP AND WORKING
WITH THEM?
THAT'S THE KIND OF EXTERNAL
PRESSURE WE'RE GOING TO HAVE TO
START TO THINK ABOUT.
12 INDIVIDUALS GOT $200 MILLION,
20 MILLION A PIECE, TO BE ABLE
TO UNRESTRICKTIVELY DO
INCREDIBLE COMMUNITY ENGAGED
WORK.
ALISON HAPPENS TO BE ONE OF
THEM.
SHE'S ON HER WAY TO A MEETING
RIGHT NOW IN ATLANTA TO TALK
THROUGH WORKING WITH THOSE
COMMUNITY-BASED ORGANIZATIONS,
WHAT THEY SHOULD BE DOING AROUND
MATERNAL HEALTH.
AND MY QUESTION TO HER AND TO
LET MAMAS MATTER ALLIANCE, FULL
DISCLOSURE, I WAS THE BOARD
SECRETARY, HOW CAN WE CONTINUE
TO IMPROVE HERE AT NIH TO CREATE
A SEAMLESS PIPELINE OF THE WORK
THAT WE DO.
HOW CAN WE HAVE BIDIRECTIONAL
COMMUNICATION THAT'S NOT
BURDENSOME TO THE POINT EARLIER,
HOW CAN WE BUILD ESSENTIAL
INFRASTRUCTURE TO MAKE SURE THAT
CAPACITY IS THERE FOR MEANINGFUL
AND AUTHENTIC COMMUNITY
ENGAGEMENT, RIGHT?
THE LEVERS FOR CHANGE MACK
ARTHUR MECHANISM IS HOW SHE'S
GOING TO RELEASE HER REQUEST FOR
APPLICATIONS, AND THEY'RE
SUPPOSED TO BE COMING OUT THIS
FALL.
HOW CAN WE PREPARE -- FUNDED
INVESTIGATORS TO BE COMPETITIVE?
HOW CAN WE THINKING ABOUT
INCUBATORS AND ACCELERATORS TO
HELP US TO REALLY BE ABLE TO PUT
OUR LEADERS IN PLACE, ALONG WITH
SHARE COMMUNITY PARTNERS,
BECAUSE I THINK MINOR CAN DO
THIS.
WE CAN FUND INVESTIGATORS AND
COMMUNITY PARTNERS.
SOME OF WHAT ROBERT WOOD JOHNSON
HAS DONE WITH INTERDISCIPLINARY
RESEARCH -- TEAMS TO BE ABLE TO
COMPETITIVELY WRITE FOR OTHER
KINDS.
WE CAN HAVE MINOR COMMUNITY
FELLOWS.
I'M PONTIFICATING HERE, BUT
LET'S -- MY JOB IS TO SEED IDEAS
AND TO ACTIVATE YOU ALL TO THINK
DIFFERENTLY ABOUT HOW CAN WE
CONSISTENTLY, AUTHENTICALLY AND
MEANINGFULLY ENGAGE WITH
COMMUNITY, AND COMMUNITIES.
SO WE'RE GOING TO MAP THE
FUTURE, FROM MY MIND, YOU'VE
HEARD A LOT OF THIS FROM THE
REPORT, I WAS ON THE WEBINAR
BECAUSE I'M SO EXCITED BY THAT
WORK.
WE HAVE TO THINK ABOUT THE
RETROFIT, WHICH IS THE FUTURE
WORKFORCE, BECAUSE AT SOME POINT
I DON'T WANT TO CONTINUE TO BE
THE LONE TENURED PROFESSOR, AND
KNOW WHO'S COMING UP THROUGH
THAT PIPELINE.
SO HOW DO WE GET THERE?
THE REFORM IS COMMUNITY
ENGAGEMENT.
WE WILL NOT ACHIEVE HEALTH
EQUITY, WE WILL NOT REDUCE
HEALTH INEQUITIES.
THE MECHANISM FOR WHICH WE
REFORM IS AUTHENTIC AND
MEANINGFUL COMMUNITY ENGAGEMENT.
THAT'S ALSO -- HERE'S THE DIRTY
LITTLE SECRET THAT NOBODY WANTS
TO SAY, IS ALSO THE ACCESS POINT
FOR SUSTAINABILITY.
WHEN COMMUNITIES OWN THESE
INITIATIVES, WHEN COMMUNITIES
OWN AND HAVE A STAKE IN THE WORK
THAT WE'RE DOING, THIS IS ONE OF
THE THINGS THAT DOULAS HAVE
TAUGHT ME.
I REMEMBER WHEN I STARTED MY
DOULA WORK IN 2013, WE HAD OUR
PROJECT PILOTING DOULA SUPPORT
FOR INCARCERATED PERSONS THAT
NOBODY -- WE HAD TO EXPLAIN TO
PEOPLE WHAT DOULAS WERE, RIGHT?
NOW EVERYBODY TALKS ABOUT
DOULAS.
THAT WAS A CONCERTED EFFORT
AMPLIFYING DOULA VOICE.
EXPLAINING TO PEOPLE, LISTENING
PARTIES, WATCH SESSIONS,
BRINGING IN DOULAS TO BE ABLE TO
TALK ABOUT THE ESSENTIAL WORK
THEY DO, THAT WAS A STRATEGY
THAT WE CAN ALSO DEPLOY WITH
COMMUNITY LEADERS WITH LIVED
EXPERIENCE.
AND THEN THE REIMAGINE IS
COMMUNITY INVESTMENT.
WE HEARD ABOUT INVESTMENTS,
WE'RE STILL WAITING FOR THOSE
INVESTMENTS.
ONE OF THE THINGS I WAS SITTING
WRESTLING WITH AND I SAW SOME OF
YOU AROUND THE BREAK AROUND THIS
IS, I WORRY THAT BY ADDRESSING
SOCIAL NEEDS WITHIN CLINICAL AND
HEALTH SYSTEMS AND MEDICAL --
AND SOCIAL NEEDS THAT WE
UNDERMINE OUR ARGUMENT.
I WORRY ABOUT THAT, AND I WANT
US TO WRESTLE WITH THAT, BECAUSE
COMMUNITY MEMBERS RECOGNIZE
ROBUST SOCIAL -- PEOPLE CAN TELL
YOU WHAT NURSE -- PARTNERSHIP
IS.
BECAUSE THEY'RE NOT COMING IN TO
THE HEALTH SYSTEM, THEY'RE
COMING IN TO COMMUNITIES.
HOW CAN WE THINK ABOUT THIS?
AND I LOVE THE FACT THAT THIS IS
A STRATEGY TO GET PEOPLE'S NEEDS
MET, AND NOW RESTORING BASIC
SOCIAL SUPPORT IS GOING TO BE
CRUCIAL IF WE WANT TO ACHIEVE
HEALTH EQUITY AND DECREASE
INEQUITIES.
WHEN WE LOOK AT DIFFERENT
COUNTRIES THAT HAVE SUPERIOR
HEALTH OUTCOMES, THEY HAVE A
ROBUST SOCIAL SAFETY NETWORK,
WHETHER IT'S PAID FAMILY LEAVE,
PARENTAL LEAVE, WHAT ARE WHATEV,
AT SOME POINT WE HAVE TO ADD
HUMAN SERVICES TO HEALTH.
I CAME HERE INTRAMURALLY AS A
LABORATORY TRAINED RESEARCHER.
I STILL DO ONCOLOGY WORK.
BECAUSE DEVELOPMENT, WHETHER
IT'S TUMORS, FETUSES, ARE
SOCIALLY CONSTRUCTED.
VERY SIMILAR TO RACISM.
WE CAN HAVE A LONG CONVERSATION
ABOUT THAT, BUT I DO
BIOSPECIMEN, BIOMARKER SURVEY
QUALITATIVE RESEARCH ACROSS THE
REPREPRODUCTIVE SPECTRUM.
WE NEED MORE SCHOLARS TRAINING
PROGRAMS, FELLOWSHIPS,
OPPORTUNITIES.
I WOULD LOVE TO BE ABLE TO HAVE
A COMMUNITY PARTNER NOT JUST AS
A CO-P.I. BUT AS A CO-TRAINER ON
OUR T32s.
WE ARE EXPERTS BY EDUCATION,
COMMUNITY MEMBERS ARE EXPERTS BY
EXPERIENCE.
AND WE SHOULD FUND THEM AS SUCH.
SO WHAT DO WE NEED?
I COULD GIVE YOU A WHOLE LIST
AND WE'RE GOING TO GENERATE ONE
TOGETHER BECAUSE WE'RE GOING TO
DO AN ACTIVITY CALLED I LIKE, I
WISH, I WONDER AND WE'LL GET TO
IT IN OUR CONVERSATION.
BUT THERE ARE DATA GAPS.
WE TALKED ABOUT THIS IN THE
REPORT.
WHEN I THINK ABOUT ABIGAIL
HAWKING, WHEN I THINK ABOUT OUR
INDIGENOUS COLLEAGUES AND THEY
TALK ABOUT DATA ARESURE, THERE
WERE METHODOLOGIES, BY NOW 20
YEARS LATER, WE WOULD ACTUALLY
HAVE ACCURATE POPULATION
ESTIMATES OF DIFFERENT
CONDITIONS AND HOW THEY SHOW UP
IN SMALL COMMUNITIES.
WE HAVE TO BE PROACTIVE NOW IN
MAKING DECISIONS WITH
COMMUNITIES TO DECIDE WHAT DATA
ELEMENTS WE WANT IN THE FUTURE.
I WOULD HAVE NEVER KNOWN THAT
COMMUNITY MEMBERS WANTED
ANCESTRY DATA WHEN WE CAME OUT
OF OUR REGISTRY OF -- WE DID A
STUDY, A COHORT STUDY LOOKING AT
PRETERM BIRTH AND LOOKING AT
ENVIRONMENTAL FACTORS AROUND
THAT, AND WHEN WE TALK ABOUT
REMUNERATION, WHAT DID YOU WANT,
WHAT DID YOU WANT, COMMUNITY
MEMBERS ARE LIKE I ACTUALLY --
WHAT PART OF AFRICA YOU
EMIGRATED FROM BECAUSE I DON'T
KNOW.
WHO KNEW PROVIDING PEOPLE
ANCESTRY DATA WAS GOING TO BE
MORE IMPORTANT FOR REMUNERATION
THAN IT WOULD BE FOR MONEY.
BUT WE ASK TO ASK THEM, WE HAVE
TO TALK TO THEM ABOUT THAT.
I WILL GET TO THE BOTTOM, WE
HAVE TO START FUNDING, WHETHER
IT'S, YOU KNOW, FEDERAL FUNDERS,
WHETHER IT'S PHILANTHROPY,
WHETHER IT'S INDIVIDUALS, WE
HAVE TO START USING THE LANGUAGE
OF TRUTH AND RECONCILIATION.
WE REALLY WANT TO BUILD TRUST.
NOT EVERYBODY CAN DO COMMUNITY
ENGAGED WORK BECAUSE YOU HAVE TO
APOLOGIZE FOR PAST HARMS EITHER
OF RESEARCH GROUPS OR THE
INSTITUTION WHERE YOU WORK.
AND THAT WORK IN AND OF ITSELF
IS VALUABLE.
AS FAR AS I'M CONCERNED.
WHEN YOU LOOK AT THE HISTORICAL
TERMS OF RESEARCH, MAYBE
COMMUNITY ENGAGEMENT IS ACTUALLY
AN APOLOGY.
I CURRENTLY HOLD THE OLDEST AND
THE WEALTHIEST ENDOWED
PROFESSORSHIP OF THE UNIVERSITY
OF WASHINGTON, WHICH USED TO BE
NAMED FOR ITS FOUNDING DEAN.
WE RENAMED THAT ENDOWED
PROFESSORSHIP BECAUSE
NOTORIOUSLY SHE BARRED BLACK
STUDENTS FROM ATTENDING THE
UNIVERSITY OF WASHINGTON SCHOOL
OF NURSING.
THAT RESULTED IN AN APOLOGY FROM
THE MAYOR, FROM DEAN WOODS WHO
IS A LONG-TIME MENTOR OF MINE,
AND A NAME CHANGE OF THAT
ENDOWED PROFESSORSHIP, BECAUSE
THE MARY MAHONEY PROFESSIONAL
NURSES ASSOCIATION WHO RECEIVED
THAT APOLOGY REQUESTED THE NAME
CHANGE.
THAT WAS IMPORTANT WORK THAT
NEEDED TO HAPPEN, THAT BUILT
TRUST WITH THE BLACK NURSES IN
THE PACIFIC NORTHWEST IN
SEATTLE.
WE NEED TO START FUNDING THAT
KIND OF WORK IF WE'RE REALLY
SERIOUS ABOUT BUILDING A STRONG
FOUNDATION FOR THE FUTURE, SO
WE'RE NOT SITTING HERE 20 YEARS
FROM NOW STILL LOOKING AT
INEQUITIES.
I THINK WE ALSO NEED -- SO I'M
GOING TO PUT MY A.I. HATER HAT
ON.
BECAUSE I'M VERY SKEPTICAL ABOUT
A.I. TO THE POINT ABOUT
REDEFINING EQUITIES AND BIAS AND
HARM, BUT I WILL ALSO SAY THAT
WE CAN BE MORE CREATIVE THAN
A.I. BECAUSE WE CREATE A.I.,
RIGHT?
I DON'T WANT TO LOSE THE HUMAN
CAPACITY TO BE ABLE TO BE
GENERATIVE AND TO BE ABLE TO
CREATE BECAUSE WE ARE SO
CONTINGENT UPON ARTIFICIAL
LEARNING FOR GENERATION OF
ACTUALLY CREATIVE SOLUTIONS.
AND THAT'S THE OTHER REASON WHY
WE NEED TO BE VERY CAREFUL WITH
AUTHENTIC MEANINGFUL COMMUNITY
ENGAGEMENT.
WE BRING BRILLIANT PEOPLE
TOGETHER AROUND A SHARED GOAL.
THAT'S WHEN MAGIC HAPPENS.
AND I DON'T WANT TO SEE THAT GET
LOST BECAUSE WE'RE TRYING TO
SHORTCUT THE MESSY WORK THAT
NEEDS TO HAPPEN AMONG AND
BETWEEN HUMANS.
HI ALSO THINK WE REALLY NEED TO
START THINKING ABOUT
INSTITUTIONAL REVIEW BOARDS AND
THEIR ROLE IN STIFLING
INNOVATION AND PARTNERSHIP.
I DON'T KNOW ABOUT YOU ALL, BUT
I SPEND A LOT OF TIME
RATIONALIZING TO MY IRB WHY
COMMUNITY MEMBERS NEED THE ROLE
THAT THEY NEED, WHY I NEED TO
COMPENSATE THEM, THE LEVELS I
NEED TO COMPENSATE THEM AT.
THAT'S A STRUCTURAL THING THAT
WE CAN FIX.
SO THAT COMMUNITY MEMBERS DON'T
FEEL LIKE BLIND SIGHTED WHEN
WE'VE GOTTEN OUR GRANT, WE'RE
READY TO START OUR WORK AND WE
CAN'T GET PAST -- BECAUSE WE'RE
STILL USING CONCEPTS THAT I
THINK ARE DATED AROUND
PROTECTING INSTITUTIONS AND NOT
INDIVIDUALS.
WE NEED A COMMUNITY-BASED SET OF
PRINCIPLES AROUND IRB.
AND HARRY A. WASHINGTON HAS
WROTE A REALLY GREAT BOOK ABOUT
THIS.
SO WE WANT TO BE THINKING, WHAT
ARE THE STRUCTURES THAT WE'RE
CURRENTLY USING THAT ARE
ACTUALLY REDEFINING COMMUNITY
MISTRUST.
THERE ARE TWO COMMUNITY IRBs
THAT I KNOW ABOUT.
AND THEY'RE BOTH RUN BY BLACK
WOMEN AND I THINK IT'S REALLY
IMPORTANT.
THEY HAVE A WHOLE DIFFERENT SET
OF PRINCIPLES WHEN YOU THINK
ABOUT THINGS LIKE COMMUNITY DATA
USE AGREEMENTS.
WE'VE WRITTEN SEVERAL -- WHAT IS
COMMUNITY-BASED PARTICIPATORY
BUDGETING LOOK LIKE?
HOW DO YOU WORK WITH COMMUNITY
MEMBERS TO PUT YOUR BUDGET
TOGETHER?
THIS IS MY CLASSMATE, PH.D.
CLASSMATE WHO NOW IS AT THE
UNIVERSITY OF MASSACHUSETTS,
SOCIOLOGIST, DR. AIRIN MARTINEZ.
SHE WROTE A SERIES OF THE PAPERS
AROUND WHAT IS THE PROCESS YOU
GO TO WHEN YOU'RE TRYING TO
DEVELOP A COMMUNITY-BASED
RESEARCH PROJECT BUDGET WITH
COMMUNITY MEMBERS?
WHAT DO WE AS INVESTIGATORS NOT
THINK WHEN WE'RE TRYING TO DO
COMMUNITY ENGAGED WORK, OR WHAT
DO DATA USE AGREEMENTS LOOK
LIKE, WHETHER THEY'RE
DE-IDENTIFIED OR NOT?
DO COMMUNITY MEMBERS GET THEIR
OWN DASHBOARD?
HOW ARE WE THINKING ABOUT DATA
DISSEMINATION AND DATA
VISUALIZATION?
CAN THEY MAKE THEIR OWN GRAPHS?
I WAS ACTUALLY REALLY STUNNED TO
SEE GRAPHIC RENDERINGS OF
RESEARCH DATA THAT I COLLECTED
DURING THE PAN KE MIBG PANDEMICA
DIGITAL SCRIBE SHOW UP AT A CITY
COUNCIL MEETING IN MEMPHIS,
TENNESSEE.
THEY HAD ONE-PAGERS MADE AND
HELD THEM UP AT THE CITY COUNCIL
MEETING OF OUR SHARED RESEARCH
PROJECT.
WHAT CREATIVITY OF NURSING CAN
WE BE UNLEASHING, THINGS WE KNOW
ABOUT ARE SHARED WORK, ABOUT THE
THEORETICAL UNDERPINNINGS OF HOW
WE ACTUALLY THINK ABOUT CARE.
WE CAN UNLEASH SO MUCH
CREATIVITY IF WE HAD THE
PRACTICE IN PLACE TO BE ABLE TO
DO SO.
I ALSO WANT US TO START BEING
REALLY MINDFUL OF SOME THINGS
THAT I THINK ARE INCONGRUENT
WITH LIKE INEQUITY AND HEALTH
EQUITY.
WE NEED TO THINK DEEPLY ABOUT
HOW WE MEASURE PROXIES.
AND WHY WE'RE USING THEM.
MY GOOD FRIEND DR. JOY PERIWHO
WILL BE SPEAKING AT THE
CONGRESSIONAL BLACK CAUCUS
MEETING TOMORROW, SHE TAUGHT ME
THIS.
MARITAL STATUS IS REALLY TRICKY
WHEN YOU'RE TALKING ABOUT PEOPLE
WITH LOW INCOMES.
BECAUSE IF YOU HAVE TWO POOR
PEOPLE WHO COME TOGETHER AND
MARRY AND THEN THEY HAVE A
CHILD, NOW YOU HAVE THREE, FOUR
PEOPLE TRYING TO LIVE ON THE
INCOME THAT TWO PREVIOUSLY POOR
PEOPLE COULDN'T.
THE MATH ISN'T MATH.
SO WE NEED TO START THINKING
WHAT ARE THE OTHER KINDS OF DATA
THAT WE COULD BE -- WE HAVE TO
START THINKING ABOUT HUMAN MONEY
SPACE TIME REPUTATIONAL
RESOURCES.
HOW ARE WE LEVERAGING THOSE?
I CAN'T TELL YOU HOW MANY
COMMUNITY GROUPS COME TO ME TO
RESERVE SPACE ON UW'S CAMPUS
BECAUSE THEY KNOW I'M A FACULTY
A MEMBER AND CAN GET IT FOR
FREE.
MAYBE THAT JUST NEEDS TO BECOME
A THING AS FAR AS AUTHENTIC
COMMUNITY ENGAGEMENT.
IF WE'RE GOING TO BE FUNDING
FELLOWS THROUGH OUR EXPERT AND
COMMUNITY-BASED WORK, MAYBE THEY
HAVE MONEYS TO BE ABLE TO BRING
IN COMMUNITY PARTNERS SO THE
COMMUNITY PARTNERS CAN PLAN
THEIR OWN WORK, WHETHER OR NOT
IT IS PART OF A SPECIFIC
RESEARCH PROJECT.
AND THEN COMMUNITY OVERSIGHT AND
REVIEW.
I'M ABOUT TO IMPLEMENT A REALLY
CRAZY THING AT HEALTH EQUITY AND
I'M REALLY EXCITED ABOUT IT.
WE'RE GOING TO PILOT A COMMUNITY
REVIEW BOARD.
WE'RE GOING TO ASK -- AND MARY
IS WORKING WITH ME ON THIS,
WE'RE GOING TO HAVE LAY
SUMMARIES OF ALL SCIENTIFIC
ABSTRACTS AND WE ARE GOING TO
PAY 20 PEOPLE TO DO PEER REVIEWS
AND WE'RE GOING TO PUT THE LAY
ABSTRACT WITH THE SCIENTIFIC
ABSTRACT AND I AS THE
EDITOR-IN-CHIEF WILL MAKE A
DECISION.
WE NEED TO PILOT FUNDING
COMMUNITY REVIEW BOARDS OF OUR
SCIENCE.
BECAUSE THEN THEY HAVE AN
INVESTED STAKE IN HOW THAT'S
DISSEMINATED, HOW IT'S ANALYZED.
THEY CAN TALK ABOUT THE PROJECT
BECAUSE THEY READ IT.
THEIR NAME WILL BE ON THE
WEBSITE AS REVIEWERS.
SO WE NEED TO OPERATIONALIZE
WHAT WE'RE TALKING ABOUT.
AND THAT'S PART OF MY JOB.
SO I LIKE, I WISH, I WONDER, IS
A TOOL, AND I'M GOING TO END ON
THIS, WHERE I WANT YOU TO THINK
ABOUT WHAT DO YOU LIKE ABOUT
WHAT YOU'VE HEARD TODAY,
REGARDLESS IF IT WAS FROM ME OR
ANY OF THE OTHER SPEAKERS, WHAT
DO YOU WISH YOU KNEW ABOUT WHAT
WE'VE SAID?
WHAT DO YOU WONDER?
I'LL GIVE YOU MINE AND THEN I'LL
END.
JUST TO GET YOUR MENTAL JUICES
FLOWING.
I LIKE THAT COMMUNITIES KNOW
WHAT THEY NEED.
I LIKE THAT WE'RE FINALLY HAVING
A CONVERSATION ABOUT ZERO SUM
GAME AND HOW IT'S FALSE.
I LIKE WHAT I SAW ABOUT COMPASS
BECAUSE FULL DISCLOSURE, WE --
OUR INSTITUTION IS A COMPASS --
I LIKE THAT WE ARE HAVING VERY
NEW AND INTERESTING
CONVERSATIONS.
I WISH THAT WE WOULD FUND TRUTH
IN RECONCILIATION EFFORTS, I
WISH WE COULD FUND -- AND REPAIR
ALMOST LIKE TRIBUNALS, I WISH WE
COULD LEARN MORE AROUND THAT
PROCESS FROM OUR INTERNATIONAL
COLLEAGUES.
I WONDER ABOUT THIS POLICY
INTEGRATION OF CLINICAL AND
SOCIAL CARE.
I WONDER HOW WE CAN BETTER
PARTNER WITH AND HAVE CO-PI
COMMUNITY INVESTIGATORS,
EXPERTS, BY EXPERIENCE, AND I
WONDER IF WE WILL HAVE COURAGE
TO DO THE IMPORTANT HARD WORK
THAT NEEDS TO BE DONE.
I'LL LEAVE YOU WITH ONE SLIDE,
WHICH IS ONE OF MY FAVORITE
PHOTOS.
L.WE HAVE DECIDED TO COME
TOGETHER, I LOVE CARL, REALLY
PUSHED AJN, OUR FLAGSHIP NURSING
JOURNAL, ONE OF THE OLDEST, TO
THINK ABOUT WHAT DOES EQUITY AND
PEER REVIEW LOOK LIKE.
HOW CAN WE START TO ASK JOURNAL
EDITORS, ASSOCIATE EDITORS AND
REVIEWERS, TO BE -- EVERYTHING
YOU'VE HEARD TODAY, IN OUR WORK
IF SCIENCE THAT WE PUBLISH.
AND I DON'T THINK WE PAID ENOUGH
ATTENTION TO UNDERSTANDING THAT
THAT RIGOR THAT LIVES IN
PERPETUITY IS ALSO A ROAD MAP
FOR US TO THINK ABOUT HOW WE
MIGHT WANT TO BETTER PARTNER
WITH COMMUNITIES AND TO BRING
THEM IN TO THE SCIENTIFIC
ENTERPRISE TO HELP US NOT ONLY
IMPROVE HEALTH OUTCOMES, BUT TO
GET CLOSER TO HEALTH EQUITY.
SO I HOPE THIS IS HELPFUL.
I HOPE THAT YOU'VE BEEN
ACTIVATED TO REALLY START TO
THINK DIFFERENTLY ABOUT WHAT YOU
LIKE, WHAT YOU WISH, WHAT YOU
WONDER, BECAUSE IF WE AS
INDIVIDUALS CAN BE ABLE TO GET
TO THAT COLLECTIVELY, WE CAN
HAVE A SHARED STRATEGY TO
COMMUNICATE TO THE REST OF THE
COMMUNITIES AND THE
CONSTITUENCIES THAT ARE
INTERESTED IN THE WORK TO ALLOW
US TO AMPLIFY OUR ROLE AS
LEADERS AND STRATEGIZERS IN
MOVING THIS WORK FORWARD.
SO THANK YOU FOR LISTENING, AND
I REALLY APPRECIATE YOU.
>> THANK YOU VERY MUCH.
YOU'VE GIVEN US A LOT TO WONDER
ABOUT, AND WE'RE GOING TO KEEP
WONDERING AS WE TRANSITION TO
DR. KNEIPP AND THEN WE WILL
ENGAGE IN DISCUSSION WITH BOTH
OF OUR SPEAKERS.
SO DR. KNEIPP IS THE SARAH
FRANCIS RUSSELL DISTINGUISHED
TERM PROFESSOR AT THE CAPITOL
HILL SCHOOL OF NURSING.
HER PROGRAM OF RESEARCH FOCUSES
ON THE SOCIAL POLICY AND
ECONOMIC DETERMINANTS THAT
IMPACT THE HEALTH OF
DISADVANTAGED POPULATIONS.
PARTICULARLY IN RELATION TO
WELFARE POLICY, EMPLOYMENT AND
WOMEN'S HEALTH.
SHE IS THE PAST CHAIR OF THE
AMERICAN PUBLIC HEALTH
ASSOCIATION PUBLIC HEALTH
NURSING SECTION, SERVES ON THE
EDITORIAL BOARD OF THE AMERICAN
JOURNAL OF PUBLIC HEALTH AND IS
COMPLETING AN NIH-FUNDED
CLINICAL TRIAL TESTING A
MULTILEVEL INTERVENTION WITH
UNEMPLOYED AND UNDEREMPLOYED
ADULTS WHO ARE SOCIALLY AND
ECONOMICALLY DISADVANTAGED.
DR. KNEIPP WILL SPEAK ON
STRATEGIES FOR MOVING NURSING
SCIENCE UPSTREAM TO FOCUS ON
SOCIAL DETERMINANTS OF HEALTH.
THANK YOU.
>> THANK YOU.
IT'S REALLY A PLEASURE TO BE
HERE TODAY AND TALK TO ALL OF
YOU.
IT LOOKS LIKE I MIGHT BE THE
LAST PERSON TO HELP YOU WONDER
ABOUT THINGS, AND THEN WE'LL GET
TO TALK ABOUT THEM.
SO I AM GOING TO BE FOCUSING MY
TALK PRIMARILY ON HOW WE CAN
ENCOURAGE UPSTREAM STRUCTURAL
ORIENTATION IN STRUCTURAL
DETERMINANTS OF HEALTH FOCUSING
SCIENCE AND HOPEFULLY BRING SOME
VERY PRAGMATIC SUGGESTIONS TO
THE TABLE AROUND THIS.
JUST AN OVERVIEW OF WHAT I'M
GOING TO TALK ABOUT.
THINKING ABOUT HEALTH INEQUITIES
OR HEALTH EQUITY, AND THE
CAUSES, THE CAUSES OF CAUSES AND
WHAT I'M BEGINNING TO THINK
ABOUT AS THIRD ORDER CAUSES.
WE'RE VERY FAMILIAR WITH SOME OF
THESE IN TERMS OF BEHAVIORAL
BIOLOGICAL SOCIAL DETERMINANTS
OF HEALTH STRUCTURAL, WHETHER
IT'S UPSTREAM, WHETHER THERE ARE
THINGS HAPPENING OUTSIDE THE
HEALTHCARE INSTITUTIONS AND WHY
THAT NEEDS TO HAPPEN AND ACROSS
SECTORS, AND THEN REALLY FOR US
TO THINK ABOUT HOW DO WE
ENCOURAGE A SOCIAL -- OR A
STRUCTURAL SOCIAL DETERMINANTS
OF HEALTH PRISSMM DEVELOPMENT IN
NURSING SCIENCE WHERE NURSES AND
NURSING SCIENTISTS ARE, SO IN
TERMS OF A PRISM, HOW DO WE GET
TO SEE WHAT'S OUT THERE.
AND I'LL SHOW A LITTLE BIT OF
DATA AROUND THAT.
SO IN TERMS OF LANGUAGE, OTHER
PEOPLE HAVE TALKED TODAY ABOUT
JUST HOW IMPORTANT LANGUAGE IS,
AND IT'S CRITICAL.
THIS IS JUST ONE SCHEMATIC FOR
THINKING ABOUT SOCIAL
DETERMINANTS AND AT WHAT LEVELS
THESE THINGS ARE FUNCTIONING.
STARTING WITH THE BLUE LEVEL IN
THE MIDDLE, I THINK WE'RE ALL
VERY FAMILIAR WITH THE TOP LEVEL
AND THE OVERPLAY THAT THAT HAS
HAD IN OUR UNDERSTANDING OR
ATTEMPTING TO UNDERSTAND WHY
THERE ARE HEALTH INEQUITIES, BUT
THINKING ABOUT THE BLUE LEVEL
HERE, THE CONDITIONS IN WHICH
PEOPLE LIVE, WORK AND PLAY, AND
PAULA BRAVEMAN TALKED ABOUT
THESE AS THE CAUSES OF CAUSES,
AND THESE THINGS ARE FUNCTIONING
IN FAMILIES, WORKPLACES,
HEALTHCARE CLINICS, SCHOOLS, YOU
KNOW, PROGRAM -- SOCIAL SERVICES
PROGRAM, SOME OF WHAT WE'VE ALSO
HEARD TALKED ABOUT A LITTLE BIT
TODAY.
AND THEN THERE ARE THESE THIRD
ORDER CAUSES, WHICH PROFESSOR
DAWES AND OTHER PEOPLE HAVE
STARTED TO WRITE ABOUT.
IN TERMS OF THE COMMERCIAL
DETERMINANTS OF HEALTH AND SOME
OF THE OTHER THINGS THAT ARE
GOING ON AT THE NATIONAL
ACADEMIES IN TERMS OF LOOKING AT
ECONOMIC STRUCTURES AS DRIVERS
OF THIS.
SO THESE ARE ALL ONE -- THIS IS
ONE SCHEMATIC IN A WAY OF
THINKING ABOUT WHAT MAYBE THE
FUNDAMENTAL CAUSES ARE IN TERMS
OF STRUCTURAL ISSUE, AND ONE OF
THE THINGS THAT I WANT TO POINT
OUT HERE WHICH I GUESS MY MOUSE
DOES SHOW, IS THE ARTICLE THAT'S
RECENTLY COME OUT BY HELLER AND
COLLEAGUES REALLY TALKS ABOUT
POWER DYNAMICS, AND MUCH OF --
AND THE IMPORTANT ROLE THAT THAT
PLAYS, BUT SORT OF ITS
INVISIBILITY IN A WHOLE LOT OF
THIS.
AND SO A LOT OF WHAT I'LL BE
TALKING ABOUT FOCUSES ON THAT.
AND I DO WANT TO POINT OUT, I
THINK THIS IS A THREAD TO KEEP
IN MIND AS I MAKE SOME OF MY
COMMENTS AND TALK THROUGH THIS
QUAGMIRE OF FACTORS, BUT POWER
DYNAMICS PLAY OUT AT THIS LEVEL
OF THE SYSTEM STRUCTURE, BUT
THEY ALSO VERY MUCH PLAY OUT
HERE.
AND SO IF WE THINK ABOUT POWER
AS ONE OF THE FUNDAMENTAL
CAUSES, IT DOESN'T NECESSARILY
MEAN WE HAVE TO BE IN THE ROOM
WHERE POLICY IS MADE TO EFFECT
THAT LEVEL OF CHANGE OF
ADDRESSING SOME OF THE POWER
STRUCTURES.
WE CAN BE DOING THAT IN SOME OF
THE PLACES WHERE YOU FIND NURSES
AND EVEN WHAT DR. MACKLE MORE
WAS TALKING ABOUT IN SOME OF THE
SPACES WHERE WE'RE ALREADY DOING
OUR WORK.
SO IF YOU HAVEN'T SEEN THIS
PUBLICATION BY HELLER, I HIGHLY
RECOMMEND IT.
THEY CALL QUITE A BIT OF
ATTENTION TO STRUCTURAL FEATURES
OF SOCIAL DETERMINANTS.
ONE OF THE THINGS THAT THEY TALK
ABOUT IS THE WHO COMMISSION ON
SOCIAL DETERMINANTS OF HEALTH,
WHICH IS REALLY QUITE DATED NOW,
BUT THAT INITIALLY DEFINED
STRUCTURAL MECHANISMS KIND OF IN
POLITICIZED TERMS, WHERE
POLITICAL HIERARCHIES WERE
TALKED ABOUT, POWER AND PRESTIGE
AND ACCESS TO RESOURCES WERE
DISCUSSED.
THEY ALSO MAKE THE HISTORICAL
POINT THAT WHEN THIS WAS TAKEN
UP, MEANING A DEFINITION BY U.S.
INSTITUTIONS SUCH AS THE CDC AND
OTHERS, THERE WAS
DEPOLITICIZATION OF THE CONCEPT.
THEY ATTRIBUTED QUITE A BIT OF
THIS TO A DOMINANTLY NEOLIBERAL
WORLD VIEW AROUND WHAT'S
POSSIBLE OR NOT POSSIBLE, AND
ONE OF THE THINGS THEY DID IN
THIS ARTICLE IS THEY DID A
REVIEW OF LITERATURE, AND FOUND
THIS WIDE VARIATION IN DEFINING
STRUCTURAL DETERMINANTS OF
HEALTH.
NOW I'M NOT SURE WHAT HAPPENED
BETWEEN 2010 WITH THE CDC AND
NOW, BUT CDC HAS NOW ADOPTED THE
WORLD HEALTH ORGANIZATION
DEFINITION, WHICH I THINK IS
REALLY IMPORTANT, AND NINR HAS A
TERM HERE, AT LEAST, THAT
SPECIFICALLY IDENTIFIES
STRUCTURAL DETERMINANTS OF
HEALTH.
SO CALLING THAT OUT AND NOT JUST
ASSUMING THAT THAT'S THE SAME AS
OTHER DETERMINANTS.
THIS IS THE COMMISSION OF SOCIAL
DETERMINANTS OF HEALTH
FRAMEWORK, AND IT'S ANOTHER WAY
OF THINKING ABOUT THIS, AND ONE
OF THE THINGS THAT YOU'LL SEE
THAT'S DIFFERENT ABOUT IT IS
INSTEAD OF A HIERARCHICAL
TOP-DOWN KIND OF A STRUCK TEU IT
POINTS TO INFLUENCE FROM LEFT
AND RIGHT.
ONE THING THAT IT DOES THAT I
THINK IS A LITTLE DIFFERENT IN
WHAT HELLER AND COLLEAGUES TALK
ABOUT, TO TAKE A LOOK AT THAT
AND READ THIS VERY CAREFULLY, IS
THAT IT EQUATES CULTURE AND
SOCIETAL VALUES WITH THE
POLICIES THAT THEY PRODUCE.
WHEN -- WHAT HELLER REALLY
POINTS TO IS THAT BRINGING --
THEY BRING POWER INTO THEIR
MENTAL MODEL OF THIS CONCEPT,
AND TALK ABOUT HOW POWER IS
EXERCISED TO, IN FACT, PRODUCE
THESE THINGS.
SO HOW WE THINK ABOUT THINGS,
WHAT WE THINK IS POSSIBLE, THE
THINGS THAT WE DON'T QUESTION,
THE THINGS WE DON'T WONDER
ABOUT, ALL GET AUTOMATICALLY
INTO POLICY.
SO THE OTHER THING THAT REALLY
STRUCK ME WHEN I WAS READING
SOME OF THESE ARTICLES THAT I
THINK WE CAN TAKE ADVANTAGE OF
HERE IN THIS MOMENT FOR NURSING
SCIENCE IS THINKING ABOUT THE
LONG CAUSAL CHAINS OF MEDIATING
FACTORS, THESE TEND TO CLUSTER
AND INTERACT, THAT IS ONE OF THE
THINGS THAT'S IN THE WHO
COMMISSION, AND IT JUST A GOOD
REMINDER THAT IT'S NOT JUST ONE
MEDIATOR OR TWO, BUT THESE ARE
INCREDIBLY, YOU KNOW, DENSE AND
COMPLICATED DYNAMIC SYSTEMS THAT
ARE ALWAYS CHANGING, SO HOW CAN
WE THINK ABOUT OUR SCIENCE IN A
WAY THAT SORT OF DOES THAT
CREDIT.
THEY DO HAVE THIS INCREASED
FOCUS ON POWER WHICH I TALKED
ABOUT BUT ALSO HOW IT OPERATES
WITHIN THE CAUSAL CHAIN.
AGAIN WHEN WE THINK ABOUT THAT,
WE TEND TO THINK ABOUT WHO'S IN
THE ROOM CREATING POLICY, BUT IF
WE CAN THINK ABOUT THAT IN
DIFFERENT WAYS, WE CAN THINK
ABOUT HOW NURSES OPERATING IN
DIFFERENT ENVIRONMENTS MIGHT
LEARN TO SEE THAT, AND UNDO IT
AS WELL, WHICH WILL ALSO DO A
LOT IN TERMS OF HEALTH EQUITY
AND HOW DECISIONS GET MADE AN
HOW PROGRAMS ARE IMPLEMENTED AND
OTHER THINGS.
HELLER USES STEVEN LUKES' THREE
FACES OF POWER.
I THINK THIS CAN BE USEFUL,
THERE ARE OTHER FRAME WORKS FOR
POWER TOO, BUT ONE IS
DECISION-MAKING, AND THE OTHER
IS AGENDA-SETTING POWER.
WHO SETS THE AGENDA FOR WHAT CAN
EVEN BE DISCUSSED OR EMPOWER?
AND THEN INVISIBLE OR
IDEOLOGICAL POWER, WHICH OTHER
FOLKS HAVE CITED AS THE MOST
POTENT OF THEM ALL, WHICH IS,
YOU KNOW, HOW WE BELIEVE THINGS
THAT WE DON'T EVEN QUESTION AND
WE MAKE THESE AUTOMATIC
ASSUMPTIONS, IT'S THE BASIS OF
IMPLICIT BIAS IN MANY WAYS.
SO I'M DRAWING HEAVILY FROM
HELLER'S ARTICLE, AND I HAD TO
PUT THIS GRAPHIC IN BECAUSE I
THINK IT'S ONE OF THE MOST
IMPORTANT THAT I'VE SEEN.
AND I KNOW IT REALLY TINY AND
VERY DIFFICULT TO SEE, BUT IF
YOU LOOK AT THE ANCHORS OF THIS
CONTINUUM ESSENTIALLY, THESE ARE
INTERVENTIONS INTO THE SOCIAL
DETERMINANTS OF HEALTH, AND
WE -- SO BOTH ANCHORS ARE THE
SAME THING, AND THIS IS A
CONTINUUM.
TOWARD THE BOTTOM, AS THE
CONTINUUM MOVES UPWARD, THERE'S
AN INCREASED IMPACT ON THE
DISTRIBUTION OF POWER, AND IT'S
REALLY THE DISTRIBUTION OF THAT
POWER THAT SORT OF KEEPS THINGS
IN MOTION, AND MAKES THINGS VERY
DIFFICULT TO UNDO.
SO WHEN YOU THINK ABOUT THE
KINDS OF INTERVENTIONS THAT
REALLY DON'T UPSET THE
DISTRIBUTION OF POWER VERY MUCH,
FOR EXAMPLE.
THERE ARE THE KINDS OF THINGS
THAT ARE BEING READILY ADOPTED
WIDELY BY NURSING IN TERMS OF
DOING SCREENING FOR SOCIAL
NEEDS, AND MAYBE DOING SOME
VOUCHER PROVISION FOR SOCIAL
NEEDS.
I WANT TO MAKE CLEAR, THIS IS
NOT TO SAY THAT WE DON'T NEED
THAT KIND OF WORK, BUT THE VAST
MAJORITY OF OUR WORK CANNOT BE
IN THAT BUCKET.
WE NEED INTERVENTIONS THAT GO
ALL ALONG THIS CONTINUUM.
SO IF YOU LOOK AT THE MIDDLE OF
THE CONTINUUM, FOR EXAMPLE, THE
EXAMPLE GIVEN IS HOW WE CHANGE
LAWS ABOUT MAYBE LAND OWNERSHIP,
SO RESIDENTS HAVE MORE CONTROL.
I MEAN, A LOT OF US, I THINK,
MIGHT EVEN CONSIDER THAT TO BE
SORT OF ONE OF THE THINGS AT THE
TOP, BUT WHAT THEY HAVE AT THE
TOP OF THIS CONTINUUM IS TO
CHANGE PEOPLE'S BELIEFS AROUND
HOUSING -- THIS JUST HAPPENS TO
BE A HOUSING EXAMPLE, HOUSING AS
A RIGHT VERSUS A COMMODITY.
THERE ARE A LOT OF PARALLELS WE
CAN DRAW AROUND HEALTH AND
ACCESS TO HEALTHCARE, AROUND
THAT, BUT IT REALLY GAVE ME
PAUSE TO THINK ABOUT HOW WE'VE
BEEN SORT OF STRUCTURING OUR
IDEAS ABOUT THE STRUCTURAL
DETERMINANTS OF HEALTH.
I THINK I'M GOING TO SKIP THIS
EXAMPLE.
SO IF WE THINK ABOUT HOW TO
DEVELOP THIS PRISM FOR NURSING,
I THINK ONE OF THE FIRST THINGS
THAT WE REALLY NEED TO DO IS
COME TO TERMS WITH WHERE WE
ACTUALLY ARE AND HAVE SOME
RADICAL ACCEPTANCE ON THAT TOPIC
IN TERMS OF COLLECTIVELY HOW FAR
HAVE WE MOVED, HOW FAR HAS OUR
THINKING COME, WHERE IS THE VAST
MAJORITY OF NURSING THINKING
AROUND SOCIAL DETERMINANTS OF
HEALTH VERY FIRMLY LOCATED, AND
THAT IS AT THE VERY BOTTOM OF
THAT CONTINUUM AND THAT DIAGRAM
THAT WE JUST LOOKED AT.
THIS PHOTO OR GRAPHIC HERE, FOR
KICKS, YESTERDAY I GOOGLED
SCHOOLS OF NURSING, AND THESE
WERE THE PHOTOS THAT CAME UP.
AND THERE'S NOT MUCH IN THERE
THAT SUGGESTS SOMETHING
DIFFERENT THAN ACUTE CARE KINDS
OF SETTINGS, ACUTE CARE KINDS OF
TASKS, ACUTE CARE ANYTHING,
REALLY, AND THIS IS JUST ONE
LITTLE SNAPSHOT OF WHAT CAME UP.
SO I HAVE SOME RECOMMENDATIONS
BASED ON WHERE WE ARE.
I THINK WE NEED TO INCREASE
EXPOSURE OPPORTUNITIES TO
OBSERVE HOW SOCIAL DETERMINANTS
OF HEALTH OPERATE FOR NURSES.
THERE ARE SOME VERY SPECIFIC
THINGS WE CAN DO ABOUT THAT.
I THINK WE NEED TO DEEPEN OUR
THEE RED CAL UNDERSTANDINGS OF
POWER AND APPLY WHEN LESS
FAMILIAR, BUT VERY WELL
DEVELOPED METHODS FOR INQUIRY
BRING THAT INTO OUR SCWEER, IF
YOU WILL.
AND THIS IS MORE OF A CHARGE OR
CHALLENGE FOR OUR FUNDING
AGENCIES HERE WHICH IS SEEK WAYS
TO INCENTIVIZE NUMBER ONE AND
NUMBER TWO, THROUGH RESEARCH
FUNDING OPPORTUNITIES.
SO THIS IS DATA FROM 2018 ABOUT
WHERE NURSES ARE EMPLOYED.
WHERE ARE RNs EMPLOYED.
IF YOU LOOK AT THIS, THE VERY
SMALL -- THESE TWO SLICES HERE
ARE BASICALLY OUTSIDE OF WHAT WE
WOULD THINK OF AS CLINICAL
SETTINGS.
THAT'S LESS -- THAT'S LIKE 3%.
OF
NURSES.
AND THAT'S ACTUALLY QUITE ON PAR
WITH THIS DROP IN PUBLIC HEALTH
NURSING WORKFORCE, AND I'M NOT
SUGGESTING ALL NURSES SHOULD BE
PUBLIC HEALTH NURSES.
THAT'S NOT WHAT I'M SAYING.
BUT IF YOU'RE LOOKING AT A
SEGMENT OF NURSES WHO ARE
PRACTICING IN COMMUNITIES,
HOPEFULLY WITH COMMUNITIES, LIKE
WE SAW FROM OUR NORTH STAR
EXAMPLE HERE AND HER FOOD -- I
DON'T WANT TO CALL IT A FOOD
TRUCK BUT HER MOBILE GROCERY
STORE, YOU KNOW, WE CAN SEE
THAT, BUT THIS HAS PRECIPITOUSLY
DROPPED TO 3.2% -- FROM 3.2% IN
2000 TO ONLY 1.4% OF THE U.S.
WORKFORCE.
THIS IS A SLIDE, IT'S BUSY, I
DON'T EXPECT TO YOU LOOK AT ALL
OF A RIGHT NOW, BUT THIS IS FROM
A TALK THAT I GAVE AT THE
NATIONAL ADVISORY COUNCIL ON
NURSE EDUCATION AND PRACTICE A
COUPLE OF YEARS AGO.
AND AT THE TIME I JUST WANTED TO
MAP WHAT WAS GOING ON SORT OF
NATIONALLY AND IN PUBLIC HEALTH
VERY GENERALLY, AND THEN
SPECIFICALLY IN THE NURSING
PROFESSION DURING THESE
DIFFERENT TIME PERIODS, 2008 TO
2016, AND THEN TO THE PRESENT.
AND IF YOU LOOK AT ANY NUMBER OF
THESE THINGS, THEY ARE IN DIRECT
CONFLICT WITH ONE ANOTHER, AND
THEY ARE HAPPENING AT THE SAME
TIME.
THERE ARE RECOMMENDATIONS FROM
THE SECOND FUTURE OF NURSING
REPORT ABOUT HOW WE NEED TO MOVE
INTO THE COMMUNITY.
THERE ARE RECOMMENDATIONS FROM
AACN ABOUT PLACING NURSES IN
NON-TRADITIONAL KINDS OF
SETTINGS TO DO THEIR WORK.
THERE ARE RECOMMENDATIONS LEFT
AND RIGHT LIKE THAT, BUT WE'VE
SEEN VIRTUALLY NOT MUCH OF
ANYTHING HAPPENING THERE.
IF ANYTHING, WE'VE SEEN PERHAPS
MORE PEOPLE GOING INTO PRIMARY
CARE SETTINGS THAT ARE STILL
FUNDAMENTALLY CLINIC-BASED
SETTINGS.
SO STILL THINKING ABOUT INTERNAL
AND EXTERNAL PRESSURES, WE STILL
HAVE THESE VERY SIGNIFICANT
EXTERNAL PRESSURES LIKE
BASICALLY POSITIONING NURSING
PRACTICE BASED ON ECONOMIC
MODELS AND HEALTHCARE FINANCING
MODELS THAT WILL KEEP THEM THERE
UNLESS WE ARE ABLE TO APPLY
PRESSURE FROM THE INSIDE OUT.
ONE OF THE THINGS THAT I TALK
ABOUT WITH MY COLLEAGUES QUITE A
BIT IS, SO WHAT DOES NURSING
HAVE THAT IS UNIQUE?
WHAT CAN NURSING BRING TO THIS
EFFORT TH THAT ISN'T DUPLICATIVR
CAN'T REALLY BE SUBSTITUTED BY
SOMEONE ELSE, OR A DIFFERENT
DISCIPLINE.
AND I THINK ONE OF THE THINGS
THAT I THINK ABOUT IS NURSING
HAS CLINICAL KNOWLEDGE, AND WE
ARE THERE, THERE'S THIS INTIMACY
THAT WE HAVE WITH THE PEOPLE WE
SERVE AND TAKE CARE OF DURING
LIFE'S MOST SENTINEL MOMENTS.
THESE ARE MOMENTS OF JOY, THEY
ARE MOMENTS OF ABSOLUTE, YOU
KNOW, HORROR AND SADNESS, AND WE
HAVE A PUBLIC TRUST.
ONE OF THE THINGS THAT WE CAN
DO, WHILE WE NEED NURSES
OPERATING HERE, PERHAPS, YOU
KNOW, IN CONGRESS, ET CETERA, OF
COURSE WE DO, THERE I THINK IS
MUCH MORE OPPORTUNITY IN THESE
LOCATIONS WHERE PROGRAMS ARE
ACTUALLY DELIVERED AND SCHOOLS,
WORKPLACES, OTHER SECTORS WHERE
NURSES HAVE NOT TRADITIONALLY
BEEN BUT THEY -- WELL, I
WOULDN'T SAY HAVEN'T
TRADITIONALLY BEEN -- WERE A
LONG TIME AGO WITH THE ORIGINS
OF PUBLIC HEALTH NURSING WERE
REPOSITIONED INTO MORE ACUTE
SETTINGS AND HOW CAN WE GO BACK
TO THOSE PLACES.
AND I'M NOT SAYING THAT'S A
PLACE TO STOP OR THAT WILL HAVE
SOLVED EVERYTHING, WITH YOU BUT
, BUT I THINKTHESE ARE THE PLACY
WHERE IF WE CAN POSITION NURSES
TO BE IN THOSE LOCATIONS, THAT'S
SOME OF WHAT GIVES YOU THIS
PRISM.
IT'S SOME OF WHERE YOU SEE THESE
INEQUITIES IN ACTION, IN WAYS
THAT ARE OUTSIDE THE HEALTH
SYSTEM AND I'LL TALK TO YOU A
LITTLE BIT ABOUT THAT.
I THINK I'M GOING TO SKIP
THROUGH THESE SLIDES BECAUSE I
KNOW WE'RE A LITTLE BIT BEHIND,
BUT FUNDAMENTALLY, THESE SLIDES
ARE SAYING LIKE, OOO, WHERE ARE
THE NURSE SCIENTISTS?
OH, YES, MANY OF THEM OR MOST OF
THEM ARE IN ACADEMIC RESEARCH
INSTITUTIONS.
SO WE'LL JUST SUM IT UP THAT
WAY.
SO THIS FIRST RECOMMENDATION,
I'M BASING A LOT OF THIS ON MY
OWN EXPERIENCE IN SORT OF DOING
RESEARCH ON SOCIAL DETERMINANTS
FOR A REALLY LONG TIME, AND ONE
OF THE WAYS THAT I WAS ABLE TO
DEVELOP A PRISM LIKE THIS IS BY
BEING EMBEDDED IN THE COMMUNITY
AND BEING EMBEDDED IN SOCIAL
SERVICES PROGRAMS THAT SERVE
COMMUNITIES.
ONE OF THOSE PROGRAMS WAS THE
TEMPORARY ASSISTANCE FOR NEEDY
FAMILIES PROGRAM, OR TANF, AND I
DID THIS WORK FOR 10 YEARS IN A
PARTICULAR COMMUNITY IN FLORIDA,
WHERE I WAS ABLE TO TAKE PUBLIC
HEALTH NURSING STUDENTS AND
PROVIDE SERVICES IN THESE
COMMUNITIES, WITH THESE
COMMUNITIES, AND DEVELOP
INTERVENTIONS WITH THEM.
THIS INTERVENTION, WE TESTED, IT
ENDED UP BEING INCREDIBLY
EFFECTIVE BY BASICALLY TAKING
NURSES OUT OF WHERE THEY
TRADITIONALLY FUNCTION AND
PUTTING THEM IN THE SPACES WHERE
PEOPLE WERE.
THERE WAS A VERY SPECIFIC NEED
FOR THIS.
AND SOME OF WHAT WE DID THERE
WAS VERY SPECIFIC IN TERMS OF
WHAT NURSING KNOWLEDGE WE COULD
BRING AROUND EXISTING HEALTH
CONDITIONS VERSUS TRYING TO
PLACE WOMEN IN PARTICULAR KINDS
OF JOBS.
AND THERE WAS OFTEN A MISMATCH
THERE THAT WENT ON TO DO MORE
HARM FOR THE WOMEN THAN GOOD,
AND THIS WAS A SPACE WHERE
NURSES COULD ACTUALLY MAKE SOME
CHANGE AND SEE HOW THE
FUNCTIONING OF THAT PROGRAM, FOR
EXAMPLE, WAS DOING SOME HARM IN
WAYS THAT WE COULD QUITE EASILY
REMEDY.
IT DIDN'T FIX EVERYTHING ABOUT
THAT PROGRAM, BUT IT WAS ABLE TO
DO SOME GOOD.
SO THE SECOND SORT OF STAGE OF
MY RESEARCH HAS BEEN IN NORTH
CAROLINA, WHERE I TOOK WHAT WE
DID IN THIS TANF PROGRAM TO THE
SOCIAL SERVICES AGENCIES THAT MY
PARTNERS THAT I BEGAN WORKING
WITH IN NORTH CAROLINA, WHERE WE
WERE PROVIDING SERVICES FOR THEM
BASED ON EVIDENCE THAT
FUNCTIONALLY HELPED THEM DO
THEIR JOBS.
AND THEY UNDERSTOOD THAT.
THEY UNDERSTOOD THIS WAS GOOD
FOR THE CLIENTS, THEY UNDERSTOOD
THAT IT ALLOWED THEM TO FOCUS ON
WHAT THEY NEEDED TO DO, RATHER
THAN DEALING WITH SOMETHING THEY
WEREN'T REALLY EQUIPPED TO DEAL
WITH, WHICH WERE KIND OF THE
HEALTH CONDITIONS THAT WERE
GETTING IN THE WAY.
THIS TOOK A WHOLE LOT OF TIME
AND EFFORT AND YOU HEARD FR ABOT
THIS, BUT THERE WAS DEEP
RECIPROCITY IN RELATIONSHIPS
THAT NEEDED TO BE BUILT DURING
THIS TIME.
THIS WAS ALL QUITE DEPENDENT ON
MY SCHOOL OF NURSING
ADMINISTRATIVE STRUCTURE
ALLOWING ME TO HAVE STUDENTS TO
TAKE INTO THOSE SETTINGS SO THAT
I COULD BE THERE, I WAS A
CONSTANT PRESENCE, AND IT WAS
NOT SOMETHING FOR A VERY LONG
TIME, THINGS WERE ABLE TO
FUNCTION IN THAT WAY, SO I
WASN'T JUST IN AND OUT BASED ON
THE SCHOOL'S CONVENIENCE.
I WAS IN IT FOR THE LONG RUN,
AND I WAS GIVEN, YOU KNOW, SOME
I GUESS PROMISES THAT I WOULD BE
ABLE TO STAY THERE IN THE LONG
RUN.
THAT ENDED UP BEING INCREDIBLY
IMPORTANT FOR US TO THEN MOVE TO
THE NEXT ITERATION OF WHAT WE
THOUGHT WE NEEDED TO DO IN THIS
PROGRAM OF RESEARCH.
I'M NOT GOING TO TALK ABOUT THIS
SPECIFICALLY, BUT KNOW THAT WAS
DONE -- IT COULDN'T HAVE
HAPPENED WITHOUT THAT DEEP
BUILDING AND MY PRESENCE IN THAT
LOCATION.
SO THAT'S THE FIRST THING, IS
HOW DO WE KR CREATE OPPORTUNITIS
WITHIN PREDOMINANTLY OUR
ACADEMIC STRUCTURES SO THAT OUR
NURSE SCIENTISTS CAN SPEND TIME
IN THE COMMUNITIES THAT THEY
NEED TO BE WORKING IN?
THERE ARE WAYS TO DO THAT,
INCREDIBLY EFFICIENTLY WITH
STUDENTS, AND MEET THE
EDUCATIONAL AIMS, MEET THE
SERVICE AIMS, ALL OF IT, AT THE
SAME TIME, BUT LARGELY THAT HAS
BEEN AN INTERNAL PRESSURE SORT
OF MECHANISM AND DEPENDENT KIND
OF WHO IS AT THE HELM AND IF
THAT'S ALLOWED WITHIN A
PARTICULAR SCHOOL.
THE SECOND RECOMMENDATION IS TO
THINK ABOUT HOW CAN WE DEEPEN
OUR THEORETICAL UNDERSTANDINGS
OF HO WE ARE POWER AND APPLY LER
METHODS FOR INQUIRY?
AND HERE A COUPLE OF THINGS COME
TO MIND.
CRITICAL DISCOURSE AND
HISTORICAL ANALYSIS.
THERE WERE A COUPLE OF PAPERS,
THIS WAS A SERIES OF PAPERS,
THIS WAS A RESEARCH PROJECT THAT
WAS COMPLETELY UNFUNDED THAT
TAUGHT ME MORE ABOUT POWER THAN
ANYTHING I THINK ELSE THAT I
HAVE DONE.
IN TERMS OF, YOU KNOW, LOOKING
AT -- WE USED A FOUCAULT'S
FRAMEWORK AND SAID HOW WAS IT
THAT THE FUTURE OF NURSING
PROCESSES WERE SHAPED -- OR WERE
CONSTRUCTED TO SORT OF FORMULATE
AN OUTCOME, RIGHT, AND HOW WAS
POWER THREADED THROUGH THAT, AND
WHAT CAN WE LEARN FROM WHAT
HAPPENED THERE?
ONE OF THE REASONS I DID THAT
ANALYSIS WAS BECAUSE WE WERE
VERY, VERY CONCERNED, I WAS
CHAIR OF THE PUBLIC HEALTH
NURSING SECTION AT THE TIME, AND
WE WERE VERY CONCERNED ABOUT
SORT OF, YOU KNOW, KEEPING THE
LEVEL OF THOUGHT OF SOCIAL
DETERMINANTS AT THE LEVEL OF
SOCIAL NEEDS SCREENING AND
PROVISION IN ACUTE CARE
SETTINGS.
SO POINT BEING, IT'S NOT WHAT'S
IN THOSE ARTICLES, IT WAS THE
METHODS THAT WE WERE ABLE TO USE
TO GET AT SOME OF THAT.
THERE'S A SIMILAR EXAMPLE BY
MEGAN FRANCIS WHO USED
HISTORICAL ANALYSIS TO LOOK AT
THE PRICE OF CIVIL RIGHTS AND
MOVEMENT CAPTURE AND HOW
DIFFERENT FUNDING AND FUNDING
AGENCIES ESSENTIALLY CONSTRUCTED
OVER TIME THE AGENDAS AND THE
FOCUS OF THE NAACP, AND WHAT
HAPPENS THERE.
AND I GUESS, YOU KNOW, I'M
ADDING THIS GRAPHIC HERE JUST TO
SHOW THAT THERE ARE WAYS TO
EXTRACT QUANTIFIABLE DATA IF
SOME OF THOSE METHODS THAT WE
CAN BE THINKING ABOUT.
AND THE REASON THIS IS IMPORTANT
IS BECAUSE HOW THIS PLAYS OUT IN
EVERY SETTING REALLY UNDERGIRDS
THE POLITICAL, COMMERCIAL AND
ECONOMIC DIMENSIONS AND
UNDERGIRD THESE POLICIES WE
DESPERATELY WANT TO PUT IN
PLACE, WHAT THEY ACTUALLY LOOK
LIKE IN TERMS OF BEING DELIVERED
ON THE GROUND, AND THAT'S WHERE
I THINK NURSING HAS A LOT OF
POTENTIAL LEVERAGE.
I THINK I WILL SKIP THAT.
THIS IS THE THIRD
RECOMMENDATION, AND YOU KNOW,
THAT IS HOW CAN FUNDING
INSTITUTES LIKE NINR INCENTIVIZE
RECOMMENDATIONS, THOSE KINDS OF
RECOMMENDATIONS.
WHAT SHAPE MIGHT THESE
INCENTIVES TAKE, AND ARE THERE
OTHER ENTITIES THAT CAN
FACILITATE THOSE KINDS OF
INNOCINCENTIVES WITHIN OR EXTERO
SCHOOLS OF NURSING AND THE
PLACES WHERE WE FIND MOST NURSE
SCIENTISTS.
SO I WILL END MY COMMENTS THERE,
THERE'S PART OF MY RESEARCH
TEAM, AND I GUESS WE'LL OPEN IT
UP FOR DISCUSSION.
>> THANK YOU VERY MUCH,
DR. KNEIPP, FOR ADDING THOSE
ADDITIONAL THINGS FOR US TO
THINK ABOUT AS WE MOVE INTO OUR
DISCUSSION.
SO WE DID SEND COUNCIL SEVERAL
QUESTIONS IN ADVANCE OF THE
MEETING TO HELP US REFLECT ON
NINR'S FUTURE ROLE IN TERMS OF
ADVANCING HEALTH EQUITY THROUGH
RESEARCH.
THE GOAL FOR US TODAY IS TO TALK
ABOUT BOLD IDEAS, INNOVATIVE
SOLUTIONS AND BIG GOALS THAT
NINR CAN, AGAIN, HELP TO ADVANCE
TOWARDS THESE GOALS THROUGH
RESEARCH.
SO I'VE ASKED DR. WANG TO HELP
LEAD US THROUGH DISCUSSION.
THANK YOU.
>> THANK YOU.
I THINK I'LL START WITH
ANSWERING THE QUESTION OF
DR. MCLEMORE ABOUT WHAT I LIKE,
WHAT I WISH AND WHAT I WONDER AS
ALL OF YOU ARE GETTING YOUR
BRAIN JUICE TOGETHER TO REALLY
THINK ABOUT WHAT'S THE NEXT BOLD
IDEA NINR CAN LEAD AND WHAT CAN
WE DO, WHAT ARE SOME OF THE OUT
OF BOX THINKING.
AND STARTING WITH I REALLY -- I
SEE HOPE WITH ALL THE
PRESENTATIONS, DIRECT
INVENTORY'S REPORT TO ALL OF THE
PRESENTERS TODAY.
WHAT I REALLY LIKE IS I REALLY
LIKE ALL THE WORK THAT HAS BEEN
HAPPENING, WHAT'S HAPPENING
RIGHT NOW, I LIKE ALL OF THAT.
AND I WISH HEALTH FOR EVERYONE
EVERYWHERE, AND I WONDER, GIVEN
WHAT WE HAVE DONE OVER THE PAST
20 YEARS AND WHAT WE HAVE
LEARNED FROM THE REPORT, THAT
DR. GILMORE HAS PRESENTED TO THE
NURSING COMMUNITY AND PROVIDED
IF NOT THE STRATEGIES, EXACTLY
WHAT CAN WE DO THROUGH THE NECK
MAYBE 40 MINUTES OF OUR
DISCUSSION, HOW CAN WE PROVIDE
SOME CONCRETE SUGGESTIONS,
OBSERVATIONS, AND TO LEAD -- TO
OFFER OUR OPINIONS FOR NINR TO
REALLY LEAD THE NEXT PHASE FOR
THE 40 YEARS TO COME?
SO THAT WE DEMONSTRATE OUR
COMMUNITY, NURSING COMMUNITY
WILL NOT ACCEPT A CONTINUING
LACK OF PROGRESS.
20 YEARS LATER, WHEN WE LOOK AT
IT, AND HOW CAN WE MOVE THAT
NEEDLE FORWARD.
I WANT TO START WITH -- THOUGH
WE HAVE LEARNED FROM DR. GILL
ABOUT THE STRATEGIC
OPPORTUNITIES IN NURSING TO LEAD
IN ELIMINATING HEALTH
INEQUITIES.
WHAT KIND OF INNOVATIVE
HEALTHCARE DELIVER REMODELS THAT
NURSES CAN LEAD, AND WHAT KIND
OF SCIENCE EVIDENCE THAT WE NEED
TO GENERATE, AND HOW IT TIES
WITH THE SCIENTIFIC WORKFORCE
DEVELOPMENT SUCH AS A NURSING
SCHOOL SHOULD BE DOING AT
DIFFERENT LEVELS, NOT JUST IN
GENERATING A NURSE SCIENTIST IN
A PH.D. PROGRAM, BUT ALSO MAYBE
STARTING FROM UNDERGRADUATE
PROGRAMS THROUGH COMMUNITY
PARTNERSHIPS.
AND ALSO WANT TO REFLECT ABOUT
JUST OUR DEPUTY DIRECTOR TALKING
ABOUT HEALTH WE CAN IT BEING A
NORTH STAR, AND WE HAVE ALL OF
THE MISSION AND ACTION WE HAVE
HEARD FROM DR. HORNING AND ALSO
REFLECTING ABOUT OUR CURRENT
TOP-RANKED IN FUNDING BEHAVIOR
AND SOCIAL SCIENCE AND FUNDING
IN HEALTH EQUITY.
AS WE ARE REFLECTING ABOUT THE
FINDINGS AND THE EVIDENCE THAT
HAS GENERATED, WHAT IS THE POWER
IN INR THAT ARE ALREADY
GENERATED AND TO ADD THE VOICE
TO THE COMMUNITY, BACK TO THE
WORKFORCE DEVELOPMENT, BACK TO
THE SCIENTIFIC WORKFORCE
DEVELOPMENT, SO WE DO NOT WANT
PEOPLE -- THIS IS REALLY
IMPORTANT, WE'VE DONE A LOT OF
WORK.
WHY ARE WE NOT MOVING FORWARD?
ARE WE RE-CREATING WORK AND HOW
CAN WE MAKE SURE THAT WE
ACCUMULATE EVIDENCE AND WE GO A
STEP FURTHER EVERY TIME,
LEARNING FROM OTHERS IN THIS
EVIDENCE GENERATION.
AND I APPRECIATE DR. HORNING'S
PRESENTATION.
I REALLY LOVE OUR QUESTION AND
ANSWER ADVANCING SCIENCE IN THE
REAL WORLD EVIDENCE, AND THE
RIGOROUS RESEARCH, AS WE HOLD
NEAR AND DEAR, BUT IT REALLY
SHOULD NOT PREVENT US FROM
THINKING RIGOROUS RESEARCH CAN
ONLY BE DONE IN CERTAIN WAYS,
AND HOW TO PARTNER WITH THE
COMMUNITY AND THE COMMUNITIES
THAT HOW CAN WE REALLY ADVANCE
SCIENCE KNOWING THAT THE REAL
WORLD IS NOT AS SIMPLE AS A VERY
WELL CONTROLLED RANDOMIZE THE
CLIL CAN TRIAL, HOW DO WE EVEN
ADVANCE METHODOLOGY, THERE ARE A
LOT OF METHODOLOGIES OUT THERE
RIGHT NOW, AND A.I. TOOLS, INFO
MA TICS TOOLS OUT THERE THAT
PROBABLY WE SHOULD EXPAND OUR
HORIZON AND LOOKING AT OUR
METHODOLOGY AS WELL THAT CAN
MARRY THE RIGOROUS SCIENCE AND
ALSO THE REAL WORLD EVIDENCE.
AND WHAT CAN I SAY, AMAZING
RESEARCHER, DR. MCLEMORE, I
REALLY ADMIRE YOUR RESEARCH, AND
I THINK WHAT I HAVE LEARNED FROM
YOU IS THAT RAOLY I REALLY HOWY
IT'S IN, WITH, FROM AND OF THE
COMMUNITIES.
AND I LOVE YOUR EXAMPLE ABOUT
BRINGING ONE OF YOUR MENTORS AND
FOUNDING PRESIDENT OF THE
NATIONAL COALITION OF ETHNIC
MINORITY NURSES ASSOCIATION, DRS
ALSO A ROW -- WHEN WE DEFINE
COMMUNITIES, THE FEDERAL
FUNDERS, THE FOUNDATION FUNDERS,
HOW CAN WE ALSO NOT FORGET ABOUT
THE PROFESSIONAL ORGANIZATIONS
MAYBE ALSO THAT HAVE THE NURSES,
THEY'RE REALLY LAYING THE
GROUNDWORK FOR HEALTH EQUITY
BEFORE THE HEALTH EQUITY BECOMES
A BUZZ WORD, AND HOW CAN WE
ENSURE THE BASIC AND SOCIAL
SAFETY NET AND THE
INFRASTRUCTURE.
AND ALSO HOW SHOULD THE FEDERAL
GOVERNMENT AND FUNDERS LOOK AT
TOOTRUE REPAIR, RECONCILIATION D
I LOVE THE FACT THAT COMMUNITY
ENGAGEMENT SOMETIMES CAN BE A
SIMPLE APOLOGY, AND THAT'S A
CRITICAL COMPONENT OF COMMUNITY
ENGAGEMENT WE CAN ALL LEARN
FROM, AND HOW CAN WE EMPHASIZE
THE HUMAN GRIFFIN A.I. THAT WE
KREE EIGHTED AI, WHAT CAN WE DO
AND LEARN FROM IT, AND ALSO THE
VALUE OF THE COMMUNITY DATA USED
AGREEMENTS AND PARTICIPATORY
BUDGETING VISUALIZATION AND
MOVING FORWARD IN SCIENCE, AND
ALSO ABOUT THE PUBLICATION, HOW
DO ENSURE EQUITY IN PE PEER
REVIEWS, AND HOW DO WE GENERATE
SCIENCE AND PUBLISH AND
DISSEMINATE THE SCIENCE.
SO I REALLY DO HAVE A QUESTION
FOR YOU BUT I'LL SAY THAT IN THE
END BECAUSE I THINK IT'S REALLY
KEY TO REALLY WHEN WE THINK
ABOUT EVEN FUNDING RESEARCH, HOW
DO WE TRANSLATE IT INTO
POLICIES.
AND I THINK THAT'S A CRITICAL
COMPONENT WHERE I THINK AN OUT
OF THE BOX IDEA WILL BE WHAT
SHOULD WE THINK ABOUT AT THE
FUNDING STAGE IN MAKING SURE THE
RESEARCH THAT WE FUND WILL
ACTUALLY BE TRANSLATED INTO
POLICY THAT WILL BRING PERMANENT
IMPACT TO THE COMMUNITY.
AND ALSO PARTNERSHIP ABOUT MAYBE
WE SHOULD PARTNER WITH SOME OF
THE FOUNDATIONS THAT ARE DOING
THE CHOOSE REPAIR AND
TRANSFORMATION WORK SUCH AS
ROBERT WOOD JOHNSON FOUNDATION.
I'M REALLY PROUD OF THE IMPACT
INVESTING, I MEAN, I HAVE A COP
FLICT OF INTEREST SERVING ON THE
BOARD BUT THAT IMPACT INVESTING
THAT ARE CREATING THE ENDOWMENT
TO COMMUNITY-BASED ORGANIZATIONS
THAT WILL PE PERPETUALLY FUND TE
ORGANIZATIONS TO DELIVER THE
WORK VERSUS GIVING WORK THAT
WILL STOP IN ONE OR TWO OR THREE
YEARS.
AND ALSO THINKING ABOUT PCORI AS
A FUNDER THAT HAS SUCCESSFULLY
FUNDED OVER THAT MANY YEARS
ABOUT FUNDING COMMUNITY
COINVESTIGATORS.
IOF COURSE REALLY APPRECIATE YOR
CONTINUITY FROM SOCIAL
DETERMINANTS OF HEALTH TO
STRUCTURAL DETERMINANTS OF
HEALTH, AND ALSO HOW SHOULD WE
THINK ABOUT MAYBE WE SHOULD
BRING BACK THE COMMUNITY-BASED
AND PUBLIC HEALTH NURSE AND
MAYBE WE SHOULD ACTUALLY -- SOME
OF THE SOCIAL CARE PRINCIPLES
AND PUBLIC HEALTH PRINCIPLES BE
THE FOUNDATION LEARNING FOR
NURSING AND NURSING WORKFORCE.
I JUST HAVE TO TIE -- AND I'LL
REMEMBER THIS AND WHEN I GIVE
STUDENT ORIENTATION ALL THE
TIME, IT'S CLINICAL KNOWLEDGE,
INTIMACY DURING LIFE'S MOST
SENSITIVE MOMENTS AND PUBLIC
TRUST, AND HOW CAN WE MARRY ALL
OF THOSE IN THINKING ABOUT THE
NURSE SCIENCE, NURSE SCIENTIST'S
ROLE.
AND I HAVE BEEN THINKING ABOUT
EVEN JUST IN HEALTHCARE, HOW CAN
WE INCENTIVIZE PEOPLE TO WORK IN
PRIMARY CARE, NOT GOING INTO
SPECIALTY?
SO HOW CAN WE INCENTIVIZE PEOPLE
TO WORK IN PUBLIC HEALTH NURSING
COMMUNITY?
SHOULD IT BE MARRYING WHAT'S
MORE INNOVATIVE OUT THERE IN
MARRYING THE COMMUNITY-BASED
PUBLIC HEALTH NURSING WAS, WITH
A.I. DATA SCIENCE WHICH MAY GET
MORE EQUALIZING WHAT THESE
COMMUNITY AND WHAT THESE ROLES
CAN MAKE A TRANSFORMATION
COMPETEING WITH ACUTE CARE
SETTING.
SO I WILL END IN KIND OF SHARING
MY PERSPECTIVE.
I LOOK FORWARD TO HEARING FROM
ALL OF THE OTHER COUNCILMEMBERS
IN HEARING LIKE WHAT YOU HAVE --
WHAT ARE SOME OF THE BOLD IDEAS,
BUT I WILL START WITH THIS
QUESTION FOR INTEREST MCLEMORE
ABOUT WHAT'S YOUR SECRET IN
TURNING RESEARCH EVIDENCE IN
POLICIES?
AND WHAT WOULD YOU ADVISE IN
NINR, IF WE ARE GOING TO DESIGN
FUNDING RESEARCH, WE NEED TO
MAKE SURE THOSE RESEARCH
EVIDENCE NEED TO TRANSFORM
POLICIES, WHAT WILL BE YOUR
RECOMMENDATIONS?
>> WELL, THANK YOU FOR THE
QUESTION.
I HAVE TO SHOUT OUT, THE LOGOS
ON MY FIRST SLIDE ARE
ORGANIZATIONS AND INSTITUTIONS I
WORK WITH, IN ADVANCING NEW
STANDARDS IN REPRODUCTIVE HEALTH
AT UCSF IS THE ONLY ONE I REMAIN
AFFILIATED WITH AT UCSF BECAUSE
THEIR DIRECT GOAL IS TO TRAIN
RESEARCHERS INTO HOW TO
TRANSLATE THEIR WORK INTO
POLICY.
NOT JUST TO CONDUCT GOOD
SCIENTIFIC RIGOROUS RESEARCH,
BUT TO ACTUALLY HAVE THE
WRAP-AROUND SERVICES THAT ARE
NECESSARY THAT ARE NOT TAUGHT IN
MOST SCHOOLS OF NURSING, WHETHER
IT'S MEDIA TRAINING,
UNDERSTANDING HOW TO REDUCE
COMPLEX SCIENTIFIC FINDINGS TO
REALLY GREAT BULLET POINT.
THEY ACTUALLY -- IT'S A SKILL A
THAT CAN BE INVESTED IN AND
TAUGHT.
SO THERE'S NO MAGIC TO HOW I
THINK ABOUT MY WORK.
I ALSO SPEND A LOT OF TIME WITH
CONGRESSIONAL STAFFERS EDUCATING
THEM ABOUT THESE ISSUES.
ONE OF THE THINGS I FIND WHEN WE
GET REALLY BAD POLICY, IT'S
BECAUSE PEOPLE DON'T UNDERSTAND
UNINTENDED CONSEQUENCES OF THE
POLICIES THAT THEY ARE EITHER
ENACTING OR CREATING THE.
AND SO YOU'VE GOT TO SPEND A LOT
OF TIME WITH STAFFERS GETTING
THEM TO UNDERSTAND THE SCIENCE.
THE PRO SCIENCE AND THE SORT OF
NULL STUDIES.
THAT'S THE OTHER THING AS A
JOURNAL EDITOR I'M STARTING TO
REALLY THINK ABOUT.
WE HAVE SKEWED VIEWS OF WHAT'S
POSSIBLE BECAUSE WE ONLY PUBLISH
SIGNIFICANT FINDINGS.
AND I'M STARTING TO REALLY THINK
THAT THAT IS A GAP IN
UNDERSTANDING POLICY BECAUSE WE
COULD LEARN A LOT FROM NULL
FINDINGS AND TRANSLATION IN THE
POLICY IF WE KNEW WHAT WORKED,
WHAT DIDN'T AND WHY, BUT WE
CAN'T KNOW THAT IF IT'S NOT IN A
PUBLISHED RECORD.
SO IT'S REALLY MORE QUESTIONING
THE FUNDAMENTAL TOOLS OF SCIENCE
THAT WE USE TO CREATE
UNDERSTANDING AND KNOWLEDGE
GENERGENERATION AND THEN BEING E
TO EX-PLANE TH EXPLAIN THAT TO N
BEING, WHICH A.I. WON'T TEACH
US.
>> THANK YOU.
CAN WE HEAR SOME OF THE OTHER
COUNCILMEMBERS?
FEEL FREE TO --
>> WELL, I WANT TO THANK
EVERYBODY THAT'S PRESENTED
TODAY.
I THINK IT'S REALLY BEEN A GREAT
CONVERSATION.
AND DR. WANG AND DR. -- I WANT
TO THANK YOU FOR ENDING ON
POLICY BECAUSE EXACTLY WHAT I
WROTE DOWN IS, YOU KNOW, THE
COMMUNITY ENGAGEMENT WE'VE BEEN
TALKING ABOUT IS WHERE YOU'RE
GOING TO FIND OUT THE NEEDS AND
THE SOLUTIONS, BUT IT'S NOT
GOING TO BE SUSTAINABLE UNLESS
WE'RE GOING TO BE ABLE TO
TRANSLATE IT FOR THE -- TO
POLICY.
SO I THINK THERE'S ANOTHER LEVEL
OF POLICY ENGAGEMENT WITH
PROFESSIONAL ORGANIZATIONS,
POLICY MAKERS, YOU KNOW, CMS,
WHOEVER IT IS BASED ON THE
PROBLEMS THAT YOU'RE LOOKING AT,
THAT WE SHOULD BE FOR NOT ALL
RESEARCH BUT FO FOR A LOT OF
RESEARCH, BRINGING TO THAT
LEVEL, AND THAT'S WHAT WILL BE
SUSTAINABLE.
SO I LOVE THE CONVERSATION
TODAY, AND I LOVE THE FACT THAT
IT IS GOING TO POLICY.
SO THANK YOU.
>> SO IT ALL CAME TOGETHER FOR
ME WITH YOUR LAST PRESENTATION
BECAUSE I THINK THERE'S A
THROUGH LINE BETWEEN THE
PRESENTATIONS THAT WE HAD TODAY.
VINCENT STARTED OFF, WE STARTED
THINKING ABOUT THIS MEANINGFUL
COMMUNITY ENGAGEMENT, AND I
THINK THERE'S ALSO THE SAME
THING IN THE OTHER CONVERSATIONS
THAT WE HAD.
ONE OF THE THINGS THAT KIND OF
CAME OUT WAS ALSO THIS IDEA OF
RE-THINKING PHILANTHROPY.
THERE IS A CRITIQUE OF
PHILANTHROPY RIGHT NOW, KIND OF
SHOWN A LITTLE BIT, BUT THIS
IDEA OF STRATEGIC PHILANTHROPY
AND MOVING TO THIS EMPOWERMENT
PHILANTHROPY WHERE WE GIVE THE
TOOLS THE OPPORTUNITY OF
COMMUNITIES TO COME UP WITH
THEIR OWN SOLUTIONS AND THEN I
THINK IT'S SOMETHING WE'VE
TALKED ABOUT IN THIS GROUP
BEFORE, THINKING ABOUT HOW WE
THINK ABOUT OUR BLIND SPOTS AND
WHO WE'RE MISSING AND HOW WE GET
COMMUNITIES ENGAGED, AND I'M
REALLY GLAD THAT YOU BROUGHT UP
WITH THE FOUNDATION, DR. WANG,
WHAT THEY'RE DOING AROUND
THINKING ABOUT PUTTING
ENDOWMENTS AND GIVING
COMMUNITIES THE TOOL WHICH IS A
REAL SHIFT.
BUT ONE OF THE OTHER THINGS THAT
CAME OUT, MAYBE IT'S JUST MY
BIAS, BUT WE'RE ALSO TALKING
ABOUT NURSING SCHOOL AND THE
OPPORTUNITIES THAT WE ARE
UNDERLEVERAGING WITH NURSING
SCHOOLS, THINKING ABOUT HOW WE
START TO TRANSFORM THAT AND
CREATE THESE OPPORTUNITIES TO --
AS GOING GOING BACK TO
DR. RAMOS' EARLIER POINT ABOUT
TALKING ABOUT THIS WORKFORCE,
NURSES ARE THE BIGGEST SHARE OF
THE HEALTHCARE WORKFORCE AND WE
REALLY SHOULD BE THINKING ABOUT
HOW WE GO AGAIN BACK TO WHERE WE
STARTED OUT.
WE STARTED OUT IN THE
COMMUNITIES AND THAT KIND OF
CAME OUT, BOTH PRESENTATIONS,
AND WE SHOULD BE GOING BACK
THERE, HOW DO WE DO THAT.
SO IT'S A LOT, BUT IT WAS REALLY
KIND OF LIKE -- YOU REALLY
BROUGHT IT BACK TOGETHER, YOUR
PRESENTATION JUST -- THESE
THEMES ARE COMING OUT OF THIS
AND HOW THEY REALLY KIND OF --
RE-THINK THAT, SO IT'S EXCITING
AND I APPRECIATE ALL THE
PRESENTATIONS TODAY BECAUSE THEY
REALLY HAVE MY BRAIN KIND OF
LIKE LIGHTING UP TO THINK ABOUT
WHAT CAN WE DO HERE AND HOW ARE
WE DOING THIS.
>> CAN I MAKE A RESPONSE TO
THAT?
YOU GO AHEAD.
>> AND MAYBE -- MAYBE IT'S THE
SAME THING, I DON'T KNOW, BUT
ONE OF THE THINGS THAT I DIDN'T
REALLY GET TO FOCUS ON JUST
BECAUSE OF TIME IN MY
PRESENTATION IS, YOU KNOW, THERE
ARE MODELS OF POWER THAT WORK ON
BUILDING ON POSITIVES,
DEVELOPING AGENCY, AND COALITION
BUILDING.
THERE'S BEEN A WHOLE LOT OF
DISCUSSION ABOUT COALITION
BUILDING AND WHAT THAT GET YOU
IN TERMS OF COMMUNITIES BEING
ABLE TO WRITE THEIR OWN FUTURE
ESSENTIALLY AND I DON'T KNOW
THAT WE HAVE REALLY GREAT
EMPIRICAL EVIDENCE OF WHAT
MODELS ARE BEST FOR TRAINING
COALITION BUILDING IN
COMMUNITIES UNDER DIFFERENT SETS
OF CIRCUMSTANCES, BUT THOSE ARE
THE KINDS OF PROJECTS, LIKE IF
WE UNDERSTOOD WHAT THAT PROCESS
SHOULD BE, WE COULD THINK OF
TRAIN THE TRAINER KIND OF
THINGS, BUT WE'D HAVE AN
EVIDENCE BASE FOR IT, WE'D SORT
OF KNOW WHAT WORKS.
I JUST DON'T KNOW THAT ANYTHING
HAS REALLY BEEN EMPIRICALLY
TESTED IN THAT WAY.
SO THAT'S A POSITIVE SORT OF
VERY SPECIFIC OUT COME THAT YOU
COULD USE A FRAMEWORK OF POWER,
YOU KNOW, TO GENERATE THAT KIND
OF SCIENCE.
>> PHILANTHROPY HAS A LOT OF
POWER.
$400 BILLION A YEAR IS IN
PHILANTHROPY.
THERE'S A LOT OF REASONS TO
THINK THAT THAT IS -- PART OF
THE CRITIQUE IS THAT
PHILANTHROPY HAS TAKEN ON THIS
ROLE OF TRYING TO -- IN THE
STRATEGIC PHILANTHROPY, THINKING
ABOUT HOW IT'S GOING TO MAKE
THESE LONG TERM SOLUTIONS WHICH
REALLY IT HASN'T BEEN ABLE TO
DO.
FEDERAL GOVERNMENT HAS WAY MORE
POWER AND WAY MORE INVESTMENT IN
THAT.
AND SHOULD PHILANTHROPY REALLY
BE THINKING ABOUT CREATING THIS
MULTI-RACIAL DEMOCRACY AND
PUTTING ITS EFFORTS TOWARDS
THAT, REALLY TO YOUR POINT ABOUT
THE POWER, REDISTRIBUTING THAT
POWER, INITIATING CONVERSATIONS
AND ONE OF THE THINGS YOU HAD IN
THE THIRD -- LIKE PREVENT THE
CORPORATIONS THAT ARE
REDEVELOPMENT CORPORATIONS BEING
ABLE TO DONATE AND BE PART OF
THAT PROCESS BECAUSE THAT
CHANGES HOUSING -- SO IT'S JUST
INTERESTING.
>> I WANT TO SAY TWO VERY
UNPOPULAR THINGS BECAUSE I THINK
THEY NEED TO BE SAID.
THE FIRST ONE I THINK IN NURSING
AND NURSING EDUCATION, I WOULD
LIKE FOR US TO REALLY CRITIQUE
THE ROLE OF EMPLOYERS.
LIKE I ALWAYS FEEL LIKE WHERE WE
WORK DETERMINES WHO WE ARE, AND
THAT IS ALWAYS VERY AWKWARD TO
ME.
PEOPLE USE MODIFIERS LIKE I'M A
BEDSIDE NURSE OR I'M AN XY AND Z
NURSE.
THAT'S REALLY BASED ON WHERE YOU
WORK.
SO I ALWAYS TELL PEOPLE I'M A
NURSE.
WHAT KIND?
AND I'M LIKE, THE KIND THAT'S
LICENSED, RIGHT?
I MEAN, BECAUSE IF I HAD TO
EXPLAIN TO PEOPLE BASED ON --
LIKE SOMETIMES I'M A LABORATORY
BENCH SCIENTIST, SOMETIMES I'M A
PUBLIC HEALTH NURSE.
IT MAKES SENSE IN MY MIND
BECAUSE I'M A NURSE.
SO THAT'S -- I THINK WE PUT TOO
MUCH EMPHASIS ON EMPLOYERS AND
THAT DRIVES HOW WE MAKE
DECISIONS ABOUT, YOU KNOW, THE
KIND OF INVESTMENTS WE WANT TO
MAKE IN NURSING.
BUT THEN THE OTHER SIDE OF THAT
WHICH IS ALSO QUITE UNPOPULAR IS
I'M GOING TO USE MY ENDOWED
PROFESSORSHIP TO TRY AND CREATE
A SITUATION WHERE EURT OF
WASHINGTON BECOMES THE EMPLOYER
OF CHOICE.
IF EVERYBODY WANTS TO BECOME THE
EMPLOYER OF CHOICE FOR THE
FUTURE OF NURSING, YOU MAKE VERY
DIFFERENT DECISIONS ABOUT WHAT
WOULD YOU INVEST IN RIGHT NOW,
RIGHT?
SO IN MY MIND, HEALTHCARE
REPARATIONS, WHEN YOU START TO
THINK ABOUT WE'RE GOING TO HAVE
DEBT-FREE EDUCATION FOR NURSING
STUDENTS FOR THE NEXT 30 YEARS,
YOU MIGHT VERY RAPIDLY BECOME
THE EMPLOYER OF CHOICE.
SO I WOULD LIKE FOR US TO
TROUBLE THIS DISCUSSION BY
TRYING TO -- HOLDING THE TENSION
OF OPPOSITES.
WE WANT TO HOLD THAT TENSION
THAT YES, PEOPLE NEED A PLACE TO
WORK AND THAT NEEDS TO BE A
THING, BECAUSE MEANINGFUL WORK
IS VERY IMPORTANT, BUT WE ALSO
WANT THAT TO DRIVE HOW WE GET AT
THESE RECRUITMENT AND THESE LIKE
ISSUES WHERE WE CAN'T HAVE A
WORKFORCE THAT LOOKS LIKE THE
PEOPLE THAT WE SERVE.
AND THAT'S WHERE I THINK WE GET
GUMMED UP.
SO TO YOUR POINT ABOUT NURSING
SCHOOLS AS A NURSING PROFESSOR,
I CAN TELL YOU ONE OF THE
REASONS WHY I'M SO PUBLIC IS TO
GET PEOPLE TO APPRECIATE THAT
PROFESSORIAL LIFE IS FUN, IT'S
MEANINGFUL, YOU GET TO GEEK OUT
WITH REALLY COOL PEOPLE.
THERE'S A WHOLE OTHER SIDE OF
NURSING PROFESSOR LIFE THAT OUR
FUTURE WORKFORCE DOESN'T SEE.
SORE HOW ARE WE SUPPOSED TO
EXPECT THEM TO THEN BE EXCITED
TO JOIN US AS THE KNOWLEDGE
PRODUCERS IN OUR DISCIPLINE?
>> SO I JUST WANT TO START BY
SAYING TODAY'S BEEN FANTASTIC.
THE LAST TWO PRESENTATIONS
REALLY OPENED I THINK ALL OF OUR
MINDS TO NEW IDEAS, AND SO THANK
YOU BOTH TO SHAWN AND TO MONICA.
I WANT TO GO BACK TO WHAT I
UNDERSTOOD THE QUESTION AS
BEING, WHICH WAS NINR AND SORT
OF LEADING IN TERMS OF THE
FUTURE OF NURSING SCIENCE, AND
SO THIS MAY BE AN
OVERSIMPLYCATION, BUT I HEARD
THREE THINGS TODAY THAT FROM MY
POINT OF VIEW REALLY STAND OUT
AS OPPORTUNITIES.
I THINK THE FIRST IS AROUND
SETTINGS AND MODELS, AND AT THE
VERY START OF THE DAY, WE HAD
SOME REALLY TERRIFIC NEWS ABOUT
THE NIH INITIATIVE AROUND
PRIMARY CARE.
I WOULD LOVE TO SEE NURSING AS
REALLY BEING INSTRUMENTAL TO
REIMAGINING PRIMARY CARE.
HOW CAN WE DEMONSTRATE NEW ROLES
FOR NURSES, NEW MODELS OF
DELIVERING PRIMARY CARE, NEW
SETTINGS THAT ARE LOCATIONALLY
FLEXIBLE, THERE'S JUST SO MUCH
THERE THAT COULD REALLY
TRANSFORM OUR NATION'S HEALTH.
THE SECOND THING I HEARD WAS ALL
THE WORK THAT IS HAPPENING
AROUND THE DEVELOPMENT OF THE
SCIENTIFIC WORKFORCE.
SO FOR ME, ALL THE COMMENTS THAT
I FEEL LIKE WERE MADE AROUND THE
RIGOR OF OUR METHODS, AND I'M
GOING TO KEEP THAT WORD RIGOR
AND NOT SAY THAT SOMEHOW THE
CHOICE OF THE BEST DESIGN IS NOT
RIGOROUS, BUT REALLY EMPHASIZING
THAT WE NEED TO DIVERSIFY THE
OPTIONS IN TERMS OF HOW WE THINK
ABOUT RIGOROUS RESEARCH THAT
ACTUALLY SHOULD BE USED IN TERMS
OF TRAINING, RETRAINING ALL OF
US, 24, 25 YEARS AS A NURSE
SCIENTIST OR AS AN INVESTIGATOR,
AND I STILL LEARN ALL THE TIME
AND I'M SORT OF VERY EAGER AND
HUNGRY TO LEARN NEW METHODS, NEW
APPROACHES.
ENSURING THAT OUR SCIENTIFIC
WORKFORCE IS REPRESENTATIVE IS
ANOTHER IMPORTANT AREA FOR THE
FUTURE.
AND THEN I GUESS THE THIRD
BUCKET IS WHAT I HAVE BEEN
INCREASINGLY SORT OF BOTHERED
BY, TO BE PERFECTLY CANDID,
WHICH IS THE INVISIBILITY OF
NURSING AND OF NURSING SCIENCE,
AND ALL OF THAT MEANS, HOW DO WE
ELEVATE THE CONTRIBUTIONS OF
NINR?
HOW DO WE DEMONSTRATE THAT OUR
CONTRIBUTIONS AS NURSE
SCIENTISTS ARE IMPACTFUL, THAT
THEY ACTUALLY TRANSFORM OUR
NATION'S HEALTH, HOW DO WE
ENSURE THAT NURSING
ORGANIZATIONS AND SCHOOLS ARE
ACTUALLY DOING THINGS THAT, YOU
KNOW, THERE'S LITTLE EVIDENCE
THAT THAT STUFF IS HAPPENING ON
THE GROUND, EVEN THOUGH SORT OF
ALL THE DIALOGUE IS OCCURRING.
I THINK THOSE ARE ALL PLACES
WHERE I WOULD HOPE THAT THE
INSTITUTE COULD BE A STRONG
LEADER OR PARTNER.
I THINK THAT'S REALLY WORTH
INVESTING IN.
THANK YOU.
>> A COUPLE OF OBSERVATIONS.
ONE IS, AS WE TALK ABOUT THESE
ISSUES AND PROBLEMS, ONE OF THE
THINGS, AND DR. WANG MENTIONED
40 YEARS, LOOKING 40 YEARS
AHEAD, THE STANFORD CENTER FOR
LONGEVITY RELEASED A REPORT
TALKING ABOUT LONGEVITY AND --
AND WHERE WE'RE SEEING GROWTH IN
THE POPULATION OVER 65 -- SO THE
STANFORD LONGEVITY CENTER,
CENTER ON LONGEVITY PREDICTS
THAT IN THE NEXT 25 YEARS,
PEOPLE OVER THE AGE OF 100 WILL
BE COMMONPLACE.
AND SO HOW DO YOU PLAN FOR THAT
FROM THE CONCEPT OF RESEARCH?
YOU'RE GOING TO HAVE A LOT OF
OLDER PEOPLE, WE'RE LIVING
LONGER, WE'RE LIVING HEALTHIER.
BUT THERE WILL BE MORE OLDER
PEOPLE HERE.
AND IF YOU'RE TALKING ABOUT 40
YEARS, THAT'S SOMETHING THAT YOU
MAY WANT TO LOOK AT MOVING
FORWARD IN TERMS OF RESEARCH.
THE OTHER THING IS, DR. WANG
ALSO MENTIONED PCORI AND I'M
FAMILIAR WITH PCORI BECAUSE I'VE
WORKED WITH PCORI.
I THINK THERE WAS ANOTHER
MENTION OF COMMUNITY ENGAGED
RESEARCH, AND THAT MAY NOT BE
WHAT YOU DO, BUT ARE THERE SOME
ASPECTS OF COMMUNITY ENGAGED
RESEARCH THAT YOU COULD LOOK AT
AND CONSIDER INCORPORATING IN
THE WORK YOU DO?
BECAUSE ULTIMATELY THE PEOPLE
THAT YOU WANT TO HELP ARE THE
PEOPLE THAT LIVE IN THE
COMMUNITIES ACROSS THE COUNTRY.
AND MAYBE THERE IS A WAY TO HAVE
SOME KIND OF FOCUS ON THAT
MOVING FORWARD.
THE LAST THING, AND THIS IS
BECAUSE I SPENT THE LAST 12
YEARS OF MY CAREER IN LEADERSHIP
AS A PUBLIC OFFICIAL, AS
ASSISTANT COMMISSIONER AT THE
CHICAGO DEPARTMENT OF PUBLIC
HEALTH AND RETIRED AS THE
REGIONAL HEALTH OFFICER FOR THE
ILLINOIS DEPARTMENT OF PUBLIC
HEALTH, AND ONE OF THE THINGS
THAT I LEARNED ABOUT POLICY,
PARTICULARLY IN A SEEN YOUR SENR
POSITION, IT REQUIRES RULES AND
REG LAYINGS, AND RULES AND
REGULATIONS CAN CREATE
STRUCTURAL ISSUES AND CAUSE
PROBLEMS.
A LOT OF TIMES PEOPLE THINK
POLICY IS A SOLUTION, BUT POLICY
CAN ALSO CREATE PROBLEMS BECAUSE
WHAT HAPPENS IS ULTIMATELY
POLICY BECOMES RULES AND
REGULATIONS, AND THERE'S SOME
UNINTENDED CONSEQUENCES WITH
POLICY.
SO I WOULD CAUTION PEOPLE WHEN
YOU TALK ABOUT POLICY TO MAKE
SURE THAT THEY TRY TO AN EXTENT
POSSIBLE TO ELIMINATE THE
STRUCTURAL DAMAGE THAT MAY BE
CAUSED BY MORE POLICY AND MORE
RULES AND REGULATIONS.
>> AGREE.
YOU NEED GOOD POLICY,
EVIDENCE-BASED POLICY.
>> GREAT.
ANY OTHER COUNCILMEMBERS THAT
WOULD LIKE TO OFFER ANY OPINIONS
FOR --
>> I CAN.
>> YES, THANK YOU.
>> I'M GOING TO USE YOUR
ACTIVITY, MONICA, TO REPORT IN.
I LIKE THE FOCUS ON THE WHOLE,
BUT THE TERM THAT WAS USED WAS
"PERSON."
I WISH WE HAD A FOCUS ON WHOLE
FAMILY.
AND I WISH WE COULD CHANGE THE
WAY WE DELIVER HEALTHCARE TO
ACTUALLY REACH THE ENTIRE FAMILY
ALL AT ONCE, AND I WONDER, AND
THIS REALLY COMES MORE FROM THE
COMPASS MEETING THAN FROM THIS
MEETING, BUT THERE WAS A LOT OF
DISCUSSION AROUND CARE TEAMS AND
THE ROLE OF THE COMMUNITY HEALTH
WORKER, AND THE CONCERNS I SEE
THERE IS THAT -- WE'VE SEEN THIS
IN THE PAST, IS THEY SORT OF
TRAIN THE IMPORTANT ELEMENTS OF
A COMMUNITY WORKER OUT OF THEM,
OR THEY PLACE THEM IN A CONTEXT
THAT NO LONGER -- THEY LOSE THE
TRUST OF THE COMMUNITY.
SO I WISH WE COULD DEVELOP MORE
RESEARCH AROUND THAT.
I KNOW THAT THERE'S A DESIRE FOR
A LOT OF RESEARCH FROM SOME
FUNDING AGENCIES ABOUT COMMUNITY
HEALTH WORKERS BUT I THINK NOW
THAT THE FOCUS HAS COME AROUND
COMMUNITY ENGAGEMENT AND PEOPLE
SEE THEM AS NATURAL LEADERS, HOW
CAN WE DESIGN MORE EFFECTIVE
MODELS THAT REALLY CAN BE
SUSTAINED, BECAUSE I THINK WE
ARE CONTRIBUTING TO SOME OF THE
INEQUITIES BECAUSE THE
INDIVIDUALS NO LONGER START TO
REPRESENT THEIR COMMUNITIES, SO
NOW THEY DON'T REALLY HAVE A
PLACE.
>> THANK YOU VERY MUCH.
I THINK EVERYONE -- ANY
FEEDBACK, PROFESSOR?
IT'S AN IMPORTANT ONE, NEXT 40
YEARS, RIGHT?
THAT IS TRUE.
LY JUST DITTO WHAT HAS BEEN
STATED.
FIRST OF ALL THANK YOU BOTH FOR
YOUR THOUGHTFUL PRESENTATIONS.
I WAS TAKING COPIOUS NOTES HERE.
AND I HEARD DR. ATKINS TALK
ABOUT UNDERLEVERAGING NURSING, I
HEARD DR. GUILAMO-RAMOS TALK
ABOUT INVISIBILITY, AND IN MY
WORK IN AN ACADEMIC HEALTH
SCIENCES INSTITUTION, MEDICINE
AND PUBLIC HEALTH, YOU KNOW,
IT'S FASES NATEING TO ME WHEN I
HEARD YOU TALK ABOUT HOW SDOH
OPERATE, DEEPEN THE THEORETICAL
UNDERSTANDINGS, WHEN YOU LOOK AT
MEDICINE, YOU LOOK AT THE PUBLIC
HEALTH, MANY OF THEM ARE
DEDICATING RESOURCE AND
ATTENTION AT THEIR ASSOCIATIONS,
AT THEIR SCHOOLS ON THESE
TOPICS.
SO I TOTALLY AGREE THAT IN
NURSING, IN ORDER TO MAKE SURE
THAT THERE GREATER VISIBILITY,
THAT WE'RE LEVERAGING THE
RESEARCH, WE'RE SHARING WHAT WE
FIND, I THINK NOW IS THE TIME TO
CONTINUE TO LEAD FROM THE FRONT,
NOT THE SIDELINES ON THESE
ISSUES.
AND I APPLAUD YOU BOTH FOR THIS
BOLD PRESENTATION ON THE
STRUCTURAL LEVEL DETERMINANTS OF
HEALTH.
THAT WAS, I THINK, PRETTY
INSIGHTFUL.
AND AGAIN OF COURSE TO THE NINR
FOR ALLOWING SUCH A DISCUSSION.
>> DR. FITZPATRICK?
>> I WAS GOING TO SAY, I ECHO
EVERYTHING THAT'S BEEN SAID.
I DON'T HAVE TOO MUCH TO ADD.
I COMPLETELY AGREE ABOUT THE
PRIMARY CARE FOCUS, BUT I'M ALSO
A SPECIALTY CARE PROVIDER AND I
THINK THERE'S TREMENDOUS WORK
THAT CAN BE DONE THERE.
I MEAN, OFTEN WE'RE IN THE
POSITION WHERE WE'RE GETTING THE
PATIENTS THAT THE PRIMARY
CARE -- THEY CAN'T TAKE CARE OF
THEM, AND THE NUMBERS ARE
OVERWHELMING, WE CAN'T GET THEM
IN TO BE SEEN, THERE'S ALL KINDS
OF BOTTLENECKS AND BARRIERS, SO
I WOULD SAY YES, ABSOLUTELY
PRIMARY CARE, BUT THERE'S A
SPECIALTY CARE COMPONENT
PARTICULARLY FOR THE VERY, VERY
ILL.
>> THANK YOU.
DR. BECKMEYER.
>> A COUPLE THINGS I'M USING
HERE, WE'VE TALKED A LOT ABOUT
NURSING, THIS HAS BUBBLED UP
QUITE A FEW TIMES, NURSING
EDUCATION IN GENERAL.
AND IT MAKES ME WONDER WHAT IS
NINR'S ROLE AS NURSING EDUCATION
IN GENERAL, SO I'D BE JUST
CURIOUS TO HEAR WHAT PEOPLE
THINK ABOUT THAT.
AND IN CONNECTION WITH THAT, I
THINK IT MAKES ME THINK OF WHEN
I USED TO TEACH UNDERGRAD
COMMUNITY HEALTH NURSING, I
ALWAYS HAD STUDENTS READ THIS
ESSAY THAT SOMEONE HAD WRITTEN
ABOUT WHAT IF NURSING STUDENTS
WERE ENCOURAGED THAT THEIR FIRST
JOB BE IN A COMMUNITY SETTING
INSTEAD OF SO OFTEN THEY'RE
STILL TOLD, I UNDERSTAND FROM
STUDENTS, THAT THEIR FIRST JOB
OUGHT T TO BE IN MED-SURG, AND W
THAT WOULD KIND OF TOTALLY
REFRAME HOW NURSES THINK IN
GENERAL ABOUT NURSING CARE.
BUT AGAIN, IT COMES BACK TO WHAT
IS NINR'S ROLE AROUND NURSING
EDUCATION.
>> AND ALSO I'M THINKING TOO, I
LIKE WHAT YOU BROUGHT UP, I LIKE
THE WHOLE DISCUSSION, THE WHOLE
DISCUSSION HAS BEEN REALLY
POWERFUL, BUT A TAKEAWAY TO ME
WAS NICELY FRAMING PARTICULARLY
WHAT NURSING CONTRIBUTIONS ARE
TO THIS WORK.
AND AT ALL LEVELS, LIKE YOU
BRING UP, IT'S MULTILEVEL.
WE REALLY DO SHOW UP IN THESE
DIFFERENT SPACES, INCLUDING THE
COMMUNITY BUT ALSO IN ACUTE
CARE.
AND WHAT DO WE BRING?
WE BRING THIS CLINICAL
KNOWLEDGE, THIS INTIMACY DURING
LIFE'S MOST SENT NEL MOMENTS,
SENTINEL MOMENTS,AND THIS REALLC
TRUST WHICH I BRING BACK AGAIN
IS A BURDEN AND A RESPONSIBILITY
AND OBLIGATION FOR US, TO USE
THAT IN EVERY WAY POSSIBLE TO
MAKE -- TO HAVE AN IMPACT ON
THIS, ELIMINATING INEQUITIES.
BUT THOSE ARE, I WOULD AGREE
THOSE ARE REALLY THE THREE SORT
OF UNIQUE POWERFUL THINGS THAT
WE BRING AS NURSE SIGN PACIFIC D
NURSES, ET CETERA.
SO THAT'S IT.
>> CAN I RESPOND TO THAT?
>> YES, PLEASE.
>> MAYBE SHANNON, MAYBE YOU
SHOULD BE RESPONDING ABOUT WHAT
CAN NINR DO ABOUT EDUCATION, BUT
I DON'T THINK WE NEED TO THINK
ABOUT IT THAT WAY.
IT'S NOT NECESSARILY WHAT NINR'S
RELATIONSHIP IS OR IS NOT TO
NURSING EDUCATION, OUTSIDE OF
EDUCATION TO BECOME A NURSE
SCIENTIST, RIGHT?
BUT IT'S -- THE WAY I WAS
THINKING ABOUT IT WAS MORE THIS
IS THE CONTEXT WHERE NURSE
SCIENTISTS -- THAT NURSE
SCIENTISTS ARE IN, AND SO MUCH
AS SOME CONTEXTS FACILITATE THE
DEEPEN GAUGEMENT AND THE WORK
THAT NEEDS TO BE DONE,
THEREFORE, INFLUENCES THE
ABILITY TO CONDUCT THE SCIENCE,
THAT IT'S IN THE, YOU KNOW, NEW
STRATEGIC PLAN.
SO WITHOUT GETTING INVOLVED IN
NURSING EDUCATION DIRECTLY,
THERE WILL BE A CASCADE EFFECT
TO IT.
IF THERE WERE WAYS TO
INCENTIVIZE SCHOOLS TO CONSTRUCT
THEMSELVES IN WAYS THAT
FACILITATE NURSE SCIENTISTS
BEING OUT IN THE COMMUNITY, AND
MOST LIKELY IT SURE COULD ENTAIL
BRINGING STUDENTS, I MEAN,
IDEALLY IT SHOULD, IT WILL HAVE
THE SPILLOVER EFFECTS IN THAT
DOMAIN.
>> CAN I SAY SOMETHING TO THAT?
BECAUSE I HAVE TO SAY, NINER HAS
HAD A VERY SPECIFIC ROLE AT
LEAST IN MY EDUCATIONAL
TRAJECTORY, BECAUSE SOME
PREVIOUS VANGUARD LEADERSHIP,
ESPECIALLY WHEN WE WERE MAPPING
THE HUMAN GENOME PROJECT, REALLY
SAW FIT TO PULL TOGETHER THE
SUMMER GENETICS INSTITUTE AND
I'M AN ALUMNI OF THE CLASS OF
2003.
SO THERE WAS THIS INVESTMENT,
THIS FORESIGHT OF WE NEED TO
RETROFIT THE WORKFORCE WITH THE
SKILLS AND TOOLS THEY NEED
BECAUSE SCIENCE IS ADAPTING AND
CHANGING, AND WE TAKE
RESPONSIBILITY FOR AT LEAST A
COHORT OF THESE INDIVIDUALS SO
WE CAN GET SOME OF THOSE
SPILLOVER BACK AT UNIVERSITIES
AND INSTITUTIONS BECAUSE THEN
YOU COULD DEVELOP CURRICULA THAT
YOU COULD MAKE AVAILABLE TO YOUR
STUDENTS.
AND I THINK THAT KIND OF
INTEREST IN COMMUNITY FUNDER
SCHOOL OF NURSING KIND OF
PARTNERSHIP, THAT COULD BE A
WHOLE OTHER SET OF COMMUNITIES
THAT WE COULD BRING TOGETHER FOR
AN INCUBATOR ACTIVITY TO SAY,
OKAY, WE HAVE A SITUATION WHERE
WE WANT TO RETROFIT HISTORICALLY
CURRICULA THAT WE'VE TAUGHT IN
TERMS OF SKILLS THAT WE WANT OR
COMPETENCIES THAT WE WANT NURSES
TO BE ABLE TO -- AND SO
THEREFORE, WHERE'S THE VENN
DIAGRAM OF ALL OF OUR ROLES IN
THAT, AND HOW CAN WE CREATE A
PLACE SPACE FOR ALL OF US TO
THINK ABOUT THAT IN A WAY THAT
CAN RESULT IN DIFFERENT
DECISIONS AND CHANGED BEHAVIOR
IN THE FUTURE.
LIKE THAT, TO ME, BEING ABLE TO
HOST AN INCUBATOR OR ACCELERATOR
OR SOME OTHER KIND OF GENERATIVE
SPACE THAT WILL ALLOW FOR US TO
SEE THE LARGER COMEUNTSZ IF WE
ALL TOOK OWNERSHIP AND
RESPONSIBILITY OF FUTURE
STUDENTS, LEARNERS, SCIENTISTS,
WHATEVER, AND SAW COMMUNITY
MEMBERS AS THE FOLKS WE ARE
PRIMARILY INTERESTED IN BRINGING
THROUGH THAT TRAJECTORY SO WE
SEE PEOPLE WHO HAVE USED OUR
SERVICES AS OUR FUTURE WO
WORKFORCE, THAT IN MY PIEND
COMIND COULDBE A REALLY MAGICAL.
>> GREAT.
ANY OTHER FEEDBACK?
I FIRST WANT TO THANK ALL OF OUR
SPEAKERS AND ALL OF OUR
COUNCILMEMBERS FOR SHARING YOUR
PERSPECTIVE.
IT'S REALLY IMPORTANT.
AND SORRY FOR FORCING SOME OF
YOU TO SHARE YOUR EXPERIENCE OR
INSIGHTS, AND I THINK IT'S JUST
CRITICAL, A CRITICALLY IMPORTANT
QUESTION FOR NINR IN GUIDING THE
NEXT 20, 40 YEARS OF NURSING
SCIENCE AND THE CRITICAL ROLE IN
SUPPORTING NURSING SCIENTISTS,
BE IT PREDOCTORAL, POSTDOCTORAL
SCIENTIST, JUNIOR, MID CAREER,
SENIOR, HOW CAN WE HELP KEEP
THIS PIPELINE COMING, AND HOW
CAN WE THINK ABOUT BEING BOLD,
MAYBE PART OF BEING BOLD IS
IMPLEMENT IN A WAY THAT MAYBE
WHEN THINGS ARE NOT WORKING,
THAT WE SHOULD THINK ABOUT
SAYING DEIMPLEMENTING OR REA
MOVINGORREMOVING SOME OF THOSE S
AND CONTINUE TO REALLY THINK
ABOUT NURSING SCIENCE WITHIN THE
CONTEXT ABOUT WELL, WE CAN'T
TRAIN NURSES TO BE EVERYWITHIN
OR WE CANNOT TRAIN COMMUNITY
HEALTH WORKERS TO BE A NURSE, SO
IN THESE KIND OF INNOVATIVE
HEALTH AND HEALTHCARE DELIVERY
MODELS THAT NURSE IS GOING TO
LEAD, HOW CAN WE ALSO THINK
ABOUT THOSE PROFESSIONAL AND
INTERPROFESSIONAL TEAMS,
PARAPROFESSIONALS IN ADVANCING
NURSING SCIENCE.
SO REALLY WHAT I WOULD LIKE TO
END IS THAT THERE IS HOPE, AND
WE REALLY WOULD LIKE TO SEE -- I
DREAM ABOUT A WORLD WHERE IF WE
THINK THAT SOME STRATEGY OR --
WE ALREADY HAVE EVIDENCE FROM
THIS RESEARCH, WHY CAN'T EVERY
COMMUNITY ADOPT IT?
IF THERE IS A TRAINING THAT ONE
SCHOOL HAS BEEN FUNDED TO CREATE
ALL THIS TRAINING, HOW CAN WE
MAKE IT EASY AND BEING ADOPTED
BY OTHER -- EVERY SCHOOL OF
NURSING?
THAT MAY NOT HAVE THE RESOURCES
AND THE TALENT AT THE TIME TO
IMPLEMENT THESE AND SO FOR
EVERYONE TO HAVE THE OPPORTUNITY
TO BE BE EDUCATED AND TO BE TRD
TO BRING THE BEST TALENT
TOGETHER TO MOVE THE NEEDLE
FORWARD, WHAT ARE THE BI BARRIES
AND HOW CAN WE REMOVE THOSE
BARRIERS IN TRANSLATING THESE
INTO ALL THE SCHOOL OF NURSING
AND ALL OF IT, SO WE KEEP
BUILDING UP THE SCIENCE TO MOVE
THE FIELD FORWARD.
SO I'LL END HERE AND BRING BACK
TO DR. ZENK.
THANK YOU.
>> FIRST LET ME THANK AGAIN
DR. KNEIPP AND DR. MCLEMORE FOR
JOINING US TODAY AND SHARING
WITH US, GENERATING THAT GREAT
DISCUSSION AND DR. WANG, THANK
YOU FOR LEADING THIS DISCUSSION
AND CALLING ON PEOPLE SO I
DIDN'T HAVE TO.
SO THANK YOU FOR THAT.
SO WE REALLY APPRECIATE
EVERYBODY'S WILLINGNESS TO
ENGAGE IN THIS CONVERSATION, TO
HELP US THINK OF GOING FORWARD
AND JUST CONSIDER THIS THE START
OF THE DIALOGUE IN TERMS OF
WHERE WE NEED TO GO NEXT IN THE
NEXT 40 YEARS OF THE INSTITUTE,
AND AGAIN GOING BACK TO OUR
NORTH STAR, RIGHT, THINKING
ABOUT HOW ALL OF THESE EFFORTS
AND ALL OF THESE IDEAS FIT
TOGETHER TO MOVE TOWARDS THAT
NORTH STAR OF HEALTH EQUITY AND
ALL THAT NEEDS TO HAPPEN SO THAT
THE LACK OF PROGRESS, THE
INSUFFICIENT PROGRESS THAT IS SO
EVIDENT AND SO PAINFUL TO SEE,
THAT WE CAN MAKE A DIFFERENCE
THROUGH OUR SCIENCE, SO AGAIN,
THANK YOU FOR EVERYONE ENGAGING
IN THIS CONVERSATION.
SO WITH THAT, GUESS WHAT, IT'S
BREAK TIME.
IT'S BREAK TIME!
SO WE WILL BREAK UNTIL 2:45, AND
THEN WE'LL COME BACK, WE HAVE A
REALLY EXCITING CONCEPT, WE'RE
INTERESTED IN YOUR FEEDBACK ON,
AND THEN WE'LL MOVE INTO CLOSED
SESSION.
SO THANK YOU ALL VERY MUCH.
>> ALL RIGHT, WELCOME BACK.
WEAR GOING TOWE'RE GOING TO MOVO
CONCEPTS.
IN ADVISORY ROLE TO THE
DIRECTOR, YOU ARE NINR SOURCE OF
NON-GOVERNMENTAL ADVICE ON
RESEARCH DIRECTIONS AND
SCIENTIFIC PRIORITIES.
NINR SEEKS COUNCIL'S ADVICE FOR
LONG TERM PLANNING AT AN EARLY
STAGE BY PRESENTING CONCEPTS FOR
CLEARANCE.
A CONCEPT IS THE EARLIEST
PLANNING STAGE OF AN INITIATIVE
BEFORE DEVELOPING A FUNDING
OPPORTUNITY OR OTHER ACTIVITY.
ANY APPROVED CONCEPT MAY OR MAY
NOT ULTIMATELY BECOME A FUNDING
INITIATIVE BASED ON A NUMBER OF
FACTORS, INCLUDING FUNDS
AVAILABILITY.
SO A SUMMARY OF TODAY'S CONCEPT
WAS MADE AVAILABLE IN THE
ELECTRONIC COUNCIL BOOK FOR YOUR
REVIEW IN ADVANCE OF THE
MEETING.
SO NEXT I AM PLEASED TO WELCOME
NINR PROGRAM DIRECTOR AND BRANCH
CHIEF DID KA DR. KAREN KEHL WITH
BUILDING CAPACITY FOR COMMUNITY,
PARTNERED NURSING RESEARCH.
>> THANK YOU, AND THANK YOU TO
THE COUNCIL.
I'M REALLY EC EXCITED TO PRESENT
THIS CONCEPT TO YOU TODAY.
SO THIS CONCEPT HAS BEEN
DEVELOPED BY A TEAM, DR. DA RRKA
BLACHMAN-DEMNER, DR. NADRA TYUS
AND I HAVE BEEN WORKING ON IT
FOR THE LAST FEW MONTHS AND
WE'RE VERY EXCITED BECAUSE THE
CONCEPT, WE THINK, ADDRESSES
MANY OF THE THINGS WE'VE BEEN
DISCUSSING TODAY.
SO YOU'VE HEARD A GREAT TEAL
TODAY ABOUT THE CONTINUED
CHALLENGES IN ACHIEVING AND
EXPERIENCING HEALTH EQUITY.
WE KNOW THAT TO ACHIEVE HEALTH
EQUITY FOR HISTORICALLY
DISADVANTAGED COMMUNITIES,
SOCIAL AND STRUCTURAL FACTORS
THAT ARE UNDERPINNING THOSE
DISPARITIES NEED TO BE
ADDRESSED.
WE ALSO KNOW THAT COMMUNITY
ENGAGEMENT IN THE RESEARCH
PROCESS IS CRITICAL TO THESE
EFFORTS.
AND WE KNOW THAT COMMUNITY
PARTNERSHIPS ARE VERY CENTRAL TO
NURSING EDUCATION AND SERVICE
DELIVERY.
THERE ARE ALSO CHALLENGES THAT
SOMETIMES PREVENT SCHOOLS AND
COLLEGES OF NURSING, ESPECIALLY
THOSE WITH LIMITED PRIOR NIH
FUNDING, TO CONDUCT THIS TYPE OF
COMMUNITY PARTNERED SOLUTIONS
ORIENTED RESEARCH, AND THERE'S A
NEED FOR SUPPORT TO FACILITATE
RESEARCH ACTIVITIES, WHICH MAY
INCLUDE THINGS LIKE SUPPORTING
INVESTIGATOR TIME, PROVIDING
SUPPORT FOR COMMUNITY PARTNERS
AND BUILDING RESEARCH STAFF AND
INFRASTRUCTURE.
AS WE'VE BEEN HEARING, COMMUNITY
ENGAGEMENT THROUGH THROUGHOUT TE
RESEARCH PROCESS IS CRITICAL TO
ENSURE THAT THE COMMUNITY'S
PERSPECTIVE AND PRIORITIES ARE
WELL INTEGRATED.
WHEN WE'RE TALKING ABOUT THE
RESEARCH PROCESS, WE VERY MUCH
MEAN FROM THE VERY BEGINNING OF
THINKING OF WHAT ARE THE
CHALLENGES IDENTIFYING THOSE
RESEARCH QUESTIONS, PLANNING
SOLUTIONS, PLANNING
IMPLEMENTATION, EVALUATION AND
DISSEMINATION.
THIS PARTNERSHIP APPROACH
ENSURES ALIGNMENT WITH COMMUNITY
NEEDS, PRIORITIES, AND GOALS,
AND HELPS TO BUILD TRU AND
FACILITATE LONG-TERM
SUSTAINABILITY OF
HEALTH-IMPROVING PROGRAMS AND
PRACTICES.
WE AIM TO STIMULATE NURSING
SCIENCE THAT'S MOVING TO THE
RIGHT ON THIS CONTINUUM TOWARDS
COLLABORATION AND SHARED
LEADERSHIP WITH THE COMMUNITY.
PREVIOUS NINR-FUNDED CENTERS
HAVE BEEN SUCCESSFUL IN
SUPPORTING THE DEVELOPMENT OF
NURSE SCIENTISTS AND
INTERDISCIPLINARY RESEARCH
TEAMS, AS EVIDENCED BY INCREASED
NUMBERS OF PUBLICATIONS AND
SUBSEQUENT NIH GRANT AWARDS.
HOWEVER, SINCE 2014, ONLY 15
SCHOOLS AND COLLEGES OF NURSING
OF THE 144 THAT ARE ACCREDITED
AND OFFERING RESEARCH
DOCTORATE DEGREES HAVE HAD
NINR-FUNDED RESEARCH CENTERS.
MANY SCHOOLS AND COLLEGES OF
NURSING, HOWEVER, DO HAVE
EDUCATIONAL AND SERVICE
COLLABORATIONS WITHIN THEIR
COMMUNITIES.
AND WE SEE THIS AS AN
OPPORTUNITY TO LEVERAGE EXISTING
PARTNERSHIPS TO CONDUCT
COMMUNITY PARTNERED
SOLUTION-ORIENTED RESEARCH.
WE DO KNOW THAT SCHOOLS AND
COLLEGES OF NURSING THAT HAVE
HAD LIMITED PRIOR NIH FUNDING
MAY NEED SOME ADDITIONAL SUPPORT
TO FACILITATE SOME OF THESE
RESEARCH ACTIVITIES.
THEREFORE THE PURPOSE OF THIS
INITIATIVE IS TO SUPPORT THE
DEVELOPMENT OF INNOVATIVE
RESEARCH CENTERS THAT WILL
FOSTER NURSING-LED PROGRAMS OF
COMMUNITY-PARTNERED RESEARCH
THAT AIM TO ADVANCE HEALTH
EQUITY BY APPLYING NINR'S
RESEARCH LENSES.
THIS INITIATIVE WOULD SEEK TO
LEVERAGE EXISTING COMMUNITY
RELATIONSHIPS OF SCHOOLS AND
COLLEGES OF NURSING, AND THEIR
FACULTY, TO PROVIDE A FOUNDATION
FOR ADVANCING COMMUNITY
PARTNERED NURSING RESEARCH.
A CENTRAL FEATURE OF THIS
INITIATIVE WOULD BE BUILDING
CAPACITY THROUGH THESE RESEARCH
CENTERS IN SCHOOLS AND COLLEGES
OF NURSING WITH AN EMPHASIS ON
THOSE THAT HAVE LIMITED PRIOR
NIH SUPPORT.
THESE CENTERS WOULD SUPPORT
PLANNING FOR NEW RESEARCH
ACTIVITIES, FOR PILOT STUDIES
THAT OFFER POTENTIAL SOLUTIONS,
AND THAT OFFER OPPORTUNITY FOR
DEVELOPING TEAMS AND
PARTNERSHIPS.
A KEY FEATURE WOULD BE TO LOOK
AT PROVIDING RESOURCES THAT
COULD INDEED FREE INVESTIGATOR
TIME FOR RESEARCH, PAY FOR
RESEARCH SUPPORT STAFF, AND
OTHER KEY INFRASTRUCTURE.
FINALLY A GOAL OF THE PROGRAM IS
TO ENHANCE THE RESEARCH CAPACITY
AND PROVIDE OPPORTUNITIES FOR
INVESTIGATORS TO IMPROVE
KNOWLEDGE AND SKILLS IN
COMMUNITY PARTNERED RESEARCH,
WHICH MAY INCROSE THEIR
COMPETITIVENESS FOR FUTURE NIH
FUNDING.
SOME EXAMPLES OF OBJECTIVES THAT
MIGHT BE INCLUDED IN THE
INITIATIVE ARE DEVELOPMENT OF
RESEARCH CENTERS THAT DO PROPOSE
THESE PILOT RESEARCH PROJECTS
THAT WOULD INCORPORATE COMMUNITY
PRIORITIES IN THE DESIGN,
CONDUCT, EVALUATION AND
DISSEMINATION OF RESEARCH.
ANOTHER POTENTIAL OBJECTIVE IS
STIMULATING STUDIES THAT UTILIZE
THE NINR RESEARCH LENSES AND
FOCUS ON DEVELOPING SOLUTIONS TO
COMMUNITY CHALLENGES.
WE KNOW PROMOTING DEVELOPMENT OF
INTERPRIS DYSPALESTINIAN RI
INTER
OF INTERDISCIPLINARY TEAMS IS
CRITICAL AND THESE ISSUES THAT
COMMUNITIES FACE AND FIGURING
OUT WAYS TO BUILD OR ADAPT
SOLUTIONS AS WELL AS TESTING
THEM ARE VERY COMPLEX.
SO THIS WOULD BENEFIT FROM THE
EXPERTISE OF SCIENTISTS OF
SEVERAL DISCIPLINES.
IN ADDITION, NURSE SCIENTISTS
CAN BENEFIT FROM MENTORS IN
DISCIPLINES OTHER THAN NURSING
TO BROADEN THEIR KNOWLEDGE AND
THEIR PERSPECTIVES.
ONE OBJECTIVE COULD BE PROVIDING
SUPPORT FOR DEVELOPING NURSE-LED
INTERDISCIPLINARY TEAMS TO
CONDUCT THIS RESEARCH WITH
COMMUNITY PARTNERS.
AGAIN BY BUILDING THESE TEAMS,
IT GIVES THEM A HISTORY OF
SUCCESSFUL TEAM WORK THAT THEY
CAN BUILD ON FOR FUTURE FUNDING
OPPORTUNITIES AND FUTURE
RESEARCH ENDEAVORS.
ANOTHER POTENTIAL OBJECTIVE
WOULD BE SUPPORTING
DEVELOPMENTAL ACTIVITIES FOR
INVESTIGATORS OF ALL LEVELS OF
EXPERIENCE, AND FOR THEIR
COMMUNITY PARTNERS, TO IMPROVE
THEIR KNOWLEDGE AND TO FOSTER
PARTNERSHIPS BETWEEN THE
ACADEMIC AND COMMUNITY GROUPS.
NEXT, PLEASE.
SO WITH THIS, I THANK YOU FOR
YOUR TIME AND ATTENTION, AND I'M
REALLY LOOKING FORWARD TO THE
COMMENTS AND DISCUSSION.
>> THANK YOU, DR. KEHL, AND
DR. STONE, I'LL LET YOU START US
OFF.
>> THANK YOU SO MUCH.
I'M REALLY EXCITED ABOUT THIS
CONCEPT.
I THINK WE'VE TALKED ABOUT IN
COUNCIL A LOT ABOUT THE SAME
SCHOOLS, ME BEING AT ONE OF
THEM, LUCKY US, THAT CONTINUE TO
GET RESEARCH FUNDING, BUT WE
NEED TO -- IF WE'RE REALLY GOING
TO MAKE MEANINGFUL CHANGE FOR
PEOPLE, WE NEED TO BE -- AND FOR
MARGINALIZED OR RACIAL AND
ETHNIC MINORITY POPULATIONS, WE
FEED TO BNEED TO BE IN SCHOOLS G
THAT ARE SERVING THAT.
AND WE NEED TO ALSO INCREASE
OUR -- DIVERSIFY OUR NURSING
SCIENTIFIC WORKFORCE TO REALLY
DO THAT, AND SO I THINK THIS IS
REALLY A WAY TO GET AT THAT.
AND SO IT REALLY VERY MUCH
EXCITED ME.
I THINK ONE OF THE THINGS
THAT -- AND IT MEETS OTHER NIH
GOALS, IT'S VERY SYNERGISTIC
WITH THE IDEA, YOU KNOW, THE
INSTITUTIONAL DEVELOPMENT
AWARDS, YOU KNOW, THAT ARE
LOOKING AT HBUs OR
INSTITUTIONS IN CERTAIN STATES
THAT DON'T GET A LOT OF NIH
FUNDING, I THINK THIS COULD BE
REALLY TRANSLATIONAL RESEARCH.
I THINK SOME OF THE THINGS THAT
IS VERY IMPORTANT IN THIS IS
THAT THE -- YOU MENTIONED,
DR. KEHL, THAT IT HAS A
POTENTIAL TO ENHANCE KNOWLEDGE
AND SKILLS AND INCREASE THE
COMPETITIVENESS FOR FUTURE NIH.
I THINK THAT IS WHERE YOU REALLY
WANT TO BE.
I MEAN, WE CAN'T ENSURE FUTURE
NIH FUNDING OBVIOUSLY, BUT
HAVING THAT -- ENSURING THAT
MENTORSHIP, WHETHER IT'S WITHIN
THE INSTITUTION OR, YOU KNOW,
OUTSIDE, YOU KNOW, PARTNERING
WITH THE RESEARCH INTENSIVE
INSTITUTION AND THE OTHER SCHOOL
OF NURSING, BUT ENSURING -- AND
HOW TO ENSURE THAT, I THINK
THAT'S REALLY IMPORTANT, BECAUSE
THAT'S WHAT'S GOING TO MAKE THIS
INVESTMENT SUSTAINABLE IN THAT
COMMUNITY AND ELEVATE THOSE
PEOPLE THAT ARE DOING THIS.
AND I THINK IT'S VERY IMPORTANT.
I LOVE THE IDEA THAT IT'S
INTERDISCIPLINARY TEAMS LED BY
NURSE SCIENTISTS.
THAT'S ALL I HAVE TO SAY.
I LIKE IT.
I KNOW WE'VE GOT 15 MORE MINUTES
TO DISCUSS THIS.
ANYBODY ELSE HAVE ANY IDEAS?
I THINK IT'S TERRIFIC.
>> SO I REALLY LOVE THE CONCEPT
AND I WAS STRUCK BY HOW
THOUGHTFUL AND DELIBERATE I
SENSED AS YOU WERE GOING THROUGH
THE SLIDES THAT THE THREE FOLKS
THAT WORKED ON IT, THERE WAS A
LOT OF THOUGHT THAT WENT INTO
EACH OF THOSE BULLETS.
IT'S VERY CLEAR FROM THE WAY IT
WAS PRESENTED AND READING THE
ACTUAL WORDS.
SO THANK YOU FOR THAT.
JUST TWO THINGS.
ONE, THAT MAY OR MAY NOT FIT
INTO TODAY'S DISCUSSION, BUT THE
15 SCHOOLS AND THIS SORT OF --
I'LL CALL IT A CONUNDRUM WE'RE
IN IN NURSING, HOW DO WE THINK
ABOUT MAYBE HAVING SOME
DISCUSSION AT SOME POINT ABOUT
SORT OF WHAT ARE THE UNDERLYING
REASONS FOR THAT?
WHAT'S REALLY HAPPENING HERE AND
WHAT ARE PLACES WHERE SCHOOLS
SHOULD BE COLLECTIVELY TRYING TO
RESPOND?
HOW THAT RELATES TO THE CONCEPT,
AND THE CREATION OF WHAT I THINK
WOULD BE AN INVALUABLE
INFRASTRUCTURE, IS THERE SUCH A
NOTION OF RECIPROCAL SORT OF
RIGOR AND IMPACT, ENSURING THAT
THE SCHOOLS THAT ARE NOT FUNDED
FOCURRENTLY BUT THAT HAVE GREAT
PROXIMITY TO THE COMMUNITIES
THAT THEY WORK WITH, THROUGH
THEIR PARTNERSHIPS, THAT THEIR
KNOWLEDGE IS TRANSFERRED TO THE
SCHOOLS THAT MAYBE ARE THE 15
THAT ARE, IN FACT, CONTINUOUSLY
GETTING FUNDING, AND VICE VERSA.
IS THERE A KIND OF SCIENTIFIC
RIGOR THAT WHETHER WE AGREE WITH
IT OR NOT, IT IS SORT OF THE
CURRENCY OF THE WAY THAT
SCHOLARSHIP AND RESEARCH AND
EVIDENCE IS RECEIVED, IS THERE
SOME WAY TO BRING THAT TOGETHER,
TO ENSURE THAT THE END OF THIS
AMAZING INITIATIVE, ASSUMING IT
WERE TO GO FORWARD, THAT IT
WOULDN'T BE DEEMED BASED ON OUR
CURRENT CRITERIA AS SOMEHOW NOT
BEING STRONG EVIDENCE?
AND JUST THROWING THAT OUT
THERE, I KNOW THOSE ARE
UNPOPULAR THOUGHTS, BUT I WONDER
IF THERE'S A WAY TO KIND OF MAKE
MORE WINS HERE IN TERMS OF HOW
IT GETS IMPLEMENTED.
>> I THINK ENSURING THAT THE
ENHANCEMENT OF THE SKILLS IS
REALLY IMPORTANT.
ONE WAY THAT YOU'RE SUGGESTING
IS THAT THERE'S A PARTNERSHIP OR
CONSORTIUM OF THE SCHOOLS THAT
GET THE FUNDING AND THE SCHOOLS
THAT GET THE FUNDING SO THAT
THERE COULD BE SHARED KNOWLEDGE
ACROSS, SHARED KNOWLEDGE ON
WHAT'S NEEDED, SHARED KNOWLEDGE
ON HOW TO DO THE RESEARCH AND
WRITE THE GRANTS ONCE YOU GET TO
THAT POINT OR MAYBE SHARED
KNOWLEDGE ON HOW TO WRITE THE
GRANTS IN THE BEGINNING TO GET
THE FUNDING.
AND THESE SCHOOLS ARE ALSO --
ALREADY HAVE PH.D. PROGRAMS, AND
OFTEN THEY HAVE PH.D. PROGRAMS
THAT THEY'RE BEING TAUGHT BY
NURSES, THAT HAVE NEVER REALLY
HAD FUNDED RESEARCH.
MAYBE THEY'VE HAD SOME, BUT THEY
HAVEN'T, SO WHAT ARE THEY TEA
TEACHING, YOU KNOW?
SO HOW THAT'S DONE, I THINK
THERE'S DIFFERENT MECHANISMS,
AND I THINK NINR HAS PROBABLY
THOUGHT ABOUT SOME OF THOSE, BUT
I THINK THAT THAT'S BECAUSE YOU
WANT THIS TO REALLY ELEVATE, AND
THAT'S GOT TO BE PART OF THAT IN
MY MIND.
>> ONE REALLY QUICK COMMENT.
I JUST WANT TO REITERATE THAT I
REFERENCED RECIPROCAL, AND THAT
REALLY IS ALSO AT THE SCHOOLS
THAT ARE OUTSIDE OF THE 15,
THERE'S SOMETHING ESSENTIAL THAT
THOSE INSTITUTIONS CAN TEACH THE
15 AND OTHERS?
>> OH, ABSOLUTELY.
>> I JUST WANTED TO MAKE SURE
THAT WAS IN THE NOTES BECAUSE
I'M AFRAID WE'RE GOING THE WRONG
DIRECTION.
>> YES, PLEASE.
>> THANK YOU.
I ALSO REALLY LIKE THE CONCEPT,
AND I THINK YOU ALL HAVE GIVEN A
LOT OF THOUGHT INTO JUST
BALANCING DIFFERENT COMPONENTS
LIKE SCHOOLS, THAT HAVE BEEN
FUNDED WITH A PH.D. PROGRAM
VERSUS SCHOOLS WHO HAVE LIMITED
FUNDING, AND ALSO I'M THINKING
ABOUT WHAT ARE WE -- YOU KNOW,
WHAT'S THE IMPACT THIS CONCEPT
CAN GENERATE THROUGH FUNDING.
SO WHEN I THINK AHEAD, I THINK
SOME OF THE THINGS THAT WE MAY
WANT TO CONSIDER IS THAT IF
WE'RE TRULY VALUING HOW THIS
CONCEPT WILL BRING THE IMPACT TO
THE COMMUNITY, I THINK SOME OF
THE HEAVILY FUNDED INSTITUTIONS,
IF THEY ARE BRINGING MAJOR
IMPACT TO THE COMMUNITIES THAT
THEY SERVE IN THAT COMMUNITY
PARTNERSHIP, I DON'T THINK THEY
SHOULD BE DISADVANTAGED JUST
BECAUSE THEY HAVE BEEN
HISTORICALLY, YOU KNOW, HAVING
FUNDING.
I ALSO THINK FOR THOSE WHO DO
NOT CURRENTLY HAVE MAJOR
FUNDINGS, OR EVEN THOSE WHO MAY
NOT HAVE A PH.D. PROGRAM OR HAVE
A COMBINED VENTURE, HOW DO WE
HELP THEM BECAUSE THEY MAY BE
THE PEOPLE WHO WILL NEVER BECOME
YOUR APPLICANTS.
WHAT'S THE KIND OF UNINTENDED
CONSEQUENCES THIS MAY CREATE?
SO I THINK BALANCING THE
DIFFERENT SIDES BUT ALSO THE
DIFFERENT SIDES OF THE DIFFERENT
SIDES, HOW CAN WE KIND OF
LEVERAGE THIS CONCEPT TO
GENERATE THE IMPACT OR THE NORTH
STAR OF NINR FOR THE HEALTH
EQUITY IS SOMETIMES MAYBE ARE WE
TARGETING THE SCHOOLS, ARE WE
TARGET THE THE PIPELINE OF
GENERATING OUR SCIENTISTS OR ARE
WE FOCUSING ON THE IMPACT OF THE
COMMUNITY, THE POPULATIONS.
AND MAYBE WE SHOULD LOOK AT
WHOEVER CAN LEVERAGE ALL OF THEM
AND CAN MARRY ALL OF IT FOR US
TO KIND OF BRING IT -- BRING THE
IMPACT THINKING ABOUT THAT
EQUITY LENS WHEN WE LOOK AT ALL
THE DIFFERENT SCHOOLS, DIFFERENT
PIPELINES AND DIFFERENT
COMMUNITIES THAT THIS CONCEPT
CAN BRING.
>> THANK YOU VERY MUCH FOR THOSE
COMMENTS.
I WAS PARTICULARLY STRUCK BY
WHAT YOU SAID ABOUT -- AND IT'S
VERY TRUE, THERE ARE SOME
SCHOOLS AND COLLEGES OF NURSING
THAT HAVE GREAT IMPACT IN THEIR
COMMUNITY.
THERE ARE ALSO SOME VERY
WELL-FUNDED SCHOOLS AND COLLEGES
OF NURSING WHERE COMMUNITY
ENGAGED RESEARCH IS NOT -- HAS
NOT BEEN A PRIORITY, IS A NEW
PRIORITY THAT MAY ALSO BENEFIT,
SO WE'RE STILL VERY MUCH AT THE
CONCEPT STAGE.
SO NOTHING IS WRITTEN IN STONE
AT THIS POINT, BUT IT'S VERY
HELPFUL TO HEAR THOSE COMMENTS.
>> ONE OF THE PIECES OF ADVICE I
WOULD OFFER IS IT'S PROBABLY
GOING TO BE HELPFUL ABOUT WHAT
THE SCORED CRITERION WOULD BE
FOR THESE APPLICATIONS, SO
THERE'S IMPACT TO THE COMMUNITY
ITSELF, MAYBE IT'S A DESPERATE
NEED AND A FABULOUS IDEA.
THERE'S ALSO BUILDING THE NEXT
GENERATION THAT'S A SCORE
CRITERION.
INDEPENDENT OF WHETHER THE
SCHOOLS HAVE BEEN FUNDED
HISTORICALLY OR NOT.
SO I REALLY THINK IT GETTING AT
WHAT THAT DELIVERABLE IS THAT
YOU WANT TO ACHIEVE IN MAKING
SURE THAT THE SCORING REFLECTS
THAT.
AND IT'S PROBABLY SOME COMPOSITE
AND THAT WILL HAVE TO BE
COMMUNICATED TO THE REVIEWERS.
>> THANK YOU VERY MUCH.
>> I THINK THERE'S PRECEDENT FOR
THIS IN DIFFERENT NIH
INITIATIVES, I THINK IN THE
ALL-OF-US, THERE WAS PRECEDENT
FOR THINGS LIKE THIS WHERE THIS
IS TO GET PEOPLE INVOLVED THAT
HAVE NOT BEEN INVOLVED BEFORE.
AND I LIKE THAT IDEA.
I REALLY DO.
AND LIKE AN R25, YOU KNOW, THERE
IS PEOPLE THAT CAME AND SAID OH,
WE SHOULD BE DOING THIS, YOU
KNOW, THIS R25 FOR ALL-OF-US.
IT LIKE NO, THAT'S NOT WHAT IT'S
ABOUT, IT'S ABOUT GETTING PEOPLE
INVOLVED IN THE RESEARCH THAT
HAVEN'T BEEN INVOLVED IN THE
RESEARCH BEFORE, IN THAT
RESEARCH.
YOU JUST WANT TO DO IT WELL SO
THEY CAN STAY INVOLVED, IT'S NOT
A ONE OFF-ER.
DR. FIT PACK TRI FITZPATRICK, IR
IDEA OF HOW THE SCORES -- YOU
KNOW, ENSURING THAT THE
PROPOSALS ARE REVIEWED AND
SCORED TO WHAT THE CRITERION
THAT YOU WANT IS GOING TO --
WOULD BE IMPORTANT BECAUSE IT'S
DIFFERENT, IT'S NOT SAME OLD
STUDY SECTION.
AND THAT IDEA OF SUSTAINABILITY
OF IT AND HOW THEY'RE GOING TO
LEARN, BUT HECK, WE GOT A LOT OF
NURSING SCHOOLS OUT THERE THAT
DON'T HAVE ANY NIH FUNDING, OR
ANY OTHER TYPE OF FUNDING AND
THEY ARE PUTTING OUT PH.D.s OR
DNSs.
AND YOU KNOW, AND THEY'RE JUST
NOT GETTING THE SAME SORT OF
LEVEL OF EDUCATION ABOUT BEING A
NURSE SCIENTIST.
AS I WOULD WANT
THEM TO.
>> I MEAN, I THINK THE RESOURCES
FOR WRITING GRANTS TEND TO FALL
ON THE CTSA-FUNDED INSTITUTIONS,
WHICH ARE THE PEOPLE YOU ARE NOT
TALKING ABOUT HERE, AND SO YOU
KNOW, THE WEBINARS AND THINGS
YOU'LL HAVE TO DO TO EVEN
INSTRUCT THESE SCHOOLS TO APPLY
IS -- IT'S NOT SMALL.
THEY DON'T HAVE CTSAs.
>> YOU ARE ABSOLUTELY CORRECT
AND I WILL SAY WE DO HAVE QUITE
A BIT OF EXPERIENCE WITH SOME OF
THE INITIATIVES WE'VE HAD IN THE
LAST COUPLE OF YEARS THAT AREN'T
LOOKING FOR YOUR USUAL CAST OF
CHARACTERS WHEN IT COMES TO
APPLYING.
SO WE ABSOLUTELY WOULD TAKE ALL
OF WHAT WE'VE LEARNED INTO
ACCOUNT IN TRYING TO SET UP
PEOPLE TO BE SUCCESSFUL EVEN IN
TERMS OF BEING ABLE TO WRITE AN
APPLICATION THAT MEETS ALL THE
CRITERIA.
>> JUST HONING ON TO SOME OF
WHAT WAS SAID HERE, TOO I'M
THINKING, YOU KNOW, I TOTALLY
AGREE, IT WOULD TAKE A LOT OF
EFFORT TO GET PEOPLE ON BOARD
EVEN THINKING ABOUT APPLYING AND
HOW TO, ET CETERA, BUT I'M
EXCITED ABOUT THE OPPORTUNITY TO
LIFT UP SOME OF THESE SCHOOLS
THAT ALREADY DO REALLY GOOD WORK
WITH THE TRIBES IN THEIR
COMMUNITY.
I'M THINKING OF A COLLEAGUE AT
MONTANA STATE UNIVERSITY AND
ANOTHER THAT WAS IN THE SCHOOL
OF NURSING IN THE DAKOTAS, AND
THAT DOES A LOT OF AMAZING NURSE
WORK.
AS NURSE FACULTY OR RESEARCHERS
WITH -- IN TRIBAL COMMUNITIES.
SO WHAT WE'RE TALKING ABOUT HERE
COULD BE A WAY TO REACH SOME OF
THESE POPULATIONS IN NEW AND
MORE EFFECTIVE WAYS IN RURAL
AREAS AND WITH INDIGENOUS
COMMUNITIES, ET CETERA.
I LOVE THE IDEA, IT'S GOING TO
TAKE A DIFFERENT WAY OF THINKING
AND REACHING FOLKS AND GIVING
THEM WHAT THEY NEED TO GET THE
RESOURCES, NOT NECESSARILY TO DO
SOME OF THE WORK BECAUSE THEY'RE
GOING TO KNOW HOW TO DO THAT
BETTER THAN WE ARE, RIGHT?
BUT IT'S EXCITING, THE IDEA IS
EXCITING AND IT GOES BACK TO
WHAT YOU WERE TALKING ABOUT,
VINCENT, IN TERMS OF REACHING
SOME OF THESE POPULATIONS,
WORKING WITH THESE POPULATIONS
IN DIFFERENT WAYS.
I LIKE IT.
>> YOU ACTUALLY GOT TO A COMMENT
I WAS INTERESTED IN.
WHAT IS HAPPENING NOW IN TERMS
OF LEADERSHIP DEVELOPMENT OF
THOSE WHO HAVEN'T BEEN FUNDED?
I'M TRYING TO THINK OF AN
INSTITUTION THAT IS NOT USED TO
HAVING THIS TYPE OF FUNDING,
THEN THEY GET THIS TYPE OF
FUNDING AND IT'S VERY TEMPTING
TO USE IT FOR OTHER PURPOSES.
SO ESPECIALLY NOW, I MEAN, WE
HAVE MORE MONEY THAN OUR
INSTITUTION.
THEY SEE OUR BUDGETS.
SO WHAT KIND OF TRAINING IS
BEING DONE, WHAT KIND OF
LEADERSHIP DEVELOPMENT?
>> SO I NEED A LITTLE BIT OF
CLARIFICATION, BECAUSE I HEARD A
COUPLE OF QUESTIONS IN THERE.
ONE BEING WHAT TYPE OF OVERSIGHT
IS THERE TO MAKE SURE THAT
PEOPLE ACTUALLY USE FUNDING FOR
WHAT THEY'RE SUPPOSED TO USE IT
FOR, AND --
>> IT'S MORE HELPING THE
INDIVIDUAL LEAD THE PROJECT OR
LEAD THE EFFORT WITHIN THEIR OWN
INSTITUTION.
>> SO WHAT I CAN SAY IS WHAT'S
BEEN DONE IN PREVIOUS EFFORTS
IN -- I'M NOT SAYING WE WOULD DO
ALL OF THESE OR THAT THIS
NECESSARILY WOULD BE PART OF IT,
IT'S JUST AN EXAMPLE OF WHAT HAS
BEEN DONE.
ONE OF THE THINGS THAT WAS DONE
IN THE PAST WAS THAT THERE WAS
AN ANNUAL MEETING WHERE ALL OF
THE CENTER DIRECTORS CAME
TOGETHER, THEY LEARNED FROM ONE
ANOTHER.
OVER TIME THAT GOT EXPANDED SO
THAT THE INVESTIGATORS, THE
PILOT INVESTIGATORS WOULD
PRESENT THEIR STUDIES, WOULD
LEARN FROM PEOPLE FROM OTHER
CENTERS, WOULD LEARN FROM THEIR
COLLEAGUES, WOULD FIND
OPPORTUNITIES TO COLLABORATE
THERE.
IN THE PAST, CENTERS HAVE ALL
HAD SCIENTIFIC ADVISORY COUNCILS
AND MANY OF THEM DID HAVE
COMMUNITY ADVISORY GROUPS OR
COUNCILS, BUT THOSE SCIENTIFIC
AND ADVISORY COUNCILS WERE VERY
IMPORTANT TO LEARN FROM PEOPLE
WHO HAD DONE OTHER SIMILAR TYPES
OF PROJECTS.
THEY MIGHT NOT HAVE HAD AN
NINR-FUNDED CENTER, THEY MIGHT
HAVE HAD SOME OTHER TYPE OF
CENTER, BUT BRINGING IN THAT
EXPERTISE FROM THE VERY
BEGINNING SO THEY HAVE A GROUP
TO GO TO AND SAY, HEY, WE DON'T
KNOW HOW TO DO THIS.
WE PROPOSED IT, IT SOUNDS REALLY
GOOD, BUT NOW HOW DO WE
OPERATIONALIZE THAT?
>> JUST TO FURTHER EXPAND ON
THAT, THE EXPERIENCE I'VE HAD IN
THOSE TYPES OF MEETINGS ARE
REALLY FOCUSED ON THE SCIENCE,
WHICH IS GREAT, ABOUT
IMPLEMENTATION AND WHATNOT.
IT LESS SO ABOUT HOW DO I MANAGE
THIS CENTER IN MY INSTITUTION.
SO JUST ENCOURAGING YOU TO HAVE
A LITTLE BIT MORE DISCUSSION
ABOUT THAT.
>> YES, THANK YOU.
I CAN TELL YOU THAT WAS
CERTAINLY SOMETHING THAT WE SAW
OVER TIME, AND IN THE MORE
RECENT ITERATION OF CENTERS,
THERE WAS A LOT MORE BUILT IN
LOOKING AT EVALUATION CRITERIA
AND HOW DO YOU DO SOME OF THOSE
OPERATIONAL PIECES.
BUT YOU'RE ABSOLUTELY CORRECT,
THAT IS SOMETHING THAT MOST
DEFINITELY NEEDS ATTENTION.
>> I TOO WANT TO ECHO HOW
EXCITED I WAS TO HEAR ABOUT THE
CONCEPT AND I SUPPORT WHAT
YOU'VE LAID OUT.
THERE ARE TWO THINGS I WANTED TO
RAISE, COMING FROM AN HBCU
MYSELF, WE'RE ALWAYS THINKING
ABOUT THE POWER DYNAMICS BETWEEN
OUR HBCUs AND OTHER
INSTITUTIONS, AND FOR I THINK
LEGITIMATE REASONS.
HISTORICAL MISTREATMENT FROM
MAYBE OTHER INSTITUTIONS, THAT'S
SOMETHING TO KEEP IN MIND AS
YOU'RE BUILDING THIS OUT AND
THEN THE POWER DYNAMICS BETWEEN
THESE INSTITUTIONS.
SO I APPLAUD THE EFFORT TO TALK
ABOUT RECIPROCITY AND RECIPROCAL
AND WHATNOT, BUT THOSE THINGS
NEED TO BE VERY CAREFULLY
THOUGHT ABOUT TO MAKE SURE THAT
HBCUs, TRIBAL COLLEGES AND
OTHERS BELIEVE THAT THEY ARE
RUNNING THIS, BECAUSE A LOT OF
TIMES FOLKS SAY, OH, NO, WE'LL
COME AND HELP YOU.
WE DON'T NEED HELP.
WE KNOW HEALTH EQUITY RESEARCH.
BUT WHAT WE NEED ARE THE
RESOURCES, AND WE WANT TO WORK
WITH OTHER FOLKS.
SO I THINK THAT NEEDS TO BE
CONSIDERED --
>> IT'S A FANTASTIC POINT, AND
ABSOLUTELY WE HAVE HAD MANY,
MANY DISCUSSIONS ON HOW
DIFFERENT WAYS WE MAY BE ABLE TO
OPERATIONALIZE THIS.
AS ALL OF YOU HAVE BROUGHT TO
LIGHT, THERE ARE MANY -- THIS IS
NOT AN EASY ENDEAVOR, IT'S A
COMPLEX ENDEAVOR AND WE'RE VERY
WELL AWARE OF THAT.
AND WE APPRECIATE THE POINTS
THAT YOU BROUGHT FORWARD JUST
BECAUSE IT HELPS CEMENT IN OUR
MIND SOME OF THE THINGS THAT WE
HAVE ALREADY DISCUSSED BUT NODED
TO GO BACK AND REVISIT.
AS I SAID, IT'S A COMPLEX
ENDEAVOR BUT IT'S ONE WE THINK
IS VERY WORTHWHILE.
>> HELLO, YES, CAN YOU HEAR ME
OKAY?
>> YES.
>> THANK YOU, GREAT.
GOOD MORNING -- SORRY --
AFTERNOON.
SORRY.
I AM IN TOKYO AT THE MOMENT, SO
IT'S A LITTLE BIT OF A TIME
SHIFT FOR ME COMING TO YOU FROM
YOUR FUTURE, BUT I JUST WANTED
TO SAY THIS WAS A TREMENDOUS
EFFORT, AND I'D LIKE TO PROFFER,
IF I COULD, AN EXAMPLE THAT THE
DOD EMPLOYS.
MANY OF YOU HAVE PROBABLY HEARD
OF TRI-SERVICE NURSING PROGRAM,
WHICH IS A GRANT FUNDING AGENCY
THAT SUPPORTS NURSE-LED SCIENCE.
AND THAT'S ONE OF THE THINGS
WE'RE DOING IS WE'RE OUT IN THE
FIELD THIS MONTH SPREADING WORD
ABOUT THAT PROGRAM AND DOING
SOME EBP COURSES.
TWO POINTS I WANTED TO ADDRESS
IS, ONE, ENSURING THAT FUNDS FOR
A PARTICULAR RESEARCH PROJECT OR
USED FOR THAT PROJECT OF COURSE
WOULD BE A FUNCTION OF THE CALL
AND NEGOTIATING THE AWARD, BUT
ONE OF THE THINGS THE
TRI-SERVICE NURSING RESEARCH
PROGRAM DOES TO SUPPORT SOLID
COMPETITIVE APPLICATIONS IS THAT
WE OFFER A LOT OF TRAINING WITH
THAT.
SO YOU MAY CONSIDER AS A
FUNCTION OF HAVING THESE AWARDS
AND A CALL TO HISTORICALLY
DISADVANTAGED INSTITUTIONS IS
OFFERING A TRAINING PROGRAM.
ONE OF THE THINGS THAT
TRI-SERVICE OFFERS IS A
GRANT-WRITING -- WE CALL IT
GRANT CAMP, RIGHT, AND IT IS A
PROGRAM TO -- ATE WEEK-LONG
MENTORED PROGRAM WHERE WE HAVE
EXPERIENCED NURSE SCIENTISTS
HISTORICALLY HAVE INTERACTED,
AND THEY ONE-ON-ONE MENTOR
INDIVIDUALS ON DEVELOPMENT OF A
SOLID GRANT APPLICATION, ALL OF
THE THINGS THAT NEED TO GO IN
THAT, SO IT'S A LITTLE BIT OF A
DIDACTIC, A LITTLE BIT OF TALK
TO THE GROUP AND A LITTLE BIT OF
ONE-ON-ONE MENTORING FOR THEM TO
HELP DEVELOP A SOLID APPLICATION
AND THEN THOSE APPLICATIONS WERE
COMPETED IN THE NEXT ROUND OF
FUNDING.
ANOTHER THING THAT'S IMPORTANT
PARTICULARLY WHEN YOU TALK ABOUT
NEW GRANTEES, WE HAVE A POST
AWARD COURSE THAT IS USED FOR
PARTICULARLY FIRST-TIME
APPLICANTS WHO ARE AWARDED
FUNDING COME TO THIS, IT'S A
REQUISITE OF THE FUNDING, THEY
COME TO THE POST AWARD TRAINING
AND THEY LEARN HOW TO DO ALL OF
THEIR REGULAR REPORTS AND HOW TO
MANAGE THE GRANT AND ANOTHER
COMPONENT WE HAVE OF COURSE IS A
RESOURCE CENTER WHERE WE CAN
BRING OTHER EXPERTISE,
STATISTICIANS AND THINGS THAT
OTHER MILITARY TREATMENT
FACILITIES MAY LACK THAT NURSES
WHO ARE WANTING TO DO SOME
SCIENCE CAN GET AFTER IT WITH
SOME OF THESE RESOURCES.
SO I THINK IT IMMINENTLY DOABLE.
I DON'T KNOW HOW IT AFFECTS THE
ULTIMATE AMOUNT OF THE AWARD.
THE CONCEPT IS FABULOUS, AND
THINK YOU CAN EMPLOY SOME OF
THOSE METHODS TO HELP EXTEND
THAT.
THANK YOU.
>> SO I'M GOING TO RESPOND TO
YOUR COMMENT.
SO I DON'T DISAGREE WITH YOU.
I THINK THE THING THAT I WAS
TRYING TO ARTICULATE, THAT I
THINK IT VERY COMPLICATED.
SO IN TERMS OF YOUR EXAMPLE, I
NO WAY AM SAYING THAT
INSTITUTIONS THAT FOR REASONS
THAT ARE COMPLEX WHO HAVE NOT
GOTTEN FUNDING ARE NOT WELL
PREPARED TO ACTUALLY DO THAT
RESEARCH.
WHAT I HEARD AT THE START OF
THIS CONVERSATION IS THAT THERE
ARE 144 SCHOOLS OF NURSING, NOT
HBCUs OR HSIs BUT SCHOOLS OF
NURSING.
THE VAST MAJORITY OF THOSE
SCHOOLS ARE ACTUALLY NOT SCHOOLS
THAT ARE SPECIFICALLY TARGETING
COMMUNITY OF COLOR.
THEY'RE THE SCHOOLS OF NURSING.
AND IN NURSING, WE'VE HAD SOME
CHALLENGES THAT WE AS A
PROFESSION HAVE TO TALK ABOUT.
WE HAVE A SHORTAGE OF PH.D.s
THAT ARE GOING INTO THE
PROFESSION, WE HAVE MANY SENIOR
NURSE SCIENTISTS RETIRING.
WE HAVE A LOT OF -- AGAIN THESE
ARE MY THOUGHTS SO I TAKE
RESPONSIBILITY FOR THEM.
WE HAVE A LOT OF EMPHASIS ON
TRYING TO WALK A FINE LINE
BETWEEN ENSURING THAT WE'RE
BEING FLEXIBLE IN HOW WE DELIVER
OUR PH.D. EDUCATION AND ALSO
TRYING TO MAINTAIN RIGOR, AND
THAT TENSION IS PALPABLE.
REVIEW COMMITTEES, IT'S NOT
UNUSUAL FOR COMMENTS TO COME UP,
WELL, THIS IS TOO
METHODOLOGICALLY RIGOROUS OR TOO
AMBITIOUS OR BLAH, BLAH, BLAH.
SO I THINK THAT WHAT I'M REALLY
GETTING AT IS THAT WE NEED TO
UNDERSTAND, WHY ARE THE MAJORITY
OF THE SCHOOLS OF NURSING NOT
GETTING FUNDED, AND WE'VE GOT
SOME WORK TO DO AND I THINK
THERE'S A GREAT OPPORTUNITY -- I
LOVE THE CONCEPT, BUT I THINK
IT'S NOT THE CASE THAT I'M
SUGGESTING SOME OF WHAT I
THOUGHT YOU MIGHT HAVE BEEN
SAYING, I'M NOT CERTAIN, BUT
IT'S NOT ABOUT SCHOOLS THAT
REPRESENT UNDERSERVED AND
ETHNICALLY AND RACIALLY DIVERSE
POPULATIONS THAT HAVE NOT GOTTEN
FUNDING FOR REASONS THAT ARE
WELL ESTABLISHED, IT'S NOT ABOUT
THAT.
THERE'S A LARGER PROBLEM.
SO I JUST WANTED TO POINT THAT
OUT BECAUSE I THINK WE'VE GOT TO
WORK ON THAT.
>> THANK YOU ALL VERY MUCH FOR
YOUR COMMENTS.
YOU'VE GIVEN US A GREAT DEAL TO
ADD TO OUR LIST OF THINGS TO
ADDRESS.
THIS IS EXACTLY WHY WE WANT TO
BRING THIS TO YOU, THOUGH, WE'D
MUCH RATHER THINK ABOUT THESE
THINGS NOW AS WE'RE MOVING
FORWARD THAN LATER, SO THANK
YOU, AND THANK YOU VERY MUCH FOR
YOUR ENTHUSIASM FOR THE CONCEPT.
>> THANK YOU VERY MUCH, DR. KEHL
AND THE WHOLE CONCEPT TEAM, DRS.
TYUS AND -- SO HEY, IT'S 3:20.
WE ARE REACHING THE END.
I WANT TO THANK YOU, THOUGH, FOR
THE INSPIRATION, THE GUIDANCE,
FOR SHARING YOUR TIME WITH US
TODAY.
THIS WAS REALLY ENERGIZING FOR
ME AND I THINK FOR ALL OF US AT
NINR, AND WE APPRECIATE YOU
SHARING YOUR -- AGAIN, YOUR
EXPERTISE, YOUR EXPERIENCE WITH
US.
SO THIS SESSION, OPEN SESSION OF
COUNCIL, WE'RE GOING TO ADJOURN.
IT IS 3:21.
COUNCILMEMBERS, THOUGH, WE ARE
GOING TO MOVE INTO CLOSED
SESSION.
SO WE DO NEED TO TRANSITION A
LITTLE BIT, SO IF FOLKS CAN SIT
TIGHT WHILE THOSE WHO ARE
EXITING CAN LEAVE THE ROOM AND
THEN WE'LL GET STARTED AGAIN.
SO THANK YOU.