FOR REJOINING US AGAIN
TODAY FOR WHAT HAS STARTED OUT
TO BE A SCIENTIFICALLY EXCELLENT
WORKSHOP, I HOPE.
I HAVE FELT THAT WAY, THE
PRESENTATIONS HAVE BEEN
FANTASTIC, SO I JUST WANT TO
THANK ALL OF OUR SPEAKERS
YESTERDAY WHO GAVE SUCH
FANTASTIC TALKS.
I KNOW I LEARNED A LOT.
YOU KNOW, SCIENTIFICALLY.
I ALSO LEARNED A LOT ABOUT HOTEL
LOGISTICS.
SO APPRECIATE EVERYBODY BEARING
WITH US AS WE WORKED THROUGH
SOME TECHNICAL SNAGS, AND I
APPRECIATE EVERYBODY'S PATIENCE
THERE.
A FEW QUICK UPDATES AND LESSONS
LEARNED FROM YESTERDAY TO THAT
END.
SO FOR LUNCHES TODAY, ALISON AND
MARK AT THE FRONT DESK WILL HAVE
A MENU, SO PLEASE BEFORE
11:00 THIS MORNING, GRAB A MENU,
SELECT YOUR CHOICE AND GIVE IT
BACK TO ALISON.
THEY WILL HAVE ALL OF THE FOOD
PREPARED AND READY TO GO FOR
LUNCH SO YOU'LL JUST NEED TO GO
AND PAY FOR YOUR FOOD AND TAKE
YOUR PREPARED BOX.
SO THAT IS HOW WE'RE GOING TO
HANDLE LUNCH TODAY.
HOPEFULLY THAT PROCESS WILL RUN
A LITTLE BIT SMOOTHER THAN IT
DID YESTERDAY BECAUSE I KNOW
EVERYBODY IS SICK OF PIZZA.
SO AGAIN, THANK YOU FOR BEING
HERE.
I'M GOING TO PASS IT OFF TO OUR
EXCELLENT PLENARY PANEL, AND
KAREN PARKER WHO WILL BE MOD
MODERATING THAT PANEL.
SO THANK YOU, EVERYBODY.
>> GREAT.
THANK YOU SO MUCH, JENNA MY NAME
IS KAREN PARKER, PRONOUNS
SHE/HER, IN THE OFFICE OF THE
DIRECTOR AT NIH.
I'VE BEEN SO PLEASED TO BE A
PART OF THE PLANNING COMMITTEE
FOR THIS WORKSHOP.
AND I WOULD JUST LIKE TO THANK
ALL OF THE SPONSORS AND REALLY
WANT TO GIVE A GREAT SHOUT OUT
TO JENNA, WHO KEPT US GOING
THROUGHOUT THIS WHOLE PROCESS
AND REALLY, I THINK, IS THE
PERSON WHO WAS MOST HELPFUL IN
GETTING THE AMAZING SPEAKERS WHO
HAVE BEEN PRESENTING YESTERDAY
AND TODAY.
SO I AM SO PLEASED TO BE HERE
TODAY TO MODERATE THIS PLENARY
SESSION.
WE WILL HAVE THREE
PRESENTATIONS, AND I WILL JUST
QUICKLY INTRODUCE THEM AND THEN
WE'RE GOING TO GET RIGHT INTO
PRESENTATIONS, AND I REALLY LOOK
FORWARD TO YOUR QUESTIONS BOTH
IN THE ROOM AND ONLINE.
SO WE WILL START TODAY WITH
DR. AMANI NURU-JETER, WHO IS
FROM THE UNIVERSITY OF
CALIFORNIA, BERKELEY.
THEN DR. DAVID CHAE FROM TULANE
SCHOOL OF PUBLIC HEALTH AND
TROPICAL MEDICINE WILL PRESENT,
AND THEN WE WILL WRAP UP THIS
PLENARY SESSION WITH DR. LISA
DIAMOND, WHO IS FROM THE
UNIVERSITY OF UTAH.
AND SO PLEASE JOIN ME IN
WELCOMING DR. NURU-JETER.
>> GOOD MORNING.
SO I'M GOING TO ZOOM OUT A BIT
FROM WHERE WE ENDED OUR DAY
YESTERDAY AND TALK MORE
HISTORICALLY AND CONCEPTUALLY
ABOUT RACE AND THE PROCESS OF
RACIALIZATION AND
MARGINALIZATION IN THE U.S.
USING THE EXAMPLE OF AFRICAN
AMERICANS AND NATIVE AMERICANS.
IN SO DOING, I HOPE TO
DEMONSTRATE THE IMPORTANCE OF
USING A HISTORICAL LENS TO
CONCEPTUALIZE THE SOCIAL,
PSYCHOBIOLOGICAL MECHANISMS
UNDERLYING THE RACISM
RELATIONSHIP IN ORDER TO ADVANCE
OUR THINKING AND UNDERSTANDING
RELATED TO CONCEPTUALIZING AND
MEASURING RACISM AND
UNDERSTANDING VARIOUS PATHWAYS
TO HEALTH AND HOW THOSE PATHWAYS
MAY VARY ACROSS GROUPS.
SO I'D LIKE TO START BY TALKING
ABOUT RACE.
SO THESE ARE DEFINITIONS OF RACE
FROM VARIOUS DISCIPLINES WITHIN
THE BIOMEDICAL SCIENCES, AND AS
YOU CAN SEE, ALL OF THESE
DEFINITIONS EXCEPT THE LAST
DEFINE RACE BASED ON IDEAS OF
GENETIC SIMILARITY.
NOTABLY, PIs OF STUDIES
LOOKING AT GENETIC ADMIXTURE
HAVE STATED THERE IS SUBSTANTIAL
SUBSTRUCTURE AND ADMIXTURE AMONG
POPULATIONS SUCH AS AFRICAN
AMERICANS AND THAT GENETIC
SIMILARITY IS CORRELATED WITH A
RANGE OF SOCIAL, CULTURAL AND/OR
ENVIRONMENTAL FACTORS THAT
INFLUENCE DISEASE OCCURRENCE YET
REMAIN UNMEASURED OR NOT
ADEQUATELY ACCOUNTED FOR IN OUR
ANALYSES, AND THAT THESE
NON-GENETIC FACTORS MAY ACCOUNT
FOR ALL OR PART OF THE
ASSOCIATION BETWEEN A PHENOTYPE
AND ANCESTRY.
NOW LOOKING AT DEFINITIONS FROM
THE SOCIAL SCIENCES, THESE
DEFINITIONS AS YOU CAN SEE
REFUTE CLAIMS ABOUT THE
BIOLOGICAL BASIS OF RACE, AND
INSTEAD DESCRIBE THE SOCIAL,
CULTURAL AND POLITICAL
FOUNDATIONS OF RACIAL
CATEGORIZATION.
SO THERE'S A CLEAR AND VERY
STARK DIFFERENCE BETWEEN THE
BIOMEDICAL AND SOCIAL SCIENCES
IN TERMS OF HOW RACE IS DEFINED.
FINALLY LOOKING AT EPIDEMIOLOGY.
THE SECOND EDITION OF THE
DICTIONARY OF EPIDEMIOLOGY
DEFINED RACE AS PERSONS WHO ARE
RELATIVELY HOMOGENEOUS WITH
RESPECT TO BIOLOGICAL
INHERITANCE.
THE ENTRY FOR RACE IN THE 6TH
AND MOST RECENT DICTIONARY OF
EPIDEMIOLOGY STATES THAT
BIOLOGICAL CLASSIFICATION OF
HUMAN RACES IS DIFFICULT, AND
SOMETIMES MEANINGLESS, BECAUSE
OF SIGNIFICANT GENETIC OVERLAPS
AMONG POPULATION GROUPS.
HOWEVER, IT STATES, RACE MAY BE
A USEFUL CONCEPT IN PUBLIC
HEALTH BECAUSE SOME EXPOSURES
AND DISEASES ARE STRONGLY
CORRELATED WITH BIOLOGICAL AND
PHYSICAL ASPECTS OF RACE.
SO STILL ADVANCING A DEFINITION
REALLY FOCUSED ON A BIOLOGICAL
BASIS OF RACE.
NOTABLY, THE DICTIONARY ALSO
STATES THAT SOCIOECONOMIC,
CULTURAL AND BEHAVIORAL
DIFFERENCES ARE MORE IMPORTANT
THAN RACIAL DIFFERENCES IN
INFLUENCING HEALTH STATUS.
HOWEVER, BY SAYING THIS, THEY'RE
IGNORING THE WAYS IN WHICH SES
AND BEHAVIORS ARE DETERMINED BY
RACISM, WHICH WE'LL TALK ABOUT A
BIT LATER.
SO WHAT DO WE KNOW ABOUT RACE IN
THE U.S.?
SO THE PURPOSE OF THE INITIAL
CENSUS WAS TO ESTABLISH
REPRESENTATION IN CONGRESS AND
FOR TAXATION PURPOSES SO THE
MORE PEOPLE YOU HAD -- THE
SOUTHERN STATES HAD MORE POWER
THAN THE NORTHERN STATES,
BECAUSE OF THE 35TH COMPROMISE
WHICH COUNTED THREE FIFTHS AS
PART OF THE OFFICIAL POPULATION
ACCOUNT ALTHOUGH SLAVES ARE NOT
ALLOWED TO VOTE AND INDIGENOUS
PEOPLE WERE NOT TAXED OR
ACCOUNTED AT ALL.
IN 1820, A COLOR COLUMN WAS
ADDED.
AND IN THIS COLUMN, ONLY BLACK
AND MULATTO PEOPLE WERE LISTED
INITIALLY THUS THEY WERE IN
EFFECT RACIALIZED AND THIS BEGAN
THE OFFICIAL FEDERAL PROCESS OF
RACIALIZATION IN THE UNITED
STATES.
INDIGENOUS PEOPLE WERE ADDED IN
1860 AND CHINESE PEOPLE WERE
ADDED IN 1870 BASED ON SOCIAL
AND ECONOMIC INTEREST RELATED TO
THE CONTROL OF RESOURCES IE LAND
AND THE CONTROLLING -- AND
CONTROLLING IMMIGRATION IN ORDER
TO PRIORITIZE A GROWING LABOR
ECONOMY.
DURING THE LATE 19TH CENTURY AND
THROUGHOUT THE 20TH CENTURY,
DIFFERENT SCHEMES WERE USED TO
CATEGORIZE SO-CALLED RACIAL
GROUPS, MOSTLY AGAIN FOR THE
PURPOSE OF TAXATION AND
REPRESENTATION, BUT ALSO FOR
GRANTING CIVIL RIGHTS SUCH AS
THE RIGHT TO PURCHASE LAND, THE
RIGHT TO PURCHASE HOUSING, AND
THE RIGHT TO EMPLOYMENT AND
WAGES, ALL OF WHICH WERE
RESTRICTED PRIMARILY TO WHITES.
THIS PROCESS OF RACIALIZATION
INCLUDED VARIOUS RACIAL PURITY
SCHEMES MOTIVATED BY SOCIAL,
ECONOMIC AND POLITICAL
INTERESTS.
FOR EXAMPLE, PERCENT BLACK AND
THE ONE DROP RULE WERE EARLY
METHODS FOR OPERATIONALIZING A
BIOLOGICAL CLASSIFICATION SCHEME
AND SUBJUGATE IN PARTICULAR
THOSE WITH AFRICAN ANCESTRY.
AFTER THE CIVIL WAR AND VARIOUS
LAWS PASSED DURING
RECONSTRUCTION INTENDED TO
IMPROVE CONDITIONS FOR THE
FORMALLY ENSLAVED, MOST SOUTHERN
STATES ADOPTED WHAT WERE CALLED
BLACK COVES.
CODES, BASED ON FORMER
SLAVE LAWS, AND WERE DESIGNED TO
LIMIT THE NEW-FOUND FREEDOM OF
EMANCIPATED BLACKS BY
RESTRICTING THEIR MOVEMENT, AND
FORCING THEM INTO A LABOR
ECONOMY BASED ON LOW WAGES AND
DEBT.
ADDITIONALLY, THESE LAWS ALLOWED
BLACKS TO BE ARRESTED FOR MINOR
INFRACTIONS, DEVELOPING A SYSTEM
OF PENAL LABOR EFFECTIVELY
RESULTING IN REENSLAVEMENT.
THUS DESPITE ALL OF THESE NEW
AMENDMENTS AND LAWS, SOUTHERN
STATES CONTINUED TO OPERATE
UNDER DE FACTO RACIAL
DISCRIMINATION AND SEGREGATION.
AFTER THE END OF RECONSTRUCTION,
SOUTHERN STATES ENACTED MORE
DISCRIMINATORY LAWS WHICH WE
KNOW AS JIM CROW LAWS.
CONSEQUENTLY, EFFORTS TO ENFORCE
WHITE SUPREMACY BY LEGISLATION
INCREASED AND DISCRIMINATION AND
SEGREGATION WERE LEGAL AND
ENFORCEABLE UNTIL THE CIVIL
RIGHTS ACT OF 1964.
THAT WAS JUST NINE YEARS BEFORE
I WAS BORN, SO WE'RE TALKING
ABOUT A VERY RECENT HISTORY.
IN FACT, I GREW UP LISTENING TO
STORIES FROM MY MOTHER WHO GREW
UP IN THE JIM CROW SOUTH SUCH AS
HAVING TO DRINK OUT OF A
COLORED-ONLY WATER FOUNTAIN.
LEGALLY, UNDER JIM CROW,
SERVICES AND FACILITIES WERE
SUPPOSED TO BE SEPARATE BUT
EQUAL.
HOWEVER, IN PRACTICE SERVICES
AND FACILITIES FOR BLACKS WERE
CONSISTENTLY INFERIOR OR AT
TIMES DIDN'T EXIST AT ALL.
AND ALTHOUGH JIM CROW WAS ALONE
IN THE SOUTH IT WAS RAMPANT IN
THE NORTH, INCLUDING THINGS LIKE
HOUSING PATTERNS ENFORCED BY
PRIVATE COVENANTS AND BANK
LENDING PRACTICES AS WELL AS JOB
DISCRIMINATION.
NATIVE AMERICANS WERE NOT
GRANTED THE FULL RIGHTS AND
PROTECTIONS OF U.S. CITIZENSHIP
UNTIL LONG AFTER
AFRICAN-AMERICANS AND WOMEN WITH
MANY HAVING TO WAIT UNTIL THE
NATIONALITY ACT OF 1940, WHICH
WAS LONG AFTER THE PASSAGE OF
THE 14TH AMENDMENT.
AND BECAUSE INDIGENOUS PEOPLES
WERE OFFICIALLY CONSIDERED
MEMBERS OF OTHER NATIONS, IE,
SOVEREIGN NATIONS, THEY WERE
DENIED U.S. CITIZENSHIP AND
SUBJECT TO FORCED REMOVAL.
THESE TREATIES WE ALL KNOW WERE
LARGELY VIOLATED BY WHITE SET
LERS.
AS A RESULT, INDIGENOUS PEOPLES
WERE CONFINED TO RESERVATIONS
WHICH WERE SUBPAR IN THEIR
CONDITIONS, MAKING TRADITIONAL
PRACTICES AROUND FARMING AND
RAISING LIFESTOCK DIFFICULT.
AS A RESULT, TRIBES BECAME
DEPENDENT ON THE BUREAU OF
INDIAN AFFAIRS, RESULTING IN
CONTINUED NEGLECT.
SO WHY THE HISTORY LESSON?
A LOT OF THIS IS STUFF THAT SOME
OF US KNOW BUT AREN'T ALWAYS TOP
OF MIND OR PRESENT IN OUR MINDS
WHEN WE THINK ABOUT ACTUALLY
WHAT RACE IS.
SO WHY THE HISTORY?
BECAUSE THIS IS ACTUALLY WHAT
RACE IS.
NOT GENETICS, AS STILL COMMONLY
REGARDED IN THE BIOMEDICAL
SCIENCES AND EVEN IN MUCH OF
EPIDEMIOLOGY.
AND THIS HISTORY SHEDS LATE ON
THE LIKELY PATHWAYS THROUGH
WHICH RACISM GETS INTO THE BODY.
SO THIS SLIDE SHOWS OUR CURRENT
RACIAL CATEGORIZATION IN THE
U.S. ESTABLISHED IN 19 1977 BY E
OFFICE OF MANAGEMENT AND BUDGET.
HERE I PROVIDE A FEW EXCERPTS
FROM THE FEDERAL REGISTER,
INDICATING THE INTENTIONS OF OUR
CURRENT RACIAL CATEGORIES.
SO AS YOU CAN SEE, CURRENT
RACIAL CATEGORIZATION IS A
DIRECT RESULT OF SOCIAL,
POLITICAL ACTIONS AND EFFORTS TO
MONITOR COMPLIANCE WITH CIVIL
RIGHTS LAWS.
THE DIRECTIVE STATES THAT RACIAL
CATEGORIES REPRESENT A
SOCIAL-POLITICAL CONSTRUCT AND
ARE NOT SCIENTIFICALLY BASED.
THEY WERE INTENDED FOR BROAD
PUBLIC ACCEPTANCE TO PRODUCE
COMPATIBLE NON-DUPLICATIVE
EXCHANGEABLE DATA, USEFUL FOR
STATISTICAL ANALYSIS AND PROGRAM
ADMINISTRATION.
SO THEN WHEN WE THINK ABOUT
HEALTH TRENDS BY RACE, IT'S NOT
SURPRISING WHAT WE SEE.
HERE WE'RE LOOKING AT LIFE
EXPECTANCY AT BIRTH BY RACE FROM
1900 TO 2015.
AND WE SEE IMPROVEMENT FOR ALL
GROUPS.
HOWEVER, WE ALSO SEE A STARK GAP
BETWEEN BLACKS AND WHITES
ALTHOUGH THAT GAP APPEARS TO BE
NARROWING OVER TIME.
NOW ZOOMING IN TO A SHORTER
PERIOD OF TIME FROM 2000 TO
2019, WE SEE BETTER THE
CONSTANCY OF RACIAL DISPARITIES
AND LIFE EXPECTANCY.
IT'S NOT THE CONTINUOUS
NARROWING THAT WE SAW IN THE
PREVIOUS SLIDE.
INSTEAD, THERE HAVE BEEN LENGTHY
PERIODS OF STAGNATION IN THE
RACIAL GAP.
THIS SLIDE SHOWS VARIOUS HEALTH
OUTCOMES.
SELF-REPORTED HEALTH STATUS,
HEALTH BEHAVIORS, CHRONIC
CONDITIONS, BIRTH OUTCOMES AND
MOREMENT AND HERE WE SEE ACROSS
THESE VARIOUS OUTCOMES, BLACKS
AND NATIVE AMERICANS DO WORSE.
NOW I KNOW THIS IS SMALL, BUT IT
JUST SHOWS A VARIETY OF HEALTH
OUTCOMES PRIMARILY CHRONIC
CONDITIONS.
AGAIN, IF YOU LOOK ACROSS THESE
OUTCOMES, YOU CAN SEE THAT
BLACKS REPRESENTED BY THE ORANGE
LINE AND INDIGENOUS PEOPLES
REPRESENTED BY THE PURPLE LINE
DO WORSE ACROSS MANY OF THESE
OUTCOMES.
AND MORE RECENTLY DURING
COVID-19, WE SAW THE GREATEST
LOSS IN LIFE EXPECTANCY AMONG
BLACKS AND NATIVE AMERICANS.
SO WHEN I WAS IN GRAD SCHOOL, I
WAS REALLY INTERESTED IN THE
QUESTION OF HOW DOES RACE GET
INTO THE BODY?
SO I WAS REALLY INTERESTED IN
UNDERSTANDING WHY IS IT THAT
BLACKS LIVE SICKER AND DIE
SOONER THAN OTHERS?
AND THIS WAS A PERIOD OF TIME
WHERE RACE WAS OFTEN USED AS A
CATCH-ALL PROXY VARIABLE AS ANY
NUMBER OF FACTORS THAT WERE
HYPOTHESIZED TO EXPLAIN RACIAL
DISPARITIES IN HEALTH.
HOWEVER, THIS QUESTION GIVEN
WHAT WE KNOW NOW HAS EVOLVED TO
NOT JUST HOW RACE BUT HOW DOES
RACISM GET INTO THE BODY.
SO THIS SLIDE SHOWS A COMMON
FRAMEWORK THAT WAS USED IN THE
90s AND EARLY 2000s TO HELP
GUIDE INVESTIGATORS INTERESTED
IN RACISM AS A STRESSOR AND IN
UNDERSTANDING THE
PSYCHOBIOLOGICAL PATHWAYS
THROUGH WHICH RACISM GETS INTO
THE BODY.
THIS IS ONE OF NANCY KRUEGER'S
EARLY PAPERS LOOKING AT RACIAL
DISCRIMINATION AND BLOOD
PRESSURE IN BLACK AND WHITE
ADULTS.
MANY OF YOU ARE FAMILIAR WITH
THIS.
THIS IS ONE OF THE FIRST PAPERS
TO SHOW WHAT IS NOW A MORE
COMMON COUNTERINTUITIVE FINDING,
THAT THOSE REPORTING NO RACIAL
DISCRIMINATION HAD HIGHER BLOOD
PRESSURE THAN THOSE REPORTING
HIGHER LEVELS OF RACIAL
DISCRIMINATION.
BASED ON CLARKE'S MODEL AND
OTHER WORK, CONCEPTUALIZING
RACISM AS A STRESSOR, KRUEGER
SHOWED DATA AND HYPOTHESIZED
THAT COPING STYLE MODERATED THE
ASSOCIATION.
AND INDEED, THEY FOUND THAT
THOSE REPORTING HIGH RACIAL
DISCRIMINATION BUT WHO ENGAGED
IN MORE ACTIVE COPING HAD LOWER
BLOOD PRESSURE THAN THOSE
REPORTING NO DISCRIMINATION BUT
WHO ENGAGE IN A MORE PASSIVE
COPING STYLE.
MUCH OF THE WORK AT THIS TIME
WAS FOCUSED ON INTERPERSONAL
DISCRIMINATION OR WHAT KAMARA
JONES CALLED PERSONALLY MEDIATED
RACISM, ESSENTIALLY RACIAL
DISCRIMINATION OCCURRING BETWEEN
INDIVIDUAL ACTORS OR AT THE
INDIVIDUAL LEVEL, AND PEOPLE
INTERESTED IN THE EMBODIMENT OF
RACISM OR, AGAIN, HOW RACISM
GETS INTO THE BODY.
SO THIS SLIDE SHOWS KRUEGER'S
EXPERIENCES OF DISCRIMINATION
SCALE.
ONE OF THE MOST COMMONLY USED
MEASURES OF PERSONALLY MEDIATED
RACISM IN PARTICULAR, IN THE
PUBLIC HEALTH LITERATURE.
AND AS YOU CAN SEE, THE MEASURE
ASKS BOTH ABOUT HOW ONE
TYPICALLY COPES WITH UNFAIR
TREATMENT AND ABOUT EXPERIENCES
OF RACIAL DISCRIMINATION.
IN THIS WAY, KRUEGER'S WORK WENT
BEYOND JUST CAPTURING THE
STIMULUS, IE, RACIAL DISCRIM NAI
AND CAPTURED ANOTHER ESSENTIAL
COMPONENT OF THE STRESS RESPONSE
PROCESS.
AND AS YOU CAN SEE, THE MEASURE
ASKS PRIMARILY ABOUT RACIAL
DISCRIMINATION OCCURRING WITHIN
SPECIFIC INSTITUTIONAL SETTINGS
OR DOMAINS SUCH AS THE
WORKPLACE, HOUSING, HEALTHCARE,
AND CRIMINAL JUSTICE.
THIS SLIDE SHOWS ANOTHER
COMMONLY USED MEASURE OF RACIAL
DISCRIMINATION IN THE PUBLIC
HEALTH LITERATURE, WILLIAMS
EVERY DAY DISCRIMINATION SCALE
WHICH SOMEONE MENTIONED
YESTERDAY.
THE EDS IS VIEWED AS A MEASURE
OF CHRONIC EVERYDAY EXPERIENCES
OR WHAT SOME HAVE CALLED MICRO
AGGRESSIONS OR IN THE CASE OF
RACISM, RACIAL MY GROW
AGGRESSIONS.
AGAIN, MUCH OF THIS EARLY WORK
BEING FOCUS FOCUSED ON PERSONAY
MEDIATED RACISM.
A LITTLE OVER 20 YEARS AGO,
KAMAR JONES' SEMINAL PEOPLE
PUSHED THE FIELD TO CONSIDER
RACISM OCCURRING AT MULTIPLE
LEVELS.
SHE ARTICULATED THREE LEVELS OF
RACISM: INTERNALIZED,
PERSONALLY MEDIATED AND
INSTITUTIONAL.
AND IN THIS PAPER, DR. JONES
ARGUED FOR ADDRESSING THE ROOT
CAUSE, WHICH SHE ARGUED WAS
INSTITUTIONAL RACISM, SUGGESTING
THAT ADDRESSING INSTITUTIONAL
RACISM WHICH AS YOU CAN SEE HERE
ALSO INCLUDES ASPECTS OF
STRUCTURAL RACISM, WOULD
NATURALLY ADDRESS OTHER FORMS OF
RACISM.
AS YOU CAN SEE, SHE ARGUES FOR
THIS KIND OF MUTUAL CONSTITUTION
BETWEEN STRUCTURAL BARRIERS,
SOCIETAL NORMS AND PERSONALLY
MEDIATED RACISM.
SO THIS IDEA OF ONE FORM OF
RACISM UPHOLDING AND REINFORCING
THE OTHER.
SINCE COVID-19, THE MURDER OF
GEORGE FLOYD AND SO MANY OTHERS
INCREASING ATTENTION HAS BEEN
PAID TO STRUCTURAL RACISM.
PRIOR TO THIS TIME, THE MAJORITY
OF WORK THAT WENT ABOVE THE
LEVEL OF THE INDIVIDUAL FOCUSED
ON INSTITUTIONAL AND SYSTEMIC
RACISM.
THAT IS, RACISM OCCURRING AT THE
SYSTEMIC LEVEL BUT WITHIN A
GIVEN SYSTEM.
PROMINENT EXAMPLES INCLUDE THE
EDUCATION SYSTEM AND THE
CRIMINAL LEGAL SYSTEM.
HOWEVER, RECENT CALLS HAVE
ARGUED FOR DEFINING,
CONCEPTUALIZING AND MEASURING
STRUCTURAL RACISM.
A COMMON DEFINITION IS THE ONE
SHOWN HERE FROM BAILEY ET AL.,
WHO DESCRIBES STRUCTURAL RACISM
IMPORTANTLY AS INVOLVING
INTERCONNECTED INSTITUTIONS
WHOSE LINKAGES ARE HISTORICALLY
ROOTED AND REINFORCED.
IT REFERS TO THE TOTALITY OF
WAYS IN WHICH SOCIETIES FOSTER
RACIAL DISCRIMINATION THROUGH
MUTUALLY REINFORCING INEQUITABLE
SYSTEMS THAT IN TURN REINFORCE
DISCRIMINATORY BELIEFS, VALUES
AND DISTRIBUTION OF RESOURCES.
A LESS COMMONLY DISCUSSED FORM
OF RACISM IS CULTURAL RACISM,
WHICH CAN BE UNDER AS THE VALUES
AND BELIEF SYSTEMS OF WHITE
SUPERIORITY THAT OPERATE AT THE
LEVEL OF OUR SHARED
CONSCIOUSNESS AND ARE EXPRESSED
IN THE LANGUAGE, SYMBOLS AND
MEDIA REPRESENTATIONS OF
DOMINANT SOCIETY.
IN THIS PAPER LED BY ONE OF MY
FORMER DOCTORAL STUDENTS, WE
DELINEATE THE MUTUAL
CONSTITUTION OF STRUCTURAL AND
CULTURAL RACISM WHICH UPHOLD
EACH OTHER AND CREATE CONDITIONS
FOR OTHER FORMS OF RACISM TO
FLOURISH, SUCH AS INTERNALIZED
AND PERSONALLY MEDIATED RACISM.
IT ALSO DESCRIBES HOW THIS
RESULTS IN A DIFFERENTIAL
DISTRIBUTION OF RESOURCES,
CALLED FLEXIBLE RESOURCES, IN
THEIR FUNDAMENTAL CAUSE CONCEPT
FRAMEWORK.
STRUCTURAL RACISM ALSO OPERATE
THROUGH PLACE-BASED RESOURCE
DEPRIVATION OR PLACE-BASED
HAZARDS THAT CREATE WHAT
SOCIOLOGIST TRISHA ROSE CALLS
THE DISACCUMULATION OF RESOURCES
AND THE HYPERACCUMULATION OF
RISK.
AND WE SEE THAT THESE MORE
UPSTREAM AND ROOT OR FUNDAMENTAL
FORMS OF RACISM CAN RESULT IN
COGNITIVE, AFFECTIVE, BEHAVIORAL
AND BIOLOGIC INTERMEDIARIES THAT
DETERMINE HEALTH INEQUITIES, AND
THEN THIS OCCURS ACROSS THE LIFE
COURSE AND MANIFESTS IN
DIFFERENT WAYS ACROSS MANY
DIFFERENT INTERSECTIONAL
IDENTITIES.
SO WITH THAT, I'LL JUST END WITH
A FEW RECOMMENDATIONS.
FOR MOVING
FORWARD IN THIS FIELD.
ONE IS TO CONCEPTUALIZE THE
PROBLEM WITHIN THE CONTEXT OF
RACISM AS A MULTIDIMENSIONAL
CONSTRUCT.
SECOND IS IDENTIFYING MEASURES
THAT ARE APPROPRIATE FOR THE
TYPE OF RACISM BEING MEASURED.
THAT WE SHOULD BE CONSIDERING
HETEROGENEOUS TREATMENT EFFECTS,
SO THINKING ABOUT THE WAYS IN
WHICH THE ASSOCIATION VARIES
ACROSS VARIOUS SOCIODEMOGRAPHIC
FACTORS, GEOGRAPHY, ET CETERA,
AND CONSIDERING THE MEASUREMENT
OF BOTH STRUCTURAL AND CULTURAL
RACISM AND THAT IMPORTANTLY, IF
WE ARE MEASURING STRUCTURAL
RACISM, WE MUST BE INCLUDING HOW
RACISM OPERATE ACROSS SYSTEMS.
WITH THAT, I'LL END.
THANK YOU.
[APPLAUSE]
>> GOOD MORNING, EVERYONE.
SO I ACTUALLY JUST WANT TO START
OFF WITH A QUICK DISCLAIMER.
MY BACKGROUND IS NOT IN DIABETES
AND DIGESTIVE AND KIDNEY
DISEASES.
I'M A SOCIAL EPIDEMIOLOGIST.
SO IT'S THE SOCIAL EPIDEMIOLOGIC
LENS THAT I USE WHEN I LOOK AT
HOW BROAD SOCIAL FORCES SHAPE
WHAT WE CALL THE UNEVEN
POPULATION-LEVEL DISTRIBUTION OF
DISEASE.
OTHERWISE KNOWN AS HEALTH
INEQUITY.
I KNOW THAT'S A VERY WORDY
PHRASE, RIGHT?
POPULATION-11 DISTRIBUTION OF-LF
DISEASE.
BUT WE KNOW THAT HEALTH IS NOT
DISTRIBUTED EVENLY IN A
POPULATION, THIS IS NOT BREAKING
NEWS, IT'S NOT A NEW
OBSERVATION.
THIS IS A QUOTE BY RUDOLPH
VIRCHOW, COMMONLY CONSIDERED TO
BE ONE OF THE FOUNDERS OF THE
FIELD OF SOCIAL MEDICINE.
HE SAYS THAT MEDICAL STATISTICS
WILL BE OUR STANDARD OF
MEASUREMENT.
WE WILL WEIGH LIFE FOR LIFE AND
SEE WHERE THE DEAD LIE THICKER,
AMONG THE WORKERS OR AMONG THE
PRIVILEGED.
AND SO ONE THING THAT I
APPRECIATE ABOUT THIS QUOTE IS
THIS REFERENCE TO THE SOCIAL
DETERMINANTS OF HEALTH, RIGHT?
ISSUES OF CLASS.
THE PRIVILEGED AND THE WORKER.
THERE'S ANOTHER SENTIMENT IN
THIS QUOTE THAT I LIKE, AND THAT
IS THE SENTIMENT OF EQUALITY,
THAT WE WILL WEIGH LIFE FOR
LIFE.
AT THE TIME MAYBE THIS WAS KIND
OF LIKE REVOLUTIONARY THINKING
TO SAY THAT THE WORKER'S LIFE
SHOULD BE WEIGHED THE SAME AS
THE PRIVILEGED PERSON'S LIFE,
RIGHT, BUT THIS IS STILL VERY
RELEVANT TODAY.
TODAY IT WOULD BE AKIN TO SAYING
SOMETHING LIKE BLACK LIVES
MATTER.
SO WHERE DO THE DEAD LIE
THICKER?
THIS IS A MAP SHOWING THE
DISTRIBUTION OF LIFE EXPECTANCY
IN THE U.S.
WE SEE THAT STATE IN THE DEEP
SOUTH ARE NOT VERY HEALTHY AT
ALL.
I'M CURRENTLY LIVING IN
LOUISIANA.
BEFORE THAT, I WAS LIVING IN
AUBURN, ALABAMA.
AND 'BA ALABAMA LAGS BEHIND OVEL
U.S. LIFE EXPECTANCY BY SEVERAL
YEARS.
WITHIN THE STATE OF ALABAMA, WE
ALSO SEE LARGE DIFFERENCES IN
HEALTH.
AUBURN UNIVERSITY IS LOCATED IN
LEE COUNTY.
YOU CAN GUESS WHOM THE COUNTY IS
NAMED AFTER.
I'LL GIVE YOU A HINT, IT'S NOT A
KOREAN GUY.
BUT LIFE EXPECTANCY, YOU KNOW
EXCEEDS THAT.
WOULDN'T IT BE SOMETHING,
THOUGH, IF IT WERE?
LIFE EXPECTANCY IN LEE COUNTY
EXCEEDS THAT OF THE STATE BY
ABOUT 3 1/2 YEARS BUT NOTABLY
IT'S STILL LESS THAN THE OVERALL
U.S. AVERAGE.
HOWEVER, LOOK AT MACON COUNTY,
RIGHT NEXT DOOR TO LEE COUNTY,
AND IT HAS AN AVERAGE LIFE
EXPECTANCY THAT'S MORE THAN FIVE
YEARS SHORTER.
AGAIN, THESE ARE NEIGHBORING
COUNTIES.
SOME OF YOU MAY NOT HAVE HEARD
OF MACON COUNTY, ALABAMA, BUT
I'M SURE ALL OF YOU HAVE HEARD
OF TUSKEGEE, WHICH IS THE MOST
INFAMOUS PUBLIC HEALTH
EXPERIMENT IN U.S. HISTORY.
TUS KTUSKEGEE IS THE COUNTY SEAF
MACON.
SO ACTUALLY HERE I WANT TO PAUSE
AND THANK DR. NURU-JETER FOR
GIVING US AN OVERVIEW OF THE
HISTORY OF RACE AND RACISM, AND
THE IMPORTANCE OF UNDERSTANDING
HISTORY IF WE ARE TO UNDERSTAND
CONTEMPORARY RACIAL INEQUITIES
IN HEALTH.
SO MACON COUNTY IS A HIGHLY
RURAL COUNTY THAT IS OVER 80%
BLACK.
LEE COUNTY, IN CONTRAST, IS MORE
THAN 70% WHITE, AND RURAL BLACK
COUNTIES LIKE MACON COUNTY
SUFFER FROM WORSE HEALTH OUT
KOMS.
OUTCOMES.
THE HEALTH INEQUITIES IN MACON
COUNTY ARE REALLY INEXCUSABLE.
THIS IS AN ARTICLE IN "U.S.A.
TODAY" THAT HIGHLIGHTED SOME OF
THE WORK THAT WE DID WHEN
LOOKING AT SOME OF THE
STRUCTURAL CHALLENGES THAT THE
RESIDENTS OF MACON COUNTY
CONTINUE TO FACE.
THIS IS 50 YEARS AFTER THE
TERMINATION OF THE TUSKEGEE
SYPHILIS STUDY.
SO THIS ISN'T JUST A PUBLIC
HEALTH ISSUE BUT IT'S ALSO A
SOCIAL JUSTICE ISSUE.
I THINK THIS ALSO HIGHLIGHTS
VERY IMPORTANT ISSUES OF AGENCY
AND ACCOUNTABILITY AND WHO IS
RESPONSIBLE.
I THINK THESE ARE ALSO TOPICS WE
NEED TO THINK ABOUT WHEN WE'RE
TALKING ABOUT RACIAL INEQUITIES
IN HEALTH.
SO IN THIS ARTICLE, IN ADDITION
TO TALKING ABOUT SOME OF THE
CONTINUING STRUCTURAL BARRIERS
TO HEALTH IN MACON COUNTY, YOU
ALSO ACTUALLY TALK ABOUT SOURCES
OF STRENGTH AND RESILIENCE IN
THE COMMUNITY.
I THINK THIS COUNTERS THE
DOMINANT PUBLIC HEALTH NARRATIVE
AROUND VULNERABILITY AND
RESILIENCE, AND THIS IS A PIECE
THAT WE PUBLISHED IN AJPH.
AND RATHER THAN SUGGESTING --
RATHER THAN LABELING COMMUNITY
AS VULNERABLE, WE SUGGEST WE
SPECIFY WHAT COUNTIES WE'RE
VULNERABLE TO.
SO FOR EXAMPLE, IS THIS
COMMUNITY VULNERABLE TO
COERCION, IS THIS COMMUNITY
VULNERABLE TO HOMOPHOBIA, OR TO
RACISM.
AND INSTEAD, RATHER THAN
APPEALING TO PEOPLE TO BE,
QUOTE-UNQUOTE, RESILIENT, WE
SHOULD BE TALKING INSTEAD ABOUT
HOW TO BUILD RESILIENT
STRUCTURES AND SYSTEMS.
BUILDING RESILIENT STRUCTURES
AND SYSTEMS INCLUDES BUILDING
RESILIENT NEIGHBORHOODS, AND SO
LIKE WHAT MAKES AN AREA HEALTHY,
WHAT MAKES A NEIGHBORHOOD OR AN
AREA UNHEALTHY.
AND ONE PARTICULAR
CHARACTERISTIC OF THE SOCIAL
ENVIRONMENT THAT I LOOK AT IS
RACISM, SO HOW RACIST A
PARTICULAR AREA ALSO IMPACTS OUR
HEALTH, BUT HOW CAN WE QUANTIFY
THIS?
SO ONE APPROACH TO THAT, LOOK AT
THE GOOGLE SEARCH FOR THE "N"
WORD, SO BASICALLY IT'S A
PORTION OF GOOGLE SEARCHES
CONTAINING THE "N" WORD IN A
PARTICULAR GEOGRAPHIC AREA.
HERE IS THE DESIGNATED MARKET
AREA LEVEL.
SO WE USE THIS AS A PROXY FOR
MEASURING RACISM AT THE AREA
LEVEL.
THIS IS A MAP SHOWING
DISTRIBUTION OF THAT, WE SEE IT
NOT DISTRIBUTED EVENLY IN THE
POPULATION.
WEST VIRGINIA WAS THE STATE WITH
THE HIGHEST SEARCH CONCENTRATION
FOR THE "N" WORD.
AND IN MULTIVARIABLE REGRESSION
MODELS, WE FOUND EACH STANDARD
DEAF YAITION INCREASE IN THIS
GOOGLE QE QUERY IS ASSOCIATED WH
AN 8.2% GREATER BLACK MORTALITY
RATE, EQUIVALENT TO AN EXCESS OF
30,000 BLACK DEATHS ANNUALLY.
YOU CAN SEE THIS RELATIONSHIP
PERSISTED AFTER CONTROLLING FOR
A NUMBER OF OTHER AREA LEVEL
FACTORS.
WE ALSO LOOKED AT BIRTH OUTCOMES
WHICH HAD BEEN SHOWN TO BE
SENSITIVE TO STRESS, AND WE
FOUND SIGNIFICANT ASSOCIATIONS
WITH BOTH PRETERM BIRTH AND LOW
BIRTH WEIGHT AMONG BLACK
MOTHERS.
SO RACIAL INEQUITIES IN HEALTH
ARE DRIVEN BY RACISM, NOT RACE.
RACE IS A SOCIAL CONSTRUCT, IT'S
BIOLOGICALLY MEANINGLESS AND
ONLY GIVEN MEANING BECAUSE OF
RACISM, AND THIS IS ONE
DEFINITION OF RACE THAT MICHAEL
OMI -- WHICH I APPRECIATE A LOT.
SO WHEN TRYING TO UNDERSTAND
RACIAL -- YOU SHOULD UNDERSTAND
HOW RACISM GETS UNDER THE SKIN.
THIS INCLUDES THINGS LIKE
EXPERIENCES IN RACIAL
DISCRIMINATION.
SO RACIAL DISCRIMINATION CAN
IMPACT A MYRIAD OF HEALTH
OUTCOMES BY ENGAGING BIOLOGICAL
SYSTEMS INVOLVING THE STRESS
RESPONSE AND THE EXPERIENCE OF
DISCRIMINATION AND OTHER
STRESSORS TIED TO RACISM ACROSS
THE LIFE COURSE CONTRIBUTES TO
WEATHERING OR ACCELERATED
DECLINES IN HEALTH.
ONE PARTICULAR BIOMARKER THAT I
CONSIDERED IN MY WORK IS
TELOMERE LENGTH.
IT'S CONSIDERED TO BE AN
INDICATOR OF BIOLOGIC OR CELL
AGING AND A CUMULATIVE MARK OF
WEAR AND TEAR ACROSS THE LIFE
COURSE.
IN OUR FIRST STUDY, THIS WAS A
SMALL CROSS-SECTIONAL STUDY OF
95 BLACK MEN, WE DID THIS ABOUT
10 YEARS AGO, WE FOUND THAT
BLACK MEN WHO REPORTED HIGH
LEVELS OF RACIAL DISCRIMINATION
AND WHO DISPLAYED AN IMPLICIT
ANTI-BLACK BIAS OR BIAS AGAINST
THEIR OWN RACIAL GROUP SHOWED
SIGNS OF ACCELERATED AGING.
THIS RESEARCH WAS THE CATALYST
FOR ADDITIONAL RESEARCH ON THE
TELOMERE MAINTENANCE SYSTEM AS A
PATHWAY THROUGH WHICH RACISM --
THESE ARE FINDINGS FROM A MORE
RECENT STUDY THAT WE PUBLISHED
FINDING REPORTS OF RACIAL
DISCRIMINATION WERE ASSOCIATED
WITH A FASTER RATE OF SHORTENING
OVER A 10 YEAR PERIOD OF TIME.
THAT LEAD TO ACCELERATED AGING
VIA WEAR AND TEAR OF THE
TELOMERE AGING SYSTEM.
ONE PARTICULAR DISEASE I STUDY
IS SYSTEMIC LUP LUPUS, ACTIVATEY
SOCIAL STRESSORS, CHARACTERIZE
BID MAJOR INEQUITIES IN
PREVALENCE AND INCIDENCE AS WELL
AS IN PROGRESSION AND SEVERITY
ALONG RACIAL AND GENDER LINES
WITH BLACK WOMEN IN PARTICULAR
BEING THE MOST AFFECTED.
MOREOVER, HERE AGAIN I WANT TO
POINT OUT THAT THERE'S NO
COMPELLING BIOLOGICAL REASON WHY
BLACK WOMEN WITH LUPUS SHOULD
EXPERIENCE WORSE DISEASE
OUTCOMES COMPARED TO THEIR WHITE
COUNTERPARTS.
SO IN THIS SENSE, EVEN THOUGH
LUPUS IS UNIQUE IN SEVERAL WAYS,
EPIDEMIOLOGY IS REALLY NOT THAT
SURPRISING.
BLACK AMERICANS WITH THE SAME
DISEASES AS WHITES, WHETHER IT
HEART DISEASE OR DIABETES,
CANCER, HIV, COVID, BLACK
AMERICANS WITH THE SAME DISEASES
AS WHITES EXPERIENCE WORSE
OUTCOMES, AND THESE HEALTH
INEQUITIES ARE SOCIALLY NOT
BIOLOGICALLY ROOTED.
SO IN 2015, MY COLLEAGUE AND I
INITIATED THE BLACK WOMEN'S
EXPERIENCES LIVING WITH LUPUS
STUDY.
THE BEWELL STUDY IS PROBABLY THE
LARGEST STUDY TO FOCUS ON THE
SOCIAL EPIDEMIOLOGY OF LUPUS.
WE RECRUITED A TOTAL OF 438
BLACK WOMEN, AND THIS IS A
SAMPLE SIZE LIKE UNHEARD OF IN
MUCH OF LUPUS RESEARCH OUTSIDE
OF PHARMACEUTICAL STUDIES.
WE FOUND THAT RACIAL
DISCRIMINATION CAN UNDERMINE
HEALTH.
IN THIS PARTICULAR STUDY, WE
FOUND IT SIGNIFICANTLY
ASSOCIATED WITH ORGAN DAMAGE AS
WELL AS DISEASE ACTIVITY.
WE'VE ALSO LOOKED AT LESS
STUDIED FACETS OF RACISM, THIS
INCLUDES VICARIOUS RACISM.
VICARIOUS RACISM INVOLVES
HEARING ABOUT OR SEEING ACTS OF
RACISM COMMITTED AGAINST OTHER
MEMBERS OF ONE'S RACIAL GROUP.
AND VICARIOUS RACISM IS A UNIQUE
EXPERIENCE OF THREAT IN THAT
IT'S NOT NECESSARILY TIED TO THE
INDIVIDUAL BUT RATHER THE RACIAL
GROUP TO WHICH THE INDIVIDUAL
BELONGS.
WE ALSO LOOKED AT ANTICIPATORY
RACISM THREAT.
THIS IS A CONCEPT THAT MY
COLLEAGUE DR. NURU-JETER HAS
ELABORATED ON AND DONE A LOT OF
WORK CONCEPTUALIZING AND
MEASURING IT.
ANTICIPATORY RACISM INVOLVES
EFFORTS TO BRACE ONE'S SELF OR
PREPARE ONE'S SELF FOR BEING THE
TARGET OF RACISM.
AND IN OUR RESEARCH, WE FOUND
THAT BOTH VICARIOUS RACISM AND
ANTICIPATORY RACISM STRESS MAY
RESULT IN HEIGHTENED DISEASE
ACTIVITY.
SO THESE FINDINGS SUGGEST THAT
RACISM COMMITTED AGAINST ONE'S
RACIAL GROUP CAN HAVE SPILLOVER
EFFECTS EVEN TO THOSE WHO ARE
NOT THE IMMEDIATE TARGETS.
EXPERIENCES OF RACISM CAN ALSO
BE HEIGHTENED VIGILANCE AND JUST
THE ANTICIPATION THAT ONE WILL
BE THE TARGET OF RACISM CAN HAVE
NEGATIVE CONSEQUENCES.
THIS IS REGARDLESS OF WHETHER OR
NOT ONE IS ACTUALLY VICTIMIZED.
WE'VE ALSO LOOKED AT C REACTIVE
PROTEIN.
AGAIN THIS IS USING THE BEWELL
DATA.
THAT IS FROM A RECENT PAPER
WRITTEN BY MY FORMER DOC STUDENT
LOOKING AT INCIDENT REPORTS OF
RACIAL DISCRIMINATION OVER A
TWO-YEAR PERIOD.
SO WHAT HE FOUND WAS THAT NEW
REPORTS OF RACIAL DISCRIMINATION
WERE ASSOCIATED WITH INCREASES
IN CRP ACROSS THIS TWO-YEAR TIME
PERIOD.
ISO WHAT HAVE WE LEARNED?
WE KNOW THAT RACISM, IN ADDITION
TO BEING A SOCIAL AND MORAL
CRISIS, IS ALSO A FUNDAMENTAL
CAUSE OF RACIAL INEQUITIES IN
HEALTH.
WE KNOW THAT RACISM SHAPES OTHER
SOCIAL DETERMINANTS OF HEALTH,
AND WE KNOW THAT RACISM ALSO
GENERATES BIOLOGICAL
VULNERABILITY.
THERE'S' LOT MORE THAT WE DON'T
KNOW, MANY UNANSWERED QUESTIONS.
THERE ARE MAJOR GAPS IN
KNOWLEDGE ON HOW WE CAN
INTERVENE THE SOCIAL
DETERMINANTS OF HEALTH AND HOW
WE CAN CREATE RESILIENT SOCIAL
CONTEXTS.
SO IN CONCLUSION, I THINK WE'VE
DONE -- YOU KNOW, WE'VE DONE
GOOD WORK ON DOCUMENTING AND
EXPLAINING, DESCRIBING THE
PROBLEM.
I THINK AS THE FIELD OF PUBLIC
HEALTH DOES A GOOD JOB AT SAYING
WHAT'S WRONG, BUT NOW I THINK IS
A GOOD TIME TO MOVE TO ACTION,
AND I THINK THAT'S THE NEXT
GENERATION OF RESEARCH THAT WE
NEED TO HEAD TOWARD.
SO WE SHOULD BE THINKING ABOUT
DEVELOPING AND IMPLEMENTING
ANTI-RACIST POLICIES AND
PRACTICES AND INTERVENTIONS NOT
ONLY BECAUSE IT'S GOOD PUBLIC
HEALTH BUT ALSO BECAUSE GOING
BACK TO TUSKEGEE, IT'S THE MORAL
IMPERATIVE, THE RIGHT THING TO
DO.
THANKS.
[APPLAUSE]
>> IT FEELS SO INEFFECTUAL, YOU
CAN'T CONTROL ANY -- FOR
SOMEBODY ELSE.
ENABLE -- ENABLE THE MACROS.
GREAT.
AS SORT OF A PERFECT TRANSITION,
DAVID, A LOT OF WHAT I WANT TO
TALK ABOUT IS VIGILANCE.
AND I'M NOT GOING TO SHOW YOU
ANY DATA.
I'M GOING TO BE TALKING ABOUT
IDEAS.
AND I'M NOT SOMEONE WHO WORKS IN
KIDNEY DISEASE OR DIABETES, I'M
A DEVELOPMENTAL HEALTH
PSYCHOLOGIST.
A LOT OF WHAT I'M GOING TO BE
TALKING ABOUT IS BASED ON THIS
PAPER WHICH FOCUSES ON LGBTQ
POPULATIONS OR SEXUALLY DIVERSE
AND GENDER DIVERSE POPULATIONS,
YOU GO IN MY SORT OF EMPHASIS ON
SOCIAL SAFETY, I REALLY THINK
THIS IS SOMETHING THAT IS TRULY
INTERSECTIONAL AND THAT SOME OF
THE MECHANISMS I'M TALKING ABOUT
ARE REALLY NOT SPECIFIC TO QUEER
PEOPLE OR TRANS PEOPLE, THEY'RE
REALLY ABOUT SOCIAL
MARGINALIZATION AND I ALSO TAKE
SORT OF AN EVOLUTIONARY
PERSPECTIVE IN TERMS OF HOW OUR
HUMAN BRAIN IS PREPARED FOR
THESE THINGS.
WE'VE TALKED ALREADY ABOUT THE
SORT OF STRESS-BASED MODELS OF
THE EFFECTS OF MARGINALIZATION
AND DISCRIMINATION, WHETHER IT'S
INTERPERSONAL DISCRIMINATION,
WHETHER IT'S STRUCTURAL, AND IN
THE FIELD OF SORT OF HEALTH
DISPARITIES WITH QUEER AND TRANS
AND LGBTQ POPULATIONS, THAT BODY
OF RESEARCH IS REALLY KIND OF
THOUGHT ABOUT AS MINORITY STRESS
THRTHEORY, WHICH IS MEYER'S SORF
LANDMARK WORK IN THE EARLY
2,000s THAT WAS SORT OF TAKING
THE SAME APPROACH TO LGBTQ
POPULATIONS THAT THE EVERYDAY
DISCRIMINATION SCALE TOOK.
IN OTHER WORDS, YOU SORT OF ASK
INDIVIDUALS ABOUT THEIR EXPOSURE
TO STIGMA-RELATED STRESSORS.
THINGS LIKE BEING TREATED
DIFFERENTLY, BEING VICTIMIZED,
HARASSMENT, THREATS, ALL THESE
SORTS OF THINGS.
AND IF YOU LOOK AT THE
MEASUREMENT OF THESE SORTS OF
EXPERIENCES BOTH WITH REGARD TO
RACE AND WITH REGARD TO GENDER
AND SEXUAL IDENTITY, THERE'S A
LOT OF VARIATION IN THE ITEMS
THAT ARE USED, IN THE TIME
SCALES THAT ARE LOOKED AT, IS IT
LIFETIME, IS IT THE PAST MONTH,
IS IT THE PAST YEAR, ET CETERA,
ET CETERA, ET CETERA.
THE OVERALL MODEL, THOUGH, SORT
OF SUGGESTS THAT IT A PILEUP
EFFECT, THAT ALLOSTATIC LOAD IS
THIS CONCEPT OF MULTISYSTEM SORT
OF WEAR AND TEAR ON STRESS
RESPONSE SYSTEMS.
THIS IS SORT OF ONE WAY TO SORT
OF THINK ABOUT HOW THAT MODEL
WORKS, IS THAT WE'RE ALL JUST
MOVING THROUGH OUR LIVES AND
THEN A STRESSOR HITS US AND WE
REACT TO IT, WE ADAPT TO IT IN
THE MOMENT AND THEN WE RETURN
BACK DOWN TO BASELINE AND THAT
ADAPTATION PUSHES US OFF OF
HOMEOSTASIS AND IT TAKES A TOLL.
SO FROM THIS PERSPECTIVE, WHAT'S
DIFFERENT ABOUT THE LIFE OF A
MARGINALIZED INDIVIDUAL IS THAT
THEY'VE GOT MORE OF THESE EVENTS
AND, THEREFORE, THEY HAVE TO
ADAPT MORE FREQUENTLY AND IT
TAKES MORE BIOLOGICAL AND
COGNITIVE EFFORT, AND WE SORT OF
MEASURE THAT BY KIND OF ASKING
THEM ABOUT THEIR STRESS
EXPOSURE, KIND OF COUNTING UP
HOW MANY, OF WHAT TYPE AND HOW
BIG THEY WERE, AND THAT'S AN
INDEX OF HOW MUCH THEY WERE
PULLED OFF OF THEIR BASELINE.
NOW THERE ARE A LOT OF THINGS
THAT WE KIND OF GOTTEN RIGHT
ABOUT THIS MODEL OVER THE YEARS.
WE HAVE DONE A FANTASTIC JOB,
YOU KNOW, OVER THE PAST 20, 30
YEARS IN MODELING THE
PSYCHOBIOLOGY OF THE STRESS
RESPONSE AT AN AUTONOMIC LEVEL,
NEUROENDOCRINE LEVEL, NEUROI
NEUROIMMUNE LEVEL.
WE ALSO HAVE GOTTEN REALLY GOOD
AT ASKING ABOUT DIFFERENT TYPES
OF STRESS EXPOSURE FROM
DIFFERENT REASONS, LIKE THE
EVERYDAY DISCRIMINATION SCALE
ASKS YOU, WHY DO YOU THINK THESE
FORMS OF DISCRIMINATION
OCCURRED?
AND CERTAINLY WITHIN THE LGBTQ
POPULATION, THERE'S BEEN A LOT
OF WORK AT DIFFERENTIATING
BETWEEN THE TYPES OF STRESSORS
THAT FACE GENDER DIVERSE
INDIVIDUALS AND THOSE THAT FACE
QUEER PEOPLE.
NONETHELESS, THERE HAVE BEEN
SOME PRETTY BIG INCONSISTENCIES
IN THIS LITERATURE, SPECIFICALLY
THAT ALTHOUGH AT A GROUP LEVEL,
INDIVIDUALS WITH MORE STRESS
EXPOSURE HAVE MORE HEALTH
DISPARITIES, AT AN INDIVIDUAL
LEVEL, WHEN YOU LOOK AT
INDIVIDUAL EXPOSURES TO MINORITY
STRESS EVENTS AND HEALTH
OUTCOMES, YOU BASICALLY FIND
THAT LIKE 50% OF THE TIME, YOU
DON'T FIND AN EFFECT.
YOU ALSO FIND THAT'S TRUE IN
EXPERIMENTAL STUDIES OF STRESS,
WHICH I'VE DONE A MILLION OF IN
MY LAB THAT CORTISOL LEVELS
DON'T CORRELATE VERY WELL WITH
PEOPLE'S SUBJECTIVE REACTIVITY.
SO AT THE BROADER LEVEL, THE
ASSOCIATION MAKES SENSE.
AT THE INDIVIDUAL LEVEL, IT
BREAKS DOWN.
AND I SPEND A LOT OF TIME KIND
OF LIKE AGONIZING ABOUT THIS
OVER THE PANDEMIC WHEN I HAD A
LOT OF TIME, AND ONE OF THE
THINGS THAT I REALLY REALIZED
WAS THE DEGREE TO WHICH WE HAVE
FAILED TO EVEN THINK OR TALK
ABOUT THIS HYPOTHESIZED BASELINE
OF CALM, WHICH IS SUPPOSED TO BE
WHAT WE'RE BEING SORT OF PUSHED
OFF.
AND THEN I DISCOVERED A PAPER
THAT CHANGED MY LIFE, THE
GENERALIZED UNSAFETY THEORY OF
STRESS BY JOS BROSSCHOT AND
COLLEAGUES.
THEY WERE NOTICING THE SAME
INCONSISTENCIES AND LINKS
BETWEEN STRESS AND HEALTH THAT
HAVE BEEN NOTED IN MARGINALIZED
POPULATIONS BUT WHAT THEY DO IS
SORT OF LOOK AT IT BOTH FROM A
NEUROBIOLOGICAL PERSPECTIVE AND
AN EVOLUTIONARY PERSPECTIVE AND
THEY ARGUE THAT WE GOT THE
BASELINE WRONG.
THE IDEA OF A CALM BASELINE
STATE IS ACTUALLY INCONSISTENT
WITH WHAT WE KNOW ABOUT STRESS
ACTIVATION IN THE BRAIN, THAT
REALLY, STRESS RESPONSES ARE
INHIBITORY.
WE START OUT VIGILANT AND THEN,
YOU KNOW, ONCE WE PERCEIVE
SAFETY, WE SORT OF KIND OF
DOWNREGULATE STRESS AND SO THEY
REALLY ARGUE THAT THE PROBLEM
WITH CHRONIC STRESS IS NOT
CHRONIC EXPOSURE TO STRESSORS.
IT'S CHRONIC EXPOSURE TO A LACK
OF PERCEIVED SAFETY.
THAT WE ARE READY FOR DANGER
FROM THE BEGINNING, AND THIS IS
A PART OF OUR ANCESTRAL
HERITAGE, AND I THINK IN OUR
MODERN CONTEXT, WE KIND OF
FORGET WHAT OUR BRAINS EVOLVED
FOR MANY, MANY -- YOU KNOW,
THOUSANDS OF YEARS AGO, AND WHAT
WE EVOLVED FOR WAS CONSTANT
THREAT.
CONSTANT THREAT AND CONSTANT
DANGER.
AND ONE OF THE THINGS THAT THEY
MENTION IN THEIR MODEL IS, YOU
KNOW, IN THOSE DAYS, IN THE
PLEISTOCENE ERA, IT WAS BETTER
TO DO IT TWICE TOO OFTEN INSTEAD
OF ONCE TOO FEW.
SO OUR DEFAULT KIND OF COGNITIVE
STATE IS VIGILANCE, SO WE START
OFF PREPARING FOR STRESS BEFORE
IT EVEN HAPPENS.
AND YET THAT PREPARATION, IT'S
ONLY RECENTLY THAT WE WERE LIKE,
WOW, ANTICIPATORY RACISM, ANTIPA
TRI THREAT.
OUR WHOLES LIVES ARE
ANTICIPATORY.
SO THIS HAS NEVER REALLY BEEN AN
ACCURATE DEPICTION OF A LIFE OF
A MARGINALIZED PERSON.
IT'S REALLY MORE LIKE THAT.
AND SO WHETHER YOU HAVE A LOT OF
EXPOSURE TO DISCRIMINATORY
EVENTS OR RELATIVELY FUEL, THAT
VIGILANCE IN BETWEEN THE EVENTS
IS WHAT'S GOING TO DRIVE MORE OF
YOUR DAY TO DAY FUNCTIONING.
AND AT LEAST IN THE FIELD OF
SORT OF STIGMA EXPOSURE, WE'VE
AGONIZED FOR YEARS OF HOW TO
MEASURE THOSE STRESS EVENTS,
WHAT'S A MICRO AGGRESSION,
WHAT'S A MACRO AGGRESSION.
AND YET WE HAVE SORT OF IGNORED
THE THOUSANDS OF MINUTES AND
HOURS AND DAYS THAT TRANSPIRE
BETWEEN THOSE STRESSORS THAT ARE
CHARACTERIZED BY KIND OF CHRONIC
HYPERVIGILANCE.
WHICH WE NOW KNOW HAS A WHOLE
HOST OF HEALTH EFFECTS THAT ARE
INDEPENDENT OF STRESS
REACTIVITY, INCLUDING EMOTION
DYSREGULATION, PROBLEMS WITH
ATTENTION, AND COGNITION AND
RUMINATION.
A GREAT WAY TO MANAGE YOUR
HYPERVIGILANCE IS TO CHECK YOUR
PHONE 10,000 TIMES A DAY AND SO,
YOU KNOW, WE'VE CREATED
STRUCTURES THAT KIND OF FOSTER
HYPERVIGILANCE.
SLEEP DYSREGULATION IS A BIG
ONE, AND NOW THERE'S A LOT MORE
DATA SHOWING THE NEGATIVE
EFFECTS OF SLEEP DEPRIVATION AND
SLEEP DISRUPTION ON MULTIPLE
ASPECTS OF HEALTH.
ISOLATION, A GREAT WAY TO HANDLE
SOCIAL VIGILANCE IS TO JUST GO
OFF AND HIDE OFF BY YOURSELF,
AND SINCE THE PANDEMIC, WE NOW
KNOW THAT THAT IS NOT SUCH A
GREAT COPING STRATEGY EITHER.
SELF-SOOTHING.
SUBSTANCE USE IS A GREAT
STRATEGY FOR REDUCING YOUR
HYPERVIGILANCE.
AND CHRONIC INFLAMMATION.
WE NOW KNOW THAT VIGILANCE AND
PER SERVETIVE COGNITION AND
RUMINATION ARE ASSOCIATED WITH
HIGHER LEVELS OF SYSTEMIC
INFLAMMATION.
SO INDEPENDENT OF STRESS
EXPOSURE, CHRONIC VIGILANCE IS
HAVING AN EFFECT ON OUR HEALTH
THAT WE HAVEN'T DONE A LOT OF
WORK ON SORT OF LOOKING AT.
NOW WHAT BRINGS IT DOWN?
HERE'S THE GOOD NEWS.
IT PRETTY SIMPLE IN THE HUMAN
NERVOUS SYSTEM.
IT'S OTHER PEOPLE.
WE ARE A FUNDAMENTALLY SOCIAL
SPECIES, AND ALTHOUGH WE LIKE TO
THINK ABOUT OURSELVES AS
INDEPENDENT, WE'RE REALLY NOT.
AND THE OTHER PAPER THAT DURING
THE PANDEMIC JUST TURNED MY
BRAIN INSIDE OUT WAS GEORGE
SLAVICH'S PAPER ON SOCIAL SAFETY
THEORY.
HE DEFINES SOCIAL SAFETY AS
UNCONDITIONAL SOCIAL CONNECTION,
PROTECTION, AND BELONGING.
AND IN THIS PAPER, HE OUTLINES
THIS REALLY COMPELLING MODEL
THAT GIVEN HOW HUMANS ARE A
SOCIAL SPECIES, WHEN WE DO NOT
PERCEIVE THAT THE PEOPLE IN OUR
PROXIMAL ENVIRONMENT ARE THERE
FOR US, TREAT US AS HUMAN, ARE
THERE TO HELP US, OUR BRAIN
REGISTERS THREAT.
SO THE ABSENCE OF SAFETY IS JUST
AS CONSEQUENTIAL FOR OUR NERVOUS
SYSTEM FUNCTIONING AND IMMUNE
FUNCTIONING AS A PRESENCE OF
STRESS.
THE OTHER THING I WANT TO POINT
OUT A LOT OF FOLKS ASK ME WHAT'S
THE DIFFERENCE BETWEEN SOCIAL
SAFETY AND SOCIAL SUPPORT, AND
THE DIFFERENCE IS PROTECTION.
THE DIFFERENCE IS THE SENSE OF
SAFETY, OF I'VE GOT YOU, I'M
SURROUNDING YOU.
AND AS A DEVELOPMENTAL
PSYCHOLOGIST, FOR ME THIS GOES
RIGHT BACK TO THE ATTACHMENT
SYSTEM.
SO THE REASONS THAT HUMANS HAVE
SUCH A STRONG ATTACHMENT SYSTEM
ALONG WITH OTHER PRIMATES IS
THAT WE ARE BORN INCREDIBLY
DEVELOPMENTALLY IMMATURE.
HUMANS, UNLIKE A LOT OF SPECIES,
YOU DON'T GIVE BIRTH TO A THANK
YOU AN AND THEY GET UP AND WALK
AWAY LIKE LITTLE HORSES.
I LIKE TO WATCH HORSES BEING
BORN ON TIK TOK.
THEY JUST GET UP AND START
WALKING AWAY.
NOT HUMANS.
WE HAVE THIS INTENSE DEPENDENCE
ON THE CAREGIVER.
AND THAT IS A PART OF THE
STRUCTURE OF OUR BRAINS.
OUR DEPENDENCE ON SOCIAL CONTACT
FOR STRESS REGULATION IS IN US.
IT IS DEEPLY WIRED INTO US.
OUR ENTIRE BRAIN IS ORIENTED
AROUND SOCIAL CONNECTION.
SO THAT IS A PART OF WHAT WE
DEAL WITH EVERY DAY, AND AS A
RESULT OF THAT, THE STRESS OF
STIGMA AND REJECTION IS A
FUNDAMENTALLY DIFFERENT FORM OF
STRESS THAN BURDEN OR OVERWHELM
OR OVERWORK, BECAUSE FOR A
SOCIAL BRAIN, REJECTION IS
EXPERIENCED AS A PRIMAL THREAT.
IN THE ANCESTRAL ENVIRONMENT, IF
YOU WERE NOT INCLUDED IN YOUR
GROUP, YOU WERE DEAD.
YOU WOULD DIE ARE OH YOU WOULD
BE ABANDONED OR HURT.
SO WE TALK ABOUT PEOPLE BEING
OVERSENSITIVE TO SOCIAL
REJECTION.
THERE IS NO SUCH THING AS BEING
OVERSENSITIVE TO SOCIAL
REJECTION FROM THE HUMAN BRAIN.
JUST THINK ABOUT THE NUMBER OF
PEOPLE WHO HAVE GOT A LITTLE
NERVOUS WITH THEIR SLIDES.
IS THERE ANY THREAT?
NO.
SO WHY DOES EMBARRASSMENT SEIZE
OUR BODY SO MUCH?
BECAUSE WE EVOLVED THAT WAY.
WE LOGICALLY KNOW THERE'S NO
THREAT, BUT OUR BODIES STILL
TREAT THE REJECTION OR THE
HOSTILITY OF OTHER PEOPLE.
, WE
RESPOND TO THAT ON A NON-VERBAL
AUTOMATIC DEEP LEVEL.
AND SO THE TYPES OF STRESSORS
THAT ACCOMPANY SOCIAL
MARGINALIZATION ARE DIFFERENT.
THEY OPERATE DIFFERENTLY ON US,
AND OUR BRAINS RETAIN THIS
LEGACY.
YOU KNOW, YOU WILL NOTICE MICRO
EXPRESSIONS OF DISGUST OR
HOSTILITY ON ANOTHER PERSON'S
FACE LIKE IN YOUR AMYGDALA,
BEFORE YOU EVEN NOTICE IT, YOU
KNOW, IN YOUR EYE.
SO OUR BODIES ARE RESPONDING TO
SOCIAL REJECTION EVEN WHEN WE
DON'T NECESSARILY SEE IT.
WE ALSO -- I MEAN, THERE'S SO
MUCH EVIDENCE NOW FOR THE HEALTH
EFFECTS OF SOCIAL ISOLATION, AND
THE SURGEON GENERAL RELEASED A
REPORT AFTER THE PANDEMIC SAYING
WE'RE BASICALLY HAVING A MENTAL
HEALTH CRISIS OF DISCONNECTION.
AND YET, LOTS OF PEOPLE ARE
LIKE, WELL, I WAS ON ZOOM, I WAS
TALKING TO FOLKS.
OBVIOUSLY THERE IS SOMETHING
ABOUT SOCIAL CONNECTEDNESS AND
BELONGING THAT IS IRREPLACEABLE,
AND WE HAVE TROUBLE MEASURING
THAT, YOU KNOW, COMPARED TO DID
A DISCRIMINATION EVENT HAPPEN TO
YOU.
AND WHAT WE'RE TALKING ABOUT IS
THIS SENSE OF NO ONE WILL COME
RUNNING IF I SCREAM.
NO ONE WILL HELP ME IF I'M HURT.
THAT'S A DEEPER SENSE OF
VULNERABILITY.
ONE OF THE WAYS YOU CAN SORT OF
SEE HOW IMPORTANT SOCIAL
CONNECTEDNESS IS TO OUR SPECIES
IS IF YOU LOOK CROSS-CULTURALLY
AND HISTORICALLY, THERE IS NO
CULTURE THAT DOESN'T HAVE
RITUALS OF CONNECTION AND
DISCONNECTION.
WE TREAT COMING TOGETHER, MAKING
ONE ANOTHER FEEL COMFORTABLE,
AND THEN SEPARATING FROM ONE
ANOTHER, THOSE ARE THINGS THAT
ALL HUMANS DO.
AND SO WE HAVE ALL THESE RITUALS
OF CONNECTION THAT WE USE TO
REASSURE REASSURE PEOPLE AROUNDT
WE'RE OKAY.
YOU BUMP INTO SOMEONE ON THE
SUBWAY AND YOU KIND OF MAKE EYE
CONTACT.
WE DO ALL THESE LITTLE THINGS TO
BASICALLY SAY, I'M A HUMAN,
YOU'RE A HUMAN, WE'RE ON THE
PLANET TOGETHER, LIKE I'M
HOLDING THE ELEVATOR DOOR FOR
YOU, ET CETERA, ET CETERA, ET
CETERA.
THOSE ARE THE TYPES OF
EXPERIENCES THAT ARE
SYSTEMATICALLY WITHDRAWN FROM
MARGINALIZED GROUPS.
FOR ALL FORMS OF
MARGINALIZATION.
SO EVEN IF THEY ARE NOT ACTIVELY
DISCRIMINATED AGAINST,
MARGINALIZED INDIVIDUALS WALK
THROUGH A WORLD IN WHICH THE
NORMAL NORMATIVE SIGNS OF SOCIAL
CONNECTEDNESS, EYE CONTACT,
FRIENDLY SMILES, NEIGHBORS
WAVING, ARE WITHDRAWN.
AND THAT LEAVES THE NERVOUS
SYSTEM FEELING VULNERABLE AND
AFRAID.
EVEN WHEN STRESS EXPOSURE IS
LOW.
ONE OF THE THINGS -- SO THIS
KIND OF HELPS TO ACCOUNT FOR THE
REASON THAT THE INDIVIDUAL LEVEL
MEASURES OF STRESS EXPOSURE
DON'T OFTEN LINE UP WITH HEALTH
OUTCOMES, BECAUSE WE'RE NOT --
WE'RE FOCUSING ON THE PRESENCE
OF STRESS.
WE HAVE NOT MEASURED THE ABSENCE
OF SOCIAL CONNECTION AND SOCIAL
SAFETY.
SOME PEOPLE SAY, BUT HEY, HOW
CAN THIS BE SUCH A PROBLEM
BECAUSE, WOW, IT'S LIKE TOTALLY
ACCEPTABLE TO BE GAY NOW.
EVERYBODY WANTS TO BE GAY AND
RACISM IS ENDING AND THE WORLD
IS GREAT.
SOMETIMES, RIGHT?
IN SOME PLACES AS WE'VE SEEN,
THERE'S A LOT OF VARIATION
WITHIN AND ACROSS COMMUNITIES.
AND THIS ACTUALLY MAKES THINGS
WORSE.
BECAUSE WHEN THE BRAIN DETECTS
THAT SOMETHING IS SOMETIMES
THERE AND SOMETIMES NOT, YOUR
BRAIN WILL TRY TO PREDICT WHEN
IT'S GOING TO OCCUR AND WHY IT
GOING TO OCCUR AND WHAT DO YOU
DO TO MAKE SURE THAT YOU'RE
OKAY.
HUMANS ACTUALLY, OUR BRAINS ARE
WIRED TO TREAT UNCERTAINTY AS A
WORSE SITUATION THAN A DEFINITE
NEGATIVE OUT COME.
AND ONE OF THE THINGS THAT
CHARACTERIZES THE STATE OF BEING
A MARGINALIZED PERSON TODAY IS
UNCERTAINTY.
IN THIS MEETING, AM I RESPECTED?
IN THAT CONFERENCE, AM I
RESPECTED?
IN THIS FAMILY GATHERING, WHAT
IS THIS PERSON THINKING ABOUT
ME, ARE THEY LOOKING AT ME, ARE
THEY NOTICING ME?
SO THERE'S LIKE THE FACT THAT
IT'S MORE ACCEPTING IN SOME
DOMAINS FOR SOME GROUPS JUST
MAKES THE ENVIRONMENT MORE
UNCERTAIN, AND IF YOU HAVE ANY
DOUBT ABOUT THE DEGREE TO WHICH
UNCERTAINTY CAN HIJACK YOUR
BRAIN, I'LL JUST HAVE YOU LOOK
AT THAT FOR A LITTLE BIT.
JUST IMAGINE YOU SEPTEMBER A SEO
SOMEONE, YOU JUST SEE THAT
FLASHING.
ARE YOU GOING TO DO ANYTHING
USEFUL DURING THAT TIME?
NO.
THAT IS THE STATE OF
MARGINALIZATION.
IT'S A SERIES OF RED DOTS
FLASHING.
WHAT IS ABOUT TO HAPPEN?
WHAT'S ABOUT TO HAPPEN TO ME?
MY COLLEAGUE BURT UCHINO HAS
DONE A LOT OF WORK SHOWING THAT
WHEN INDIVIDUALS ARE INTERAKINGG
WITH SOMEONE WHO IS SOMETIMES
POSITIVE AND SOMETIMES NEGATIVE
TOWARD THEM, THEIR BLOOD
PRESSURE IS HIGHER THAN WHEN
THEY'RE INTERACTING WITH SOMEONE
WHO'S ALWAYS NEGATIVE.
BECAUSE, AGAIN, VIGILANCE.
LIKE, WHAT, WHAT, WHAT, WHAT,
WHAT?
AND THIS IS ONE OF THE REASONS
THAT I THINK ALL THE EMPHASIS ON
NEIGHBORHOODS IS SO IMPORTANT,
BECAUSE IT'S REALLY NOT THE --
LIKE THE OUTSIDE FORC FORCES, WE
OFTEN AWARE OF THEM COGNITIVELY
BUT ON THE DAY TO DAY LEVEL,
IT'S THE PEOPLE IMMEDIATELY
AROUND US THAT OFTEN DETERMINE
OUR DAY TO DAY PHYSIOLOGICAL
FUNCTIONING.
SO THIS IS THE MODEL THAT I LAY
OUT IN THE PAPER.
THE TOP SAYS, IS IT SAFE FOR ME
HERE?
BECAUSE HUMANS ARE CONSTANTLY
SCANNING OUR ENVIRONMENT FOR
SIGNS OF SAFETY.
IT LIKE, IMAGINE YOU GET DRESSED
UP TO, LIKE, GO TO A WEDDING AND
YOU GO TO THE EVENT AND YOU'RE
NOT SURE IF YOU'RE IN THE RIGHT
PLACE BECAUSE YOU GO TO THE ROOM
AND YOU CAN'T SEE ANYONE AND
YOU'RE ALL KIND OF NERVOUS.
AND THEN IMAGINE THAT YOU SEE A
FRIEND OF YOURS AND YOU'RE LIKE,
OH, NO, IT'S OVER HERE, AND YOU
KNOW IMMEDIATELY THAT YOU'RE
OKAY.
SO IT'S LIKE, THAT KIND OF SHIFT
IN YOUR BODY, FROM UNSAFE TO,
OH!
AND WHEN YOU'RE SAFE, YOU
INHIBIT THREAT VIGILANCE, THE
PREFRONTAL CORTEX GOES AHEAD AND
INHIBITS THREAT VIGILANCE,
YOU'RE NOT HAVING TO MONITOR
YOURSELF OR ANOTHER, YOU REDUCE
YOUR PERSEVERATIVE COGNITION AND
YOU'RE RUMINATION.
WE KNOW THAT IS A STATE THAT
LOWERS YOUR LEVEL OF
INFLAMMATION.
YOU HAVE MORE ATTENTION AND
ENERGY AVAILABLE FOR ALL YOUR
ACTIVITIES.
YOU'RE MORE LIKELY TO HAVE A
FEELING STATE THAT'S CALM AND
CONNECTED, AND THE BEHAVIORS
THAT YOU PURSUE WHEN YOU FEEL
SAFE ARE EXPLORATION,
EMPATHIZING.
YOU DON'T EMPATHIZE WHEN YOU
DON'T FEEL SAFE.
AND WE KNOW ALL THESE LINKS WITH
VARIOUS HEALTH OUTCOMES.
SO ALL THE REVERSE HAPPENS WHEN
YOU DON'T FEEL SAFE.
YOUR THREAT VIGILANCE STAYS UP,
YOU'RE MONITORING YOURSELF,
YOU'RE MONITORING OTHER PEOPLE.
IT'S VERY TAXING.
IT DEMANDS YOUR ATTENTION AND
YOUR ENERGY.
YOUR FEELINGS ARE MORE
ASSOCIATED WITH BEING AGITATED
AND AFRAID AND ALONE.
AND THE BEHAVIORAL ADAPTATIONS
ARE ALL THOSE THAT WE KNOW TO BE
BAD FOR HEALTH.
ISOLATING, RESTRICTING, USING
SUBSTANCES TO SELF-SOOTHE.
SO ONE OF THE THINGS I'M SORT
OF, YOU KNOW, WANTING TO URGE
PEOPLE TO DO IS TO CONTINUE
MEASURING EXPOSURE TO STRESSORS
BUT TO ALSO MEASURE THE
AVAILABILITY OF SOCIAL
CONNECTEDNESS AND SOCIAL SAFETY
IN THE DIFFERENT DOMAINS OF
PEOPLE'S LIVES.
IN THEIR HOUSEHOLD, IN THEIR
CLOSE FRIENDS, IN THEIR WORK
ENVIRONMENT, IN THEIR HEALTHCARE
SETTING, WHICH IS REALLY
CRITICAL FOR INDIVIDUALS WITH
CHRONIC DISEASE CONDITIONS.
SO YOU CAN SORT OF IMAGINE
STRESS AND SAFETY AS BEING
ORTHOGONAL DIMENSIONS.
ONE WAY TO THINK ABOUT THE STATE
OF BEING PRIVILEGED IS THAT YOU
HAVE LOW EXPOSURE TO STRESS AND
YOU ALSO HAVE HIGH ACCESS TO
SAFETY.
YOU'VE KIND OF GOT IT ALL.
HAVING A LOT OF SOCIAL SAFETY, A
LOT OF IMMEDIATE NURTURANCE AND
BELONGING IN CONDITIONS OF HIGH
STRESS, THAT'S WHAT IS COMMONLY
CALLED RESILIENCE.
AND I ABSOLUTELY AGREE WITH THE
COMMENTS TODAY THAT RESILIENCE
IS REALLY A FEATURE OF THE
SOCIAL ENVIRONMENT, NOT AN
INDIVIDUAL TRAIT.
YOU DON'T FOSTER GRIT IN A KID
BY, LIKE, YOU KNOW, HOW YOU
RAISE THEM.
YOU FOSTER GRIT AND RESILIENCE
BY CREATING A NURTURING RELIABLE
NETWORK OF PROTECTIVE SOCIAL
CONTACTS THAT CAN BUFFER THAT
PERSON AGAINST STRESS.
THE STATE OF HAVING LOW OR
INCONSISTENT SAFETY AND LOW
LEVELS OF STRESS IS
HYPERVIGILANCE.
AND I THINK A LOT OF INDIVIDUALS
WHO ARE MARGINALIZED IN ONE
DOMAIN BUT ARE PRIVILEGED IN
OTHERS OFTEN WALK AROUND BEING
LIKE, WHY DO I STILL FEEL SO
STRESSED OUT?
NOTHING THAT BAD HAS HAPPENED TO
ME.
BUT THE VIGILANCE IS WHAT KEEPS
THOSE CHRONIC HEALTH CONDITIONS
UP.
AND THEN THE STATE OF HAVING LOW
SOCIAL SAFETY AND HIGH EXPOSURE
TO STRESS IS ONE WAY TO THINK
ABOUT TRAUMA, WHEN THE STRESSORS
OVERWHELM YOUR ABILITY TO COPE
WITH THEM.
SO BIG QUESTION IS WHAT'S
ENOUGH?
WHAT'S ENOUGH SAFETY TO GET YOU
INTO A HEALTHY ZONE?
WE DON'T KNOW.
BECAUSE WE HAVEN'T EVEN MEASURED
THIS.
I DO HAVE A MEASURE I'VE BEEN
PILOTING AND I'M HAPPY TO SEND
TO FOLKS, BUT ONE OF THE THINGS
THAT WE'RE FINDING IS THE AMOUNT
OF SAFETY THAT YOU NEED NOW
DEPENDS ON WHAT YOU WERE EXPOSED
TO AS A CHILD.
AND AS A DEVELOPMENTAL
PSYCHOLOGIST, I'M REALLY PLEASED
TO SEE HOW MANY FOLKS HAVE
ALREADY TALKED ABOUT EARLY LIFE
STRESS AND CHILDHOOD ADVERSITY.
IT GOES UNDER LOTS OF DIFFERENT
NAMES.
PEOPLE TALK ABOUT THE ACES, THE
ADVERSE CHILD EXPERIENCES STUDY,
PEOPLE -- YOU KNOW, SEXUAL,
EMOTIONAL AND PHYSICAL ABUSE,
TRAUMA.
THERE'S A LOT OF DIFFERENT
MEASUREMENTS OF THIS.
BUT ONE THING THAT I WOULD ALSO
URGE EVERYONE TO DO IS, IN
ADDITION TO USING THOSE GLOBAL
MEASURES, IT'S REALLY IMPORTANT
TO PARSE OUT THREE DIFFERENT BIG
DOMAINS OF THESE EARLY
EXPERIENCES THAT DEVELOPMENTAL
PSYCHOBIOLOGISTS HAVE FOUND TO
HAVE SORT OF DISTINCT EFFECTS.
THREAT, WHICH IS ANY SORT OF
PHYSICAL THREAT TO THE CHILD,
NEGLECT, WHICH IS THE WITHDRAWAL
OF EITHER FOOD OR NURTURING
INPUT AND CONTACT, AND THEN
UNPREDICTABILITY, WHICH IS
INSTABILITY IN THE REARING
ENVIRONMENT, FREQUENT
RESIDENTIAL CHANGES, CHANGES IN
PEOPLE IN THE HOUSEHOLD.
AND THE REASON THAT IT'S
IMPORTANT TO DIFFERENTIATE
BETWEEN THESE IS THAT WE NOW
HAVE REALLY GOOD EVIDENCE THAT
THE REASON THEY HAVE DIFFERENT
BIOLOGICAL AND BRAIN EFFECTS IS
BECAUSE OUR SPECIES EVOLVED TO
EXPECT THAT A CHILD'S
ENVIRONMENT WOULD BE REALLY
DIFFERENT FROM HERE TO THERE AND
THE FIRST JOB FOR THE DEVELOPING
PLASTIC HUMAN BRAIN IS TO FIGURE
OUT WHAT KIND OF AN ENVIRONMENT
YOU'RE IN.
IS NEWER TRANS AVAILABLE OR IS
IT NOT?
IS IT IN A PREDICTABLE
ENVIRONMENT OR IT'S NOT.
WHAT STUDIES HAVE FOUND IS THAT
CHILDREN WHO ARE IN THREATENING
AND UNPREDICTABLE ENVIRONMENTS
TEND TO DEVELOP WHAT'S CALLED A
FAST LIFE HISTORY DEVELOPMENTAL
PHENOTYPE.
THEY MATURE A LITTLE EARLIER,
THEY ARE MORE THREAT-SENSITIVE
AND MORE REWARD-SENSITIVE AND
THERE'S SOME SUGGESTION FROM THE
EVOLUTIONARY LITERATURE THAT
WHAT YOU'RE SEEING IN SHORTENED
TELOMERES IS PART OF A SPECIES
LEVEL ADAPTATION THAT IF YOU'RE
IN AN UNPREDICTABLE AND
THREATENING ENVIRONMENT, LIVE
FAST AND DIE YOUNG.
THAT YOUR GOAL IS TO GET TO
PUBERTAL MATURATION, REPRODUCE
AND DIE.
AND SO WHAT MAKES SENSE AT A
SPECIES LEVEL DOESN'T
NECESSARILY HELP INDIVIDUALS AT
AN INDIVIDUAL LEVEL.
AND SO MEASURING THESE DIFFERENT
DIMENSIONS IS REALLY IMPORTANT.
WE ALSO KNOW SOME OF THESE EARLY
EXPOSURES GET BIOLOGICALLY
EMBEDDED INTO THE STRESS
RESPONSE SYSTEM.
THE BRAIN IS SO PLASTIC, HUMAN
BRAIN PLASTICITY IS JUST
ASTOUNDING.
SO I LIKE TO TELL FOLKS WHEN
YOU'RE TALKING ABOUT BIOLOGICAL
VERSUS SOCIAL EFFECTS, EARLY
CHILDHOOD EXPERIENCES ARE
BIOLOGICAL EVENTS.
THEY'RE NOT ENVIRONMENTAL.
THEY ARE BIOLOGICALLY EMBEDDED
BECAUSE OF BRAIN PLASTICITY.
OUR BRAINS ARE WIRED TO TAKE IN
THE ENVIRONMENT AND USE IT.
THE HUMAN BRAIN IS KIND OF LIKE
BUILDING THE PLANE WHILE FLYING
IT.
THE CHILD'S BRAIN IS TRYING TO
FIGURE OUT WHAT EXISTS IN THIS
ENVIRONMENT, WHAT IS THERE FOR
ME?
SO THESE EFFECTS CAN BE REALLY,
REALLY ENDURING.
AS I MENTIONED, THEY ALTER BOTH
THREAT RESPONSIVITY AND REWARD
RESPONSIVITY.
I FIND THAT REALLY INTERESTING
WITH RESPECT TO THE DATA ON
RESPONSES TO FOOD, AND OBESITY.
BECAUSE PART OF THE FAST LIFE
HISTORY PROGRAM FOR AN
ADVERSITY-EXPOSED BRAIN IS WHEN
YOU SEE A FO FOOD THAT CAN NOURH
YOU, GO GET IT, GO GET IT,
BECAUSE YOU MAY NOT GET IT IN
THE FUTURE.
SOME OF THESE THINGS ARE REALLY
DEEPLY ROOTED IN OUR ANCESTRAL
CONDITIONS.
WE ALSO KNOW THAT INDIVIDUALS
RAISED IN THREATENING AND
DEPRIVED AND UNPREDICTABLE
ENVIRONMENTS TEND TO DEVELOP
WHAT'S CALLED A PRO-INFLAMMATORY
PHENOTYPE.
THEIR LEVELS OF SYSTEMIC
INFLAMMATION ARE HIGH AND
THEY'RE MORE REACTIVE TO FUTURE
STRESSORS.
SO YOU CAN GET AN ESCALATING
EFFECT OF INFLAMMATION OVER THE
LIFE COURSE WHICH THEN HELPS TO
MAKE SENSE OF SOME OF THOSE
MORTALITY AND MORBIDITY
STATISTICS THAT YOU SEE.
SO THIS SORT OF MEANS THAT IF
YOU GOT AN ADVERSITY-EXPOSED
KID, THEN THEIR LIFETIME
EXPOSURE TO MARGINALIZATION AND
DISCRIMINATION IS LIKELY TO BE
GREATER.
AND THIS IS SOMETHING THAT HAS
RECEIVED A LOT OF ATTENTION IN
THE LITERATURE ON RACIAL AND
ETHNIC MARGINALIZATION, BUT I'VE
TRIED TO GET MORE ATTENTION TO
IT IN THE LIVES OF QUEER PEOPLE
BECAUSE SEXUAL AND GENDER
MINORITIES HAVE SIGNIFICANTLY
GREATER EXPOSURE TO ALL FORMS OF
CHILDHOOD ADVERSITY.
CG THERE MEANS CAREGIVER.
SO CAREGIVER SUBSTANCE USE IS A
CLASSIC MEASURE OF
UNPREDICTABIPREDICTABILITY BECAU
MIGHT HAVE A REALLY NEW NURTURE
ANTICAREGIVER WHO IS SOMETIMES
DRUNK.
SO IT'S NOT LIKE THEY'RE ALWAYS
NEGLECTFUL.
IT'S INCONSISTENT.
CAREGIVER MENTAL ILLNESS,
INCARCERATION, SO YOU CAN SEE
THAT IT'S NOT JUST ONE FORM OF
ADVERSITY, IT'S REALLY ALL OF
THEM.
SO THESE ARE INDIVIDUALS WHO ARE
GOING TO HAVE STRESS-ADAPTED
PHENOTYPES.
I ALSO WANT TO BRIEFLY TALK
ABOUT TRAUMA, BECAUSE IT'S
ANOTHER THING THAT IS MEASURED
BY PSYCHOLOGISTS A LOT.
I WISH EPIDEMIOLOGISTS WOULD DO
MORE.
WHEN WE THINK ABOUT PTSD, WE
THINK ABOUT PEOPLE WHO COME HOME
FROM WAR AND THERE WAS A BOMBING
AND THEN THEY HAVE THIS SORT OF
TRAUMA RESPONSE TO THE MEMORY,
AND I THINK IT'S REALLY
IMPORTANT AND THE WORD TRAUMA
GETS THROWN AROUND LIKE IT'S ALL
OTHER TIK TOK, YOU KNOW, TIK TOK
DISCOVERED TRAUMA AND THE WORLD
WILL NEVER BE THE SAME.
TRAUMA IS NOT ABOUT A MEMORY OF
A BAD EVENT.
TRUE MA IS ABOUT A REACTION THAT
SEEMINGLY HAS NOTHING TO DO WITH
THE EVENT.
SO TYPICALLY, WHEN FOLKS
DIAGNOSE PTSD, THEY LOOK FOR THE
CRITERIA A EVENT.
THE EVENT THAT MADE YOU AFRAID.
THE BOMBING, THE ASSAULT, THE
LOSS EXPERIENCE.
AND THEN THEY ASSESS ALL THE
ADAPTATIONS.
THE PTSD RESPONSES ARE REALLY
COMPLEX DEPENDING ON WHAT TYPE
OF STRESSOR IT WAS, WHEN IT
OCCURRED, ET CETERA, ET CETERA,
ET CETERA, AND NONE OF THE
WE'VE REALIZEDTHERE'S A WHOLE BE
WHO HAVE THESE SYMPTOMS, BUT
CANNOT POINT TO A SINGLE EVENT
THAT CAUSED IT.
THERE WAS NO BOMBING, THERE WAS
NO THIS, AND YET THEIR BODIES
AND BRAINS ARE THROWING OFF ALL
OF THESE SORTS OF REACTIONS, AND
SO OVER THE YEARS, PSYCHOLOGISTS
HAVE TALKED ABOUT CPTSD OR
COMPLEX TRAWL MA, WHICH IS
TRAUMA ALSO THOUGHT OFAS DEVELO.
THAT OFTEN A CHILD'S PROLONGED
EXPOSURE TO AN UNSAFE
ENVIRONMENT WILL PRODUCE THE
SAME SORTS OF PSYCHOBIOLOGICAL
ADAPTATIONS TO THREAT THAT A
SINGLE EVENT WILL.
SO IT LIKE YOU CAN DEVELOP PTSD
FROM EXPOSURE TO STRESS OR
EXPOSURE TO INSUFFICIENT SAFETY.
AND THE EFFECTS ARE BASICALLY
THE SAME.
AND ONE OF THE IMPLICATIONS OF
THIS THAT I THINK, YOU KNOW, WE
HAVE FAILED TO APPRECIATE UP
UNTIL NOW IS THAT STIGMA IS
TRAUMA.
THE EXPERIENCE OF GROWING UP,
FEELING THAT THE PEOPLE AROUND
YOU DON'T CONSIDER YOU HUMAN
ENOUGH TO SAVE, THAT'S TRAUMA.
THAT'S A FORM OF COMPLEX
DEVELOPMENTAL TRAUMA.
SO YOU WON'T BE ABLE TO LINK ALL
THOSE SYMPTOMS TO STRESS EVENTS.
THEY ARE PART OF THE CONTEXT OF
INSUFFICIENT SOCIAL SAFETY.
SO YOU KNOW, THEN IT'S LIKE,
WELL, GREAT, WHAT DO WE DO NOW?
HOW DO WE INCREASE SOCIAL
SAFETY?
OBVIOUSLY, WE HAVE TO KEEP
FIGHTING STRUCTURAL AND
INSTITUTIONAL FORMS OF
DISCRIMINATION AND REJECTION AND
PASS AFFIRMATIVE LAWS AND
POLICIES.
BUT UNFORTUNATELY, THOSE ALL
WORK AT THE PREFRONTAL CORTEX
LEVEL.
THEY'RE NOT GOING TO AFFECT YOUR
AMYGDALA.
OUR ANCIENT BRAINS ARE CRAVING
REAL HUMAN SOCIAL INPUT,
AFFIRMATIVE CONTACT.
ONE OF THE REASONS THAT I THINK
EVERY GRADUATE STUDENT IN THE
UNITED STATES BECAME LIKE REALLY
DEPRESSED DURING THE PANDEMIC IS
THEY WERE DOING ALL THEIR
MEETINGS, YOU KNOW, WITH THEIR
ADVISER ON ZOOM.
THERE WAS NO BUMPING UP AGAINST
INDIVIDUALS IN THE HALLWAY, NONE
OF THIS, OH, HOW'S YOUR -- HOW'S
THAT PAPER GOING?
AND, LIKE, LITERALLY, I KNOW AT
MY UNIVERSITY AND OTHER
UNIVERSITIES, EVERYBODY WENT A
LITTLE CRAZY.
ZOOM IS NOT GOING TO SAVE US.
ONLINE SOCIAL SUPPORT -- EVEN I
THINK FOR A LOT OF QUEER FOLKS
IN MARGINALIZED PARTS OF THE
COUNTRY WHO ARE REALLY ISOLATED,
ONLINE SOCIAL SUPPORT IS GREAT
BUT YOU KNOW WHAT, THAT'S NOT
WHAT OUR SOCIAL BRAINS EVOLVED
FOR.
WE EVOLVED FOR IN-PERSON SOCIAL
CONNECTION WITH PEOPLE WHO LOOK
AT US WARMLY, AUTHENTICALLY, IN
A WAY THAT CAN'T BE FAKED.
BUT WE DON'T KNOW HOW MUCH IS
ENOUGH.
ONE OF THE STUDIES I'M DOING NOW
IS TRYING TO FIGURE OUT, HOW
MUCH TIME SPENT WITH PEOPLE WHO
MAKE YOU FEEL SAFE IS ENOUGH TO
SORT OF CHANGE YOUR PHYSICAL
FUNCTIONING.
AND ONE OF THE -- THIS IS WHERE
INTERSECTIONALITY REALLY COMES
TO THE CORE BECAUSE THERE ARE
SOME SOCIAL CONNECTIONS IN YOUR
LIFE WHERE YOUR CONNECTION AND
BELONGING ON ONE ASPECT OF YOUR
IDENTITY MAKES YOU REJECTIBLE ON
THE BASIS OF ANOTHER FORM OF
YOUR IDENTITY.
SO BASICALLY YOUR BRAIN IS
PICKING WHICH IS A MORE RELIABLE
SOURCE OF SAFETY?
WHAT'S GOING TO PROTECT ME MORE?
AND SO ONE OF THE THINGS THAT WE
NEED TO DO IS TO SORT OF FILL IN
SOME OF THESE GAPS IN THE SAFETY
NET.
I'M DOING A STUDY RIGHT NOW,
BASICALLY CALLED STUDENTS USING
SMARTPHONES TO SORT OF MAP WHAT
ARE THE SPACES ON CAMPUS THAT
FEEL SAFE FOR THE BLACK QUEER
STUDENTS OR THE LATINO
NON-BINARY STUDENTS OR THE FIRST
GENERATION STUDENTS?
WHAT ARE THE CUES THAT PEOPLE
LOOK TO IN ORDER TO DETERMINE
WHETHER OR NOT THEY FEEL SAFE?
WHETHER YOU CAN HEAR PEOPLE
LAUGHING, LIKE IMAGINE BEING AT
A COFFEE SHOP WHERE YOU HEAR
NOTHING VERSUS A COFFEE SHOP
WHERE YOU HEAR PEOPLE TALKING.
THERE ARE CUES THAT OUR BRAINS
ARE LOOKING FOR.
BUT WE DON'T MEASURE, RIGHT?
WE'RE LIKE, OH, THAT'S NOT
IMPORTANT.
WELL, TO THE AMYGDALA, IT'S KIND
OF IMPORTANT.
THE OTHER THING THAT I'VE REALLY
STARTED TO FOCUS ON IS THE FACT
THAT THE OUTDOORS IS OFTEN, YOU
KNOW, AN AUTOMATIC CUE FOR KIND
OF RECOVERY.
THERE WAS A STUDY SHOWING THAT
YOUR VAGAL TONE INCREASES WHEN
YOU HEAR BIRD SONG.
THIS MAKES SENSE, EVOLUTION
NARELY, IF YOU ARE OUTSIDE AND
THERE ARE BIRDS SINGING, YOUR
BRAIN SAYS SOMEWHERE THERE'S
WATER, SOMEWHERE THERE'S SKY.
SO I THINK IN ADDITION TO
BUILDING QUEER YOUTH CENTERS
WHERE KIDS CAN COME TOGETHER,
I'M ALSO WORKING IN UTAH TO SEE
IF WE CAN JUST GET QUEER AND
TRANS YOUTH OUTSIDE HIKING WITH
QUEER AND TRANS ELDERS, TO JUST
LITERALLY BE WALKING AND TALKING
TOGETHER BECAUSE WALKING AND
TALKING TOGETHER IS THE OLDEST
KNOWN COPING MECHANISM KNOWN TO
HUMANS.
THE OTHER KIND OF THINGS THAT I
THINK WE NEED TO THINK ABOUT A
LITTLE BIT MORE IS IN TERMS OF
ADDING SAFETY BACK TO
INDIVIDUALS' LIVES.
THE ROLE OF THA HUMOR, I ALSO TK
HAS BEEN UNDERSTUDIED.
THINK OF WHEN YOU'RE WATCHING A
MOVIE OR TV SHOW AND THEY WANT
TO COMMUNICATE THAT SOMETHING IS
GOING TO BE OKAY, THEY'LL ADD A
JOKE.
THEY'LL ADD LIKE A MOMENT OF
HUMOR.
WHY DO THEY DO THAT?
BECAUSE ALL OF US VIEW HUMOR AS
A SIGN THAT IT'S OKAY.
RIGHT?
AND HUMOR IS OFTEN SOMETHING IN
THE SOCIAL CONTEXT THAT BONDS
PEOPLE.
SO WE NEED TO FIND WAYS TO
ENHANCE SOCIAL SAFETY NOT
THROUGH HAVING PEOPLE
NECESSARILY TALK ABOUT THEIR
TRAUMA, BUT HAVING PEOPLE SHARE
JOY AND SHARE CREATIVITY.
I'M DOING ANOTHER PROJECT WITH
TRANS YOUTH WHO ARE MAKING
DOCUMENTARY FILMS WITH MENTORS.
MAYBE THE ONLY WAY TO REDUCE
SUICIDALITY IN TRANS POPULATIONS
IS FOR EVERYBODY TO MAKE
DOCUMENTARY FILMS.
WHATEVER YOU'RE GOING THROUGH,
THERE'S ANOTHER PERSON SHARING
THAT EXPERIENCE.
SO IN TERMS OF RESEARCH
PRIORITIES, I HOPE THAT EVERYONE
WILL START ADDING MEASURES OF
CHILDHOOD ADVERSITY TO WHAT
THEY'RE LOOKING AT AND TO ASSESS
IT AT DIFFERENT DEVELOPMENTAL
STAGES, BECAUSE THE BRAIN IS
MOST PLASTIC DURING THE FIRST
FIVE YEARS OF LIFE.
SO MOST OF THE ACES STUDIES JUST
ASK ABOUT EVERYTHING UP UNTIL
AGE 18, WHICH IS BETTER THAN
NOTHING, BUT THERE'S A LOT OF
DIFFERENCE BETWEEN ENVIRONMENTAL
EXPOSURES AT AGE 5 AND
ENVIRONMENTAL EXPOSURES AT
PUBERTY.
AND AGAIN, TO DIFFERENT -- AND
MOST OF THE ACES MEASURE THAT'S
AVAILABLE, YOU CAN DIVIDE IT UP
INTO MEASURES OF THREAT,
UNPREDICTABILITY AND NEGLECT.
THEY'RE ALL IN THERE.
IT'S JUST A MATTER OF NOT ADDING
THEM ALL TOGETHER AND LOOKING AT
THEM SEPARATELY.
MY COLLEAGUE JOHN RUIZ AT THE
UNIVERSITY OF ARIZONA HAS A
FANTASTIC MEASURE OF SOCIAL VINL
LENS WHICH IS IS ANOTHER THING E
SHOULD ALL BE LOOKING AT, YOUR
SORT OF READINESS FOR KIND OF
THREAT AND WATCHFULNESS IN THE
ENVIRONMENT AROUND YOU.
I'VE DEVELOPED A MEASURE OF
SOCIAL SAFETY THAT PEOPLE SORT
OF IDENTIFY THE MAJOR DOMAINS OF
THEIR LIFE LIKE HOUSEHOLD, CLOSE
FRIENDS, WORK, RELIGIOUS
CONTEXT.
IN UTAH, THAT'S A BIG THING.
THE MEDICAL ENVIRONMENT, YOUR
COMMUNITY ENVIRONMENT.
AND THEN YOU'RE ASKED IN EACH
DOMAIN, HOW MUCH TIME DO YOU
SPEND THERE?
AND THEN HOW DO PEOPLE RESPOND
TO YOU?
LIKE, HOW OFTEN DO PEOPLE AT
YOUR WORKPLACE SEEM HAPPY TO SEE
YOU WHEN YOU WALK INTO A ROOM?
HOW OFTEN DO THEY MAKE YOU LAUGH
OR SMILE?
HOW OFTEN DO THEY NOTICE OR CARE
IF YOU'RE ABSENT OR SICK?
HOW OFTEN DO THEY MAKE YOU FEEL
THAT YOU MATTER TO THEM?
HOW OFTEN DO YOU FEEL LIKE YOUR
REAL SELF WITH THEM?
SOME OF THE OTHER ITEMS ON THIS
SCALE ARE HOW OFTEN ARE YOU SO
COMFORTABLE IN A SPACE THAT YOU
LOSE TRACK OF TIME?
BECAUSE PEOPLE DON'T LOSE TRACK
OF TIME WHEN THEY'RE VIGILANT,
RIGHT?
SO THERE'S A LOT MORE SUBTLE
MEASURES OF PEOPLE'S MENTAL
STATE THAT WE COULD BE LOOKING
AT.
SO I WANT TO END WITH THIS BEUSS
BEAUTIFUL QUOTE.
QUESTION ARE INDIVIDUALS, YES,
BUT INDIVIDUALS WHOSE LIFE BLOOD
IS CONNECTION.
WE ARE INDIVIDUALS WHOSE VERY
EXISTENCE IS PREDICATED ON
BELONGING.
AND I'LL PUT MY EMAIL BECAUSE
I'M PUBLISHING A VALIDATION
PAPER ON THE SOCIAL SAFETY
MEASURE AND IT PREDICTS
SUICIDALITY AND DEPRESSION OVER
AND ABOVE EXPOSURE TO BOTH
GENDER MINORITY STRESSORS AND
SEXUAL AND MINORITY STRESSORS.
SO THAT'S COMING UP.
ALL RIGHT.
[APPLAUSE]
>> SO THANK YOU, OF COURSE, TO
OUR THREE DYNAMIC SPEAKERS.
I HAVE TO SAY, I'VE HEARD LISA
DIAMOND DO THIS TALK OR A
SIMILAR TALK ON SEVERAL
OCCASIONS AND EACH TIME, THE
FIRST THING I DO IS RUN OUT AND
BUY LIKE A NEW T-SHIRT THAT
SAYS, LIKE, YOU ARE SAFE WITH
ME.
AND I WEAR IT EVERYWHERE I GO.
SO THANK YOU FOR THAT REMINDER,
LISA, TO SMILE AND HAVE EYE
CONTACT.
SO WE ARE NOW OPEN FOR
QUESTIONS.
>> YES.
AS PEOPLE ARE THINKING OF THEIR
QUESTIONS, I JUST WANT TO MAKE
ONE QUICK ANNOUNCEMENT/REMINDER.
SO EVERYBODY SHOULD HAVE
RECEIVED A MENU.
PLEASE CIRCLE YOUR OPTION, WRITE
YOUR NAME ON THE SHEET AND
ALISON WILL BE COLLECTING THEM
AND GETTING THEM BACK SO LUNCH
ORDERS -- PAMMIS PANELISTS YOU'E
AN EXTENSION ON THE DEADLINE SO
YOU CAN GET YOURS IN AFTER THE
PANEL SO TAKE YOUR TIME.
AND THEN WE HAVE A FEW QUESTIONS
ON THE ZOOM.
AGAIN, NAME ON THE TOP OF YOUR
MENU, CIRCLE YOUR SELECTION,
GIVE TO ALISON.
OKAY.
SO FOR THE QUESTIONS, WE'VE GOT
SEVERAL THAT HAVE COME IN FROM
THE ZOOM.
SO THE FIRST QUESTION FOR ALL OF
THE PANELISTS.
CAN YOU COMMENT ON HOW WE CAN
BEST AVOID USING SOCIAL
DETERMINANTS OF HEALTH AS
PROXIES FOR RACISM MUCH LIKE SES
HAS BEEN USED FOR RACE IN THE
PAST?
AND HAVE WE SORT OF FIT THAT IN
TO THE WAY WE'RE DOING RESEARCH
IN THE SPACE?
>> I CAN START BY JUST SAYING I
THINK THAT IT IS AN AGE-OLD
PRACTICE TO USE A VARIABLE,
WHATEVER VARIABLE WE CAN THINK
ABOUT SES, WE CAN THINK ABOUT
SOCIAL CAPITAL, WE CAN THINK
ABOUT RACE.
AND FOR ME, IT'S FIGURE OUT WHAT
YOU WANT TO STUDY AND MEASURE
THAT.
BECAUSE WHEN WE DON'T DO THAT,
WE'RE ACTUALLY SUBJECT TO
MEASUREMENT ERROR, AND WE
ACTUALLY HAVE NO IDEA WHAT WE'RE
ACTUALLY CAPTURING, RIGHT,
WHATEVER WE'RE NOT MEASURING,
WHICH IS A THING WE REALLY WANT
TO MEASURE, THERE'S SO MUCH
OTHER STUFF BEING CAUGHT UP IN
THE EFFECT OF THAT ONE VARIABLE
THAT WE'RE USING AS A PROXY.
AND I THINK THE BIGGEST
CHALLENGE OF THAT IS THAT IT
COMPROMISES VALIDITY AND
EPIDEMIOLOGIC -- IN ANY STUDIES,
RIGHT?
AND WHEN I SAY VALIDITY, I'M NOT
TALKING ABOUT GENERALIZABILITY
OR INTERNAL VALIDITY.
I'M TALKING ABOUT JUST THE BASIC
ESSENCE OF WHAT VALIDITY IS,
WHICH IS TRUTH.
AND WE CANNOT GET TO THE TRUTH
WHEN WE'RE USING A VARIABLE AS A
PROXY FOR SOMETHING ELSE, AND
ONE OF THE THINGS WE'VE ALL SEEN
IN RESEARCH IS THAT -- WELL, I'M
SURE SOME OF YOU HAVE SEEN IT
TOO, THAT TWO DIFFERENT STUDIES
COULD EXAMINE THE SAME VARIABLE,
HAVE THE SAME OR DIFFERENT
OUTCOMES, AND THEY WILL, IN
THEIR DISCUSSION SECTION,
INTERPRET THEM COMPLETELY
DIFFERENT BECAUSE THEY'RE
RESTING ON HOW THEY'RE
INTERPRETING THE RESULTS BASED
ON THEIR OWN PHILOSOPHICAL
ASSUMPTIONS, THEIR OWN WORLD
VIEWS, YOU KNOW, ET CETERA, SO I
THINK IT'S REALLY DANGEROUS TO
NOT MEASURE WHAT YOU ACTUALLY
WANT TO MEASURE.
AND IF WE DON'T HAVE THOSE
MEASURES AVAILABLE, THEN WE NEED
TO CREATE THEM.
>> LOOKS LIKE DAVID AND LISA
FEEL AMANI COVERED THAT ONE
BEAUTIFUL AND I AGREE,
BRUTEFULLY.
SOBRUBEAUTIFULLY.
NEXT QUESTION.
IS THERE A WAY TO REFRAME OR
RECONSIDER RESILIENCY TO SHIFT
FROM SORT OF PUTTING THE BURDEN
ON PEOPLE WHO ARE BEING
OPPRESSED OR MARGINALIZED BY
THESE BROADER SYSTEMS ?M YOU
YOU KNOW, SUCH THAT, YOU KNOW,
YOU'RE PROVIDING MAXIMAL
OPPORTUNITY FOR PEOPLE TO TAKE
ADVANTAGE OF WHATEVER SOLUTIONS
MIGHT BE AVAILABLE TO THEM
WITHOUT SORT OF PUTTING THE ONUS
ON THEM.
HOW DO YOU BALANCE THAT, I THI
THINK?
I'M KIND OF PARAPHRASING HERE.
>> YOU KNOW, I THINK A LOT --
SOME OF THE STUDIES THAT WERE
PRESENTED YESTERDAY, I THINK
SORT OF EARLY ENVIRONMENT SORT
OF BUFFERING, AND I THINK WHEN
YOU HAVE A NURTURANT KIND OF
FAMILY OR SCHOOL OR COMMUNITY
ENVIRONMENT, THEN THE IDEA IS
THAT YOU DON'T HAVE TO ACCESS
YOUR NETWORK, IT'S JUST THERE.
YOU'RE JUST WALKING IN A NETWORK
THAT IS KIND OF, YOU KNOW,
AVAILABLE TO YOU.
AND THAT PHRASE LIKE PULLING UP
BY YOUR BOOTSTRAPS AND THAT
WHOLE THING, THERE SHOULD BE NO
PULLING, RIGHT?
LIKE, THERE SHOULD BE NO
PULLING.
AND SO THE IDEA IS THAT IN
SMALLER, MORE FACE-TO-FACE
COMMUNITIES, WHEN YOUR NERVOUS
SYSTEM IS REGISTERING THAT
THERE'S A WHOLE BUNCH OF
DIFFERENT PROTECTIVE FOLKS
AVAILABLE, RESILIENCE IS NOT
HAVING TO ASK YOURSELF WHAT AM I
GOING TO DO?
RESILIENCE IS HAVING THAT KIND
OF SOCIAL NETWORK AROUND YOU SO
THAT YOU DO NOT ASK THE
QUESTION.
THE MOMENT YOU START THINKING,
WHAT THE HELL AM I GOING TO --
GAME OVER.
RIGHT?
I THINK THAT'S ANOTHER
DIFFERENCE BETWEEN SOCIAL
SUPPORT AND SOCIAL SAFETY.
SUPPORT IS, OH, MY GOD, WHAT AM
I GOING TO DO, WHO AM I GOING TO
CALL?
SAFETY IS, YOU DON'T EVEN HAVE
TO ASK THE QUESTION BECAUSE YOU
JUST REACH OUT YOUR HAND, YOU
HAVE WARM PEOPLE WHO ARE GOING
TO BE THERE FOR YOU.
>> MY PERSPECTIVE IS THAT, YOU
KNOW, PEOPLE, I THINK, ARE
GENERALLY RESILIENT, AND I THINK
THE DANGER IN KIND OF LIKE THESE
CURRENT PUBLIC HEALTH NARRATIVE
AROUND JUST BUILDING RESILIENCE
HAS SOME DANGERS THAT COME ALONG
WITH THAT.
SO ONE, IT ASSUMES THAT
COMMUNITIES THAT WE LABEL AS SO
CALLED VULNERABLE ARE NOT
RESILIENT, WHEN WE'RE ACTUALLY
FINDING QUITE THE OPPOSITE, THAT
SOME OF THE MOST SO-CALLED
VULNERABLE COMMUNITIES ARE
ACTUALLY VERY RESOURCEFUL AND
VERY RESILIENT, YOU KNOW, AND SO
I THINK WHAT HAPPENS WHEN WE ARE
TALKING ABOUT THINGS LIKE RACISM
OR HOMOPHOBIA IS THAT WE ARE
CHALLENGING PEOPLE'S EXISTING
RESILIENCE, SO WE SHOULD REALLY
BE THINKING ABOUT HOW DO WE
CREATE SAFE ENVIRONMENTS OR MORE
RESILIENT SOCIAL CONTEXTS.
I THINK PEOPLE GENERALLY ARE
RESILIENT.
>> THANK YOU.
THOSE WERE GREAT.
>> IF I COULD JUST ADD ONE THING
TO THAT.
I WASN'T GOING TO SAY ANYTHING,
BUT I LOVE WHAT BOTH LISA AND
DAVID BOTH MADE COMMENTS ABOUT
THE IDEA OF RESILIENT
STRUCTURES, AND JUST TO KIND OF
APPLAUD THE PERSON WHO ASKED
THAT QUESTION, ONE OF THE
CHALLENGES WITH THIS IDEA OF
RESILIENCE IS THAT WE DON'T ALL
HAVE TO BE RESILIENT.
AND THE FACT THAT WE DON'T ALL
HAVE TO BE RESILIENT IS A
PROBLEM.
THAT NEED TO BE RESILIENT IS AN
ADDITIONAL BURDEN THAT CERTAIN
GROUPS CARRY AND OTHER GROUPS
DON'T.
SO THIS IDEA OF RESILIENT
STRUCTURES AND RESILIENT
NEIGHBORHOODS AND RESILIENT
COMMUNITIES IS REALLY INTENDED
SO THAT NONE CH US H OF US HAVEE
RESILIENT, THAT WE ARE ALL SET
UP IN CONDITIONS WHERE WE CAN
ALL THRIVE, AND THAT IS NOT THE
CASE.
SO GOING BACK TO THE PREVIOUS
QUESTION, HOW DO WE MEASURE
THAT, RIGHT?
LIKE, LET'S STOP MEASURING
RESILIENT AT THE INDIVIDUAL
LEVEL, AND REALLY FIGURE OUT,
FLIP THE QUESTION TO ONE OF
IMAGINING WHAT A WORLD MIGHT
LOOK LIKE IF WE ALL LIVED IN
RESILIENT COMMUNITIES, SO THAT
WE WEREN'T FORCED TO TAKE ON
THOSE ADDITIONAL BURDENS.
>> THANK YOU.
THAT WAS GREAT.
I DO HAVE ONE MORE QUESTION FROM
ZOOM, BUT I DON'T WANT MY
STANDING AT THE PODIUM TO
INTERFERE WITH ANYBODY WHO WANTS
TO ASK QUESTIONS FROM THE ROOM,
SO I'LL KEEP ASKING QUESTIONS
FROM ZOOM BUT IF YOU HAVE A
QUESTION IN THE ROOM, PLEASE --
GO AHEAD.
>> JUST TO PIGGY BACK ON THE PAM
AND CONSIDERING RESILIENCE, AND
HOW THE RACIAL STRUCTURES,
STRUCTURAL RACISM AND EQUITY,
WE'RE GOING TO NOW CONNECT THAT
WITH EQUITY, HOW DO WE -- I'M AN
EARLY INVESTIGATOR, I JUST
GRADUATED WITH MY PH.D.
HOW DO WE THEN APPLY THE
KNOWLEDGE THAT WE ALL SEEK, THAT
WE ALL HAVE, INTO THE
COMMUNITIES TO UNDERSTAND HOW WE
TIE THE CONNECTION BETWEEN WHAT
THE SCIENCE IS SAYING AND WHAT
THE COMMUNITY IS SEEING, IS
LIVING AND THRIVING, HOW DO WE
THEN TAKE THAT IMPLEMENTATION
AND PUT IT INTO THE COMMUNITIES?
AND THEN MY SECOND PART OF THAT
QUESTION IS, I'VE BEEN DABBLING
INTO ADVERSE CHILDHOOD EVENTS,
AND I THINK I LOVE -- DR. LISA,
I LOVE THAT, YOUR PRESENTATION,
I THINK THAT IS ALSO SOMETHING
WE SHOULD ALSO ASSOCIATE WHEN WE
CONSIDER EQUITY, COMMUNITY
RESILIENCE, AND THAT ALL
COMMUNITIES SHOULD NOT HAVE TO
TAKE ON THAT BURDEN.
HOW DO WE THEN ALLEVIATE AND
CLOSE THE GAPS BETWEEN THE
SCIENCE AND THE COMMUNITY?
THANK YOU.
>> THAT'S LIKE THE QUESTION I
ASK MYSELF EVERY DAY AT 3:00 IN
THE MORNING.
ONE OF THE THINGS THAT HAS SORT
OF SHIFTED IN ME SINCE I STARTED
DOING THIS WORK IS THAT IN
ALMOST ANY COMMUNITY, PEOPLE ARE
SO SOCIAL, THEY CANNOT HELP, YOU
KNOW, GLOMMING TOGETHER, AND I'M
NOW LOOKING FOR WAYS TO
CAPITALIZE ON WHAT HUMANS ARE
ALREADY DOING, SO FOR EXAMPLE,
IN SCHOOL SYSTEMS, I'VE TALKED
TO SOME OF THE SCHOOL SYSTEMS IN
SALT LAKE ABOUT, LIKE, YEAH,
THERE'S OFTEN LIKE ONE OR TWO
PARENTS WHO END UP BEING THE
PARENTS THAT OTHER PARENTS CALL
WHEN THEIR KID IS NOT DOING WELL
OR THEY COME OUT OR SOMETHING IS
GOING WRONG.
OFTEN THERE IS A SUPPORTIVE
OTHER THAT HAS A SHARED
EXPERIENCE THAT THEY CAN CONNECT
WITH.
THEN THE OTHER SCHOOL
ENVIRONMENTS, THERE AREN'T.
SO IT'S LIKE, WELL, WHEN YOU
FIND ONE OF THOSE PARENTS, WHEN
ONE OF THEM NATURALLY EMERGES,
CAN WE, LIKE, CAPTURE THAT
PERSON AND MAYBE COMPENSATE THEM
AND SAY, HEY, CAN WE ACTUALLY
HAVE YOU BE LIKE THE PARENT ON
CALL FOR THE NINTH GRADE CLASS?
LIKE, CAN EVERYONE IN THE SCHOOL
KNOW THEY HAVE ONE PHONE NUMBER
THAT THEY CAN CALL?
AND SO I THINK, YOU KNOW, IN
ADDITION TO INVESTING IN LARGE
SCALE STRUCTURE, WE NEED TO
THINK SMALL, WE NEED TO THINK
REALLY LOCAL.
OFTEN FOR KIDS WHO ARE EXPOSED
TO EARLY ADVERSITY, IT'S AMAZING
HOW CONSISTENT IT IS.
THEY'LL OFTEN SAY THERE WAS ONE
PERSON, ONE PROTECTIVE ADULT IN
THEIR LIFE WHO MADE THEM FEEL
THAT THEY MATTERED.
JUST ONE.
THE BIG DIFFERENCE IS BETWEEN
ZERO AND ONE.
SO WE MAY NOT BE ABLE TO FIX A
LOT OF THINGS, BUT CAN WE MAKE
IT EASIER FOR KIDS TO FIND THAT
ONE, AND MAYBE THAT ONE IS NOT A
THERAPIST, MAYBE IT'S A MUSIC
TEACHER, MAYBE IT'S A NEIGHBOR.
MAYBE IT'S -- WHO KNOWS?
BUT CAN WE LOOK FOR
OPPORTUNITIES TO ENHANCE THE
SORT OF SAFETY STRUCTURES THAT
HUMANS CAN'T HELP CREATING
EVERYWHERE.
AND FIND SORT OF SMALL SCALE
WAYS TO DO THAT.
>> I'LL JUST GIVE MY 2 CENTS
ABOUT ACES.
SO IN OUR BEWELL STUDY, WE DID
LOOK AT ACES AND DISEASE
ACTIVITY, AS ONE MIGHT
HYPOTHESIZE, WE SAW THIS
POSITIVE RELATIONSHIP BETWEEN
ACES AND DISEASE ACTIVITY, BULL
WBUTWHAT HAPPENED WHEN WE CONTRD
FOR ADULT TRAUMAS WAS THAT THE
EFFECT OF ACES WENT AWAY.
SO ADULT TRAUMA MEDIATED THE
RELATIONSHIP BETWEEN EARLY LIFE
ADVERSITY --
>> AND FOLKS WHO HAVE EARLY
ADVERSITY ARE MORE LIKELY TO
HAVE THE ADULT, SO IT ENDS UP
BEING LIKE A DOUBLE THING.
>> RIGHT, SO WHAT I WAS TRYING
TO SAY IS THAT, YOU KNOW, IT'S
ALIGNED WITH THIS IDEA OF STRESS
PROLIFERATION THEORY, RIGHT,
WHICH IS THAT EARLIER LIFE
STRESSORS GENERATE OR PUT YOU AT
RISK FOR LATER LIFE STRESSORS,
BUT SO I THINK THE IMPORTANCE OF
THOSE FINDINGS, THOUGH, IS THAT
WHILE WE CAN'T NECESSARILY UNDUE
TRAUMAS THAT HAPPENED EARLIER,
WE SHOULD TRY OUR BEST TO
INTERVENE LATER -- AT LATER
STAGES OF THE LIFE COURSE TO
PREVENT THOSE LATER LIFE TRAUMAS
THAT STEM FROM EARLIER LIFE
TRAUMAS.
GENERALLY SPEAKING, I DO THINK
THAT THERE IS SOMETHING TO
ACINGS.
ACESRES.
I THINK THESE EARLY CHILDHOOD
WILL EXPOSURES DO MATTER.
THEY PUT YOU ON A TRA JEK TRILL
TOWARDS GREATER RISK FOR WORSE
HEALTH BUT WITHIN THAT
TRAJECTORY, THERE'S SO MUCH
ROOM.
RIGHT NOW I THINK THE DISCOURSE
AROUND ACES IS A LITTLE BIT TOO
FATALISTIC FOR MY TASTES.
I THINK, AGAIN, THERE IS SO MUCH
ROOM IN THAT TRAJECTORY THAT
SOME OF THE THINGS THAT -- THE
HEALTH EFFECT ARE REVERSIBLE.
SO I THINK IF ANYTHING, IT'S
TELLING US THAT WE SHOULD
INTERVENE AND WE SHOULD DO
SOMETHING.
>> AND THEN IN RESPONSE TO THE
FIRST PART OF YOUR QUESTION
RELATED TO -- I HEARD IT AS
OTHER KNOWLEDGE.
I REMEMBER EARLY ON, I DON'T
REMEMBER IF I WAS A POSTDOC OR
AN ASSISTANT PROFESSOR AND I
WENT TO THE SOUTHWEST BERKELEY
HEALTH FORUM TO PRESENT -- TO
PRESENT MY RESEARCH, AND I
PRESENTED MY RESEARCH AND THEN A
WOMAN IN THE AUDIENCE STOPPED ME
AND SAID, YOU HAD TO DO A STUDY
TO FIGURE THAT OUT?
YOU COULD HAVE JUST CAME AND
ASKED US.
[LAUGHTER]
THE COMMUNITY KNOWS.
THEY KNOW WHAT WORKS AND THEY
KNOW WHAT DOESN'T WORK.
I'M CURRENTLY SERVING AS THE
DIRECTOR OF EVIDENCE FOR ACTION,
WHICH IS A NATIONAL PROGRAM OF
THE ROBERT WOOD JOHNSON
FOUNDATION FOCUSED ON REALLY
ADVANCING ACTION-ORIENTED
COMMUNITY ENGAGED RACIAL EQUITY
AND HEALTH RESEARCH, AND THIS
YEAR, WE ARE ENGAGING IN A
YEAR-LONG SERIES OF SYMPOSIA
TITLED "WAYS OF KNOWING."
AND THE WHOLE POINT OF THIS
SYMPOSIA IS TO, IN MY OWN WORD,
TO DECOLONIZE THE SCIENTIFIC
ENTERPRISE.
THE WAY THAT THE TRADITIONAL
GATEKEEPERS -- THE TRADITIONAL
GATEKEEPERS, AND I'M TALKING
ABOUT FUNDERS, I'M TALKING ABO
ABOUT -- WE'RE AT NIH.
FUNDERS, JOURNAL EDITORS, ET
CETERA, HAVE DETERMINED FOR US
WHAT IS KNOWLEDGE, WHAT AND
WHOSE KNOWLEDGE IS VALUED, SO
THIS EFFORT IS REALLY AN EFFORT
TO SAY THAT THE KNOWLEDGE IS OUT
THERE AND WE HAVE KEPT THAT
KNOWLEDGE AT BAY.
BECAUSE WE'VE DECIDED WHAT
KNOWLEDGE COUNTS.
SO WE HAD AN OPENING AT TULANE.
DAVID WAS THERE.
OUR NEXT ONE IS ON INDIGENOUS
WAYS OF KNOWING, AND REALLY
TRYING TO LEARN FROM TRADITIONAL
WAYS OF KNOWING HOW THAT OTHER
KNOWLEDGE CAN REALLY CONTRIBUTE
TO THE QUESTIONS THAT WE ALL
HAVE, TO THE ANSWERS THAT WE'RE
TRYING TO GENERATE.
AND SO YOU KNOW, MY HOPE IS THAT
SCIENCE WILL BE MORE -- THAT THE
SCIENTIFIC ENTERPRISE WILL BE
MORE OPEN TO OTHER WAYS OF
KNOWING.
AND WHEN I SAY OTHER, I DON'T
MEAN OTHERING LIKE IT OTHER.
I'M JUST SAYING, THEY'VE BEEN
KEPT OUT OF THE STORY.
AND BY DOING THAT, WE COULD ALL
DO ALL OFOURSELVES A DISSERVICES
OF TRYING TO FIGURE OUT NOT ONLY
WHAT THE PROBLEMS ARE, BUT WHAT
ARE THE SOLUTIONS, BECAUSE
AGAIN, COMMUNITIES KNOW, AND SO
JUST THE IMPORTANCE OF NOT JUST
DOING COMMUNITY ENGAGED WORK BUT
COMMUNITY-LED WORK, AND WE ALSO
HAVE A CURRENT CALL FOR
PROPOSALS THAT'S CALLED
INDIGENOUS-LED SOLUTIONS FOR
ADVANCING RACIAL EQUITY.
AND ONE OF OUR REQUIREMENTS IS
THAT THE GRANTS, THE PRIMARY
GRANTEE COMES FROM AN
INDIGENOUS-SERVING ORGANIZATION
OR SOMEONE WHO -- OR SOMEONE OR
AN ENTITY THAT IS A TRIBAL
ORGANORGANIZATION.
SO IT IS REALLY TO PUSH BACK AND
TURN ON ITS HEAD THE WAY WE
TRADITIONALLY THINK ABOUT
RESEARCH.
IT'S NOT JUST HAVING A CAB, IT'S
NOT JUST HAVING A COMMUNITY
ADVISORY BOARD THAT YOU MEET
WITH TWICE A YEAR AND GIVE THEM
$50.
THAT'S NOT WHAT COMMUNITY
ENGAGED OR COMMUNITY LED
RESEARCH IS.
>> I JUST WANT TO ADD MY 2
CENTS.
THE WAY I VIEW THE RELATIONSHIP
BETWEEN LIKE THE EPIDEMIOLOGIST
AND THE COMMUNITY IS KIND OF, I
THINK, ANALOGOUS TO THE DOCTOR
AND THE PATIENT RELATIONSHIP,
AND ALL OF THE DISTRUST AND THE
STEREOTYPING AND THE BIAS THAT
CHARACTERIZES PHYSICIANS AND
PATIENT RELATIONSHIPS IS
SIMILAR, I THINK, TO THE
EPIDEMIOLOGIST AND THE
COMMUNITY.
SO WHAT DO WE DO WITH -- YOU
KNOW, WHAT'S ONE OF THE WAYS WE
CAN ENHANCE THE
PHYSICIAN-PATIENT RELATIONSHIP?
BRING MORE PHYSICIANS OF COLOR
OR PHYSICIANS FROM MARGINALIZED
COMMUNITIES TO SERVE AS
PHYSICIANS, RIGHT?
SAME THING CAN BE SAID FOR, I
THINK, THE ACADEMIC ENTERPRISE
AND RESEARCH GENERALLY.
>> SO I BELIEVE WE'RE AT TIME.
DO WE HAVE TIME FOR ONE MORE
QUESTION, JENNA?
ARE YOU SURE?
OKAY.
GREAT.
WELL, PLEAS JOIN ME IN THANKING
THE PANEL ONE MORE TIME, AND
THEN WE'LL MOVE ON.
[APPLAUSE]
>> THANKS FOR RETURNING AFTER
THAT QUICK BREAK.
I'M BILL ELMWOOD FROM THE
NATIONAL INSTITUTE OF DENTAL AND
CRANIOFACIAL RESEARCH.
I'D LIKE TO POINT OUT WE'VE
TALKED A LOT ABOUT RESILIENCE
TODAY AND YESTERDAY.
THERE ARE MANY WAYS OF
CONCEPTUALIZING THAT.
AND ANOTHER THAT MAY NOT HAVE
COME UP IS THE NIH-WIDE NETWORK
TO COORDINATE RESILIENCE ON
RESEARCH.
THEY HAVE A WEBSITE HOSTED BY
THE OFFICE OF DIETARY
SUPPLEMENTS.
LAST YEAR THEY PUT OUT A SPECIAL
ISSUE ON THIS.
SO WHEN YOU ARE LOOKING FOR WAYS
OF KNOWING AND CONCEPTUALIZATION
AND PERHAPS FUTURE NOFOs, DO
CHECK THAT OUT.
IT MIGHT BE ANOTHER RESOURCE FOR
YOU.
MORE IMPORTANTLY, THOUGH, IS OUR
PANEL ON BIOBEHAVIORAL
MECHANISMS WITH OUR
DISTINGUISHED VISITING SCHOLARS,
DRS. ALVAREZ AND DIE A LOW.
FIRST IS DR. GABRIELLA ALVAREZ
FROM THE UNIVERSITY OF
PITTSBURGH.
>> OKAY.
THANK YOU ALL SO MUCH FOR HAVING
ME.
MY NAME IS GABRIELLA ALVAREZ.
I AM A JUNIOR FACULTY AT THE
UNIVERSITY OF PITTSBURGH,
PARTICULARLY WITHIN THE
BIOLOGICAL AND HEALTH PSYCHOLOGY
PROGRAM THERE.
I AM VERY EXCITED TO BE HERE
SPEAKING ON SOME OF MY WORK
REGARDING THE NEURAL PROCESSES
LINKING RACISM AND HEALTH.
AND I JUST WANT TO BRIEFLY ADD
SORT OF APPRECIATION AND
GRATITUDE FOR BEING HERE TODAY,
I'M A BLACK LATINA AND I'M
SHARING THE STAGE WITH SOME OF
MY HEROS, IT HAS BEEN SUCH A
WONDERFUL EXPERIENCE, ESPECIALLY
AS THIS WORK HASN'T ALWAYS
NECESSARILY BEEN SUPPORTED.
SO I WANT TO SORT OF BEGIN --
YOU MIGHT HAVE SEEN THIS DIAGRAM
ALREADY BEFORE ON A DISCUSSION
OF A REVIEW THAT I DID WITH SOME
OF MY COLLABORATORS IN WHICH WE
LOOKED AT THE PATHWAYS LINKING
BRAIN AND BODY AND HOW THAT
MIGHT BE ALTERED VIA EXPERIENCES
OF RACISM AND DISCRIMINATION.
AND WHILE WALKING THROUGH THE
FULL PAPER AND SORT OF THE
DISCUSSION THERE, I WANT TO JUST
POINT TO THE PARTICULAR INTEREST
THAT I HAVE AND WHAT I BROUGHT
TO THIS CONVERSATION, BUT REALLY
LOOKING AT THE ROLE THAT THE
BRAIN PLAYS IN TRANSLATING
INEQUALITY TO HEALTH, AND HOW
THAT MIGHT SORT OF FEED THE
ORGAN THAT'S SORT OF INTERFACING
WITH OUR EXTERNAL WORLD AND
POTENTIALLY SORT OF LEADING TO
THESE MOLECULAR CHANGES THAT
HAVE RELEVANCE FOR HEALTH.
AND SO BEFORE I SORT OF GET INTO
PRESENTING THE NITTY GRITTY OF
THE DATA ANTITHE RESULTS I THINK
IT'S IMPORTANT FOR ME TO DISCUSS
SOME OF THE THEORETICAL
BACKGROUND, SORT OF THE IDEAS
THAT HAVE FORMED A LOT OF MY
THINKING HERE.
ONE OF THOSE -- I GUESS YOU
CAN'T SEE THE CITATIONS AT THE
TOP BUT THESE ARE PREDOMINANTLY
SUPPORT BID PETER STERLING,
WHICH YOU'VE HEARD ABOUT AL
STASIS, AND ALSO LISA FELDMAN
BARRETT AND KAREN QUIGLEY AS
WELL, BUT THINKING ABOUT THE
BRAIN AS ENGAGING IN PREDICTION
TO MANAGE ALLOSTASIS.
SO WHEN I MEAN PREDICTION, THIS
SORT OF IS COUNTERACTING A LOT
OF THE SORT OF COMMON
CONCEPTIONS OF HOW WE THINK THE
BRAIN WORKS.
OFTENTIMES WE'RE THINKING THAT
IT'S VERY REACTIVE, WE MIGHT SEE
A STEAK AND OUR BRAIN OR
AMYGDALA IS SORT OF RESPONDING
TO THAT, BUT REALLY CONSENSUS IS
GROWING IN NEUROSCIENCE THAT
SUGGESTS THAT IT'S REALLY ABOUT
THE FACT THAT OUR BRAIN IS SORT
OF PREDICTING AND MODELING THAT
INFORMATION BEFORE WE'RE COMING
INTO CONTACT WITH THAT.
SO THE REASON THE BRAIN MIGHT BE
DOING THAT IS SO THAT IT CAN
MAKE PROCESSES MORE EFFICIENT
AND SO THAT YOU HAVE THE
PHYSIOLOGICAL AND METABOLIC
RESOURCES IN ORDER TO DO SO.
SO SOMETIMES I THINK IT'S
HELPFUL TO HAVE AN EXAMPLE TO
SORT OF DISTINGUISH THIS, BUT
LET'S SAY WE'RE IN TRAFFIC AND
EVEN BEFORE THE CAR IN FRONT OF
YOU IS POTENTIALLY BRAKING, YOU
MIGHT BE SLOWING DOWN BECAUSE
YOU'RE EXPECTING THAT IT WILL
HAPPEN BASED OFF OF THE TRAFFIC
PATTERNS THAT YOU'RE SEEING.
SO THIS IS HELPFUL BECAUSE
YOU'RE SORT OF PREPARING TO
REACT QUICKLY, AND THAT'S
HAPPENING EVEN BEYOND CONSCIOUS
AWARENESS.
AND THIS IS ADVANTAGEOUS TO DO
SO.
IT'S IMPORTANT IN SORT OF THIS
UNDERSTANDING OF THE BRAIN AS
PREDICTION IS IT'S NEEDING TO
UTILIZE THIS INFORMATION IN
ORDER TO MANAGE ALLOSTASIS, AND
ALLOSTASIS IS, I THINK, OUR
PRIOR PANEL I THINK WAS SORT OF
DISCUSSING BEAUTIFULLY WITH THE
GRAPHS AND CONVERSATIONS ABOUT
ALLOSTASIS AS SORT OF THE
PROCESS IN WHICH THE BODY IS
SORT OF MOUNTING THE
PHYSIOLOGICAL RESPONSE TO REACT
TO THESE STRESSORS.
AND SO IT'S THE BODY'S NEED TO
SORT OF FACILITATE BEHAVIOR AND
PHYSIOLOGICAL CHANGES TO MEET
THOSE DEMANDS.
AND IT'S DOING THIS BY UTILIZING
OUR PRIOR EXPERIENCES OR OUR
EXPERIENCES RELATING TO HISTORY,
AS WELL AS THE INTERNAL
PHYSIOLOGICAL SIGNALS WITHIN OUR
BODY.
I THINK IT'S ALSO IMPORTANT TO
REMEMBER THAT THE BRAIN IS A
VERY RESOURCE-INTENSIVE ORGAN.
IT REALLY REQUIRES A LOT OF
GLUCOSE AND OXYGEN IN ORDER TO
FUNCTION, AND THAT'S NEEDED FOR
THE BRAIN TO PROCESS ALL OF THE
COGNITIVELY DEMANDING
INFORMATION AS WELL AS OUR
PHYSIOLOGY AND IN ADDITION TO
ALL THE OTHER ORGANS AND OTHER
RESOURCES THAT WE'RE HAVING.
SO THIS IS SORT OF SOME OF THE
IDEAS SO HOPEFULLY SORT OF HAVE
YOU ALL IN LINE TO SORT OF HOW
I'M APPROACHING THESE QUESTIONS
AND HOW I'M THINKING ABOUT THESE
PROCESSES IS THAT THE BRAIN IS
NOT REACTIVE BUT PREDICTIVE IN
NATURE.
ALL RIGHTY.
AND SO I THOUGHT IT WOULD BE
HELPFUL TO SORT OF WALK THROUGH
THE PARTICULAR TASK THAT I'LL BE
TALKING ABOUT IN MY PRESENTATION
TODAY WITH SORT OF THIS LITTLE
EXAMPLE, SO HERE WE HAVE TRISH
AND SHE IS REPRESENTED BY THIS
MEMORY BUBBLE OR THOUGHT BUBBLE
THAT SHE'S HAD POTENTIAL
EXPERIENCES OF LIFETIME
DISCRIMINATION.
LET'S SAY THAT SHE IS WALKING
DOWN THE STREET, AND UPON HER
TRAVELS, SHE COMES INTO CONTACT
WITH AN INDIVIDUAL.
HOW MIGHT HER BRAIN BE SORT OF
RESPONDING OR PREPARING TO
RESPOND WITH THIS INTERACTION?
SO SOME OF THE PSYCHOLOGICAL
LITERATURE WOULD SUGGEST THAT
GENERALLY IF TRISH HAS
ENCOUNTERED DISCRIMINATION IN
HER EXPERIENCES SHE MIGHT JUST
BE VIGILANT.
SO WE HAD THESE CONVERSATIONS
ABOUT MAYBE IT'S MORE ABOUT SORT
OF THAT REACTION TO THAT EVENT
OR REACTION TO THAT PARTICULAR
EXPERIENCE.
AND THAT SHE MIGHT BE SURVEYING
OR BEING VIGILANT FOR NOT VERBAL
AND VERBAL CUES OF PREJUDICE.
BUT THERE'S OTHER WORK THAT
SUGGESTS THAT THIS REACTION OR
THIS SORT OF PREPARATION OF THE
BRAIN MIGHT BE MORE NUANCED AND
THAT DISCRIMINATION MIGHT NOT BE
PROMOTING THIS GENERALIZED
THREAT VIGILANCE BUT REALLY THAT
AFFECTIVE CONTEXT MATTERS.
SO MAYBE POTENTIALLY AFTER SORT
OF EXPOSURE TO A NEGATIVE OR
STEREOTYPE-RELEVANT CUE, PERHAPS
LIKE A BARKING DOG THAT I HAVE
HERE, SHE MIGHT THEN BE MORE
VIGILANT OR THREAT-RESPONSIVE TO
THOSE SOCIAL INTERACTIONS AND
THOSE SOCIAL QUEUES.
SO IN THIS PARTICULAR STUDY I'LL
BE DISCUSSING, WE WANTED TO SORT
OF MODEL THIS SOCIAL COGNITIVE
PROCESS TO SORT OF GET AT SOME
OF THESE REACTIONS TO BE ABLE TO
CAPTURE THIS VIGILANCE IN THE
MOMENT.
SO THESE DATA ARE COMING FROM
THE -- THE SLIDE THAT WE'RE
DOING IS LOOKING AT AN AFFECTIVE
SPILLOVER TASK IN WHICH
PARTICIPANTS WERE IN THE
SCANNER, THEY WERE EXPOSED TO
THREE DIFFERENT CONDITIONS THAT
WE HAD NEGATIVE, NEUTRAL AND
POSITIVE CONDITIONS.
AND IN THIS SORT OF SETUP, I'LL
WALK YOU THROUGH ONE PARTICULAR
TRIAL, WOULD BE EXPOSURE TO A
NEGATIVE IMAGE, SO THIS IS AN
EVOCATIVE, COMPLEX NEGATIVE
IMAGE BASED OFF OF NORM STIMULI
CALLED THE IOX IMAGE, THEN A
NEUTRAL FACE WAS SPONTANEOUSLY
DISPLAYED FOR ABOUT HALF A
SECOND.
THESE NEUTRAL FACES SORT OF
SERVE AS THIS AMBIGUOUS CUE THAT
THE PARTICIPANT IS SORT OF
RESPONDING TO.
AND SO FOR THE NEUTRAL AND
POSITIVE CONDITIONS, SIMILARLY,
WE HAVE THESE IAP IMAGES THAT
WE'RE SEEING ARE EITHER NEUTRAL
IN CONTEXT OR POSITIVE HERE.
AND PARTICULARLY FOR THIS
ANALYSES AND THESE QUESTIONS
THAT I HAVE WAS REALLY
INTERESTED IN HOW SORT OF THE
BRAIN IS PROCESSING THE
AMBIGUOUS STIMULI, THESE
AMBIGUOUS SOCIAL CUES OF THESE
NEUTRAL FACE DISPLAYS,
PARTICULARLY BASED OFF OF YOUR
PRIOR EXPERIENCES WITH
DISCRIMINATION.
SO YOU MIGHT BE WONDERING, OKAY,
GABBY, YOU SAID YOU'RE GOING TO
BE TALKING ABOUT THE BRAIN, WHAT
PART?
SO I JUST WANTED TO SORT OF
INTRODUCE A SYSTEM, A NEURAL
SYSTEM IN WHICH I SPEND A LOT OF
TIME THINKING ABOUT AND SORT OF
ANALYZING, BUT IT'S SORT OF A
SET OF REGIONS THAT ARE THOUGHT
TO SORT OF INTEGRATE OUR PRIOR
EXPERIENCES, SO SORT OF OUR
MEMORY, OUR HISTORIES, OUR PAST.
IN ADDITION TO NETWORKS THAT ARE
INVOLVED IN INTERNAL STIMULI,
SORT OF PROCESSING THE
INFORMATION IN OUR BODY, SORT OF
HOW EVERYTHING IS DOING, AS WELL
AS EXTERNAL STIMULI, SO WHAT
EXACTLY I'M SEEING OR ENGAGING
WITH.
AND SO THIS SET OF NETWORKS IS
CALLED THE ALLOSTATIC INTERROW
ACCEPTIVE SYSTEM.
THIS IS LARGELY INSPIRED BY LISA
FELDMAN BARRETT IN WHICH SHE
SORT OF -- WE DISCUSS HOW THESE
REGIOREGIONS ARE HELPING TO REGE
PHYSIOLOGICAL PROCESSES IN THE
SYSTEM BUT ALSO ENGAGING WITH
SORT OF OUR PRIOR CONTEXT.
THIS CONSISTS OF WHAT YOU MIGHT
HAVE HEARD OF BEFORE CALLED THE
DEFAULT MODE NETWORK IN ADDITION
TO THE SALIENCE NETWORK OR
FRONTAL ATTENTION NETWORK, AND
ALTHOUGH THESE ARE SOME -- SOME
NAMES FOR THESE NETWORKS,
THERE'S LOTS OF OTHER SORT OF
DISTINCTION, BUT I'M USING THESE
BECAUSE THEY'RE THE MOST
COMMONLY REFERENCED NETWORKS
THAT MIGHT BE IMPORTANT HERE.
AS WELL AS SIGNALS FROM THE
SUBCORTICAL REGION, SO THE MOST
COMMONLY EXPLAINED ONE HERE
WOULD BE THE AMYGDALA, HIPPO
CAMPUS, FOR EXAMPLE.
SO THIS BRAIN SYSTEM IS WHAT I
WAS PARTICULARLY INTERESTED IN
TO SEE HOW THIS SYSTEM IS SORT
OF PREPARING TO RESPOND TO
INFORMATION.
SO THESE DATA WERE BASED OFF OF
THE NEUROSCIENCE REFRESHER
SAMPLE FROM THE MIDAS DATASET
AND PARTICIPANTS REPORTED
EXPOSURES TO DISCRIMINATION
BASED OFF OF THE EVERYDAY SCALE,
WHICH WE'VE HEARD DISCUSSED
QUITE A FEW TIMES, AS WELL AS
THE MAJOR EXPERIENCES OF
DISCRIMINATION, SO THIS IS MORE
OF A LIFETIME MEASURE, IN
ADDITION TO PROVIDING
INFORMATION ABOUT THE SOURCE OF
THAT DISCRIMINATION.
AND SO WE WERE PARTICULARLY
INTERESTED IN LOOKING AT THE
UNIQUE EFFECT OF RACIAL
DISCRIMINATION, GIVEN THE
CONTEXTUAL AND HISTORICAL
CONTEXTS THAT MANY HAVE SO
ELOQUENTLY DESCRIBED WHILE I
DEFINITELY AGREE THAT
DISCRIMINATION GENERALLY IS
REALLY IMPORTANT AND IMPACTFUL
AND WE'VE SEEN SORT OF THAT
RELEGATED, I REALLY WANTED TO BE
ABLE TO HONE IN ON WHAT THOSE
PARTICULAR EXPERIENCES MIGHT BE
BASED OFF OF THESE PRIOR RACIAL
EXPERIENCES.
SO IN ORDER TO BE ABLE TO
ISOLATE THAT, ONE METHODOLOGICAL
APPROACH I'VE TAKEN HERE IS THAT
WE'VE INCLUDED BOTH THE BLACK
PARTICIPANT SAMPLE AS WELL AS
INDIVIDUALS WITHIN -- THERE WERE
MOSTLY ONLY BLACK AND WHITE
INDIVIDUALS IN THE PARTICULAR
NEUROSCIENCE REFRESHER DATASET,
BUT OF THE WHITE PARTICIPANTS
THAT REPORTED ANY DISCRIMINATION
EVENTS, WE EXCLUDED THOSE WHO
REPORTED RACE AS A PRIMARY
SOURCE OF DISCRIMINATION JUST
BECAUSE OF THE SORT OF INTERNAL
VALIDITY THERE IN TERMS OF
COMPARING BETWEEN GROUPS AND THE
LACK OF HISTORICAL CONTEXT TO
SUPPORT SEEING THAT THEY
FUNCTION EXACTLY THE SAME
BETWEEN THESE TWO GROUPS.
WHAT I WANTED TO EXPLORE IS THIS
SORT OF INTERACTION EFFECT, DO
WE SEE THAT THE INTERACTION AND
EXPOSURE TO DISCRIMINATION BY
RACE IS SIGNIFICANTLY DIFFERENT
ON THESE NEURAL PATHWAYS.
AND THEN IF YOU'RE CURIOUS, THE
SAMPLE CHARACTERISTICS HERE
SUGGEST THAT THERE ARE
SIMILARITIES BETWEEN THE WHITE
AND BLACK SAMPLE WHERE THEY HAD
SIMILAR LEVELS OF EDUCATION,
INCOME, AGE, AND ALSO MOTION IN
THE SCANNER, WHICH IS A VERY
IMPORTANT COVARIATE IN OUR
ANALYSES.
ALL RIGHT.
SO NOW SORT OF HERE, WHAT I WANT
TO SORT OF DEMONSTRATE IS THAT
BECAUSE WE ARE PARTICULARLY
INTERESTED IN THE REACTIVITY
DURING THE FACES, WHAT I DID IS
I COMPARED ACTIVITY WITHIN THE
ALLOSTATIC INTEROCEPTIVE SYSTEM,
PRECEDED BY A NEGATIVE IMAGE
VERSUS NEUTRAL, AND PLOTTED SORT
OF DISCRIMINATION EXPOSURE BY
RACIAL GROUP.
AND WHAT WE SEE HERE IS THAT
WITHIN THE FULL SAMPLE, ONLY
LIFETIME DISCRIMINATION WAS
SIGNIFICANTLY ASSOCIATED WITH
INCREASED CONNECTIVITY TO THOSE
NEGATIVE VERSUS MUTUAL -- FACES
FOLLOWING VERSUS NEUTRAL IMAGES
IN THE BLACK GROUP, SO THE BLUE
LINE ARE THE WHITE PARTICIPANTS
IN THE SAMPLE AND THE YELLOW
LINE IS THE BLACK PARTICIPANTS
NAT SAMPLE.
WE REALIZE THE SAMPLE SIZE IS
SMALL SO HOPEFULLY EXCITING TO
HAVE FUNDERS INTERESTED IN THESE
CONVERSATIONS TO HELP FUND THE
VERY EXPENSIVE FEES ASSOCIATED
WITH SCANNING THE PEOPLE.
AND WE ALSO, AS WE ALSO TALKED
ABOUT THE IMPORTANCE OF
POSITIVITY, I THINK YOUR TALK
WAS WONDERFUL FOR SETTING UP A
LOT OF THE THINKING AND
FORMULATION AROUND SOME OF THESE
IDEAS HERE, BUT ALSO WANTING TO
CONSIDER POSITIVE CONTEXTS IN
WHICH THE SOCIAL COGNITIVE
PROCESSES MIGHT BE INVOLVED, AND
THERE'S NO WORK THAT HAS LOOKED
AT THIS PARTICULARLY AS IT
RELATES TO DISCRIMINATION.
SO INTERESTINGLY, WE ALSO FOUND
THAT THE ALLOSTATIC
INTEROCEPTIVE SYSTEM WAS
ASSOCIATED WITH INCREASED
CONNECTIVITY AS WELL TO FACES
FOLLOWING THE POSITIVE STIMULI
AS COMPARED TO THE NEUTRAL, AND
THIS ASSOCIATION AGAIN HAPPENS
BY RACE GROUP SO THAT WE'RE
SEEING THAT THOSE INDIVIDUALS
WHO REPORT GREATER RACIAL
DISCRIMINATION, BLACK
INDIVIDUALS ARE DEMONSTRATING
HIGHER CONNECTIVITY IN THIS
NETWORK.
ALL RIGHTY.
SO I THINK WHAT'S IMPORTANT HERE
IS TO RECOGNIZE THAT SORT OF
LIFETIME EXPERIENCES AND
HISTORICAL CONTEXTS ARE SHAPING
THE BRAIN AND SHAPING OUR FUTURE
INTERACTIONS WITH SOCIAL CUES
AND SOCIAL INDIVIDUALS IN OUR
ENVIRONMENT, BOTH WITHIN
NEGATIVE AND POSITIVE CONTEXTS,
SUGGESTING THIS SORT OF NEED TO
SORT OF BE RESPONSIVE, ATTUNED,
ALERT, TO ALL SORT OF AMBIGUOUS
CUES IN PREPARATION FOR ACTION.
AND I THINK THIS IS -- I'M ALSO
REALLY EXCITED TO BE ABLE TO
MAKE A COMMENT ABOUT THE
SPECIFICITY OF RACIAL
DISCRIMINATION WITHIN THE NEURAL
IMAGING LITERATURE HERE, AND
THEN FINALLY I THINK THAT THE
IMPORTANCE OF THE NETWORKS AND
THE REGIONS HERE IS REALLY
POWERFUL, AND THAT THERE'S BEEN
LOTS OF CONVERSATIONS
POTENTIALLY ABOUT THE AMYGDALA
OR THE MEDIAL PREFRONTAL CORTEX
OR SORT OF REGIONS IN ISOLATION
BUT THERE'S BEEN A LOT OF SORT
OF EXPANSION IN OUR THINKING
HERE SORT OF THE CONSOLATION OF
CONNECTIVITY BETWEEN THESE
REGIONS AND HOW IN THE WOA AND
SORT OF THE BRAIN IS FUNCTIONING
IN REALTIME THAT REALLY MATTERS.
SO I WANT TO TOUCH ON THIS A
LITTLE BIT WITH ANOTHER STUDY
THAT I'VE ALSO RECENTLY
PUBLISHED THAT LOOKED AT ANOTHER
FORM OF MARGINALIZATION THAT'S
IMPORTANT AND SOMETHING THAT I
STRONGLY CONSIDER WHICH IS
SOCIOECONOMIC POSITION.
IN THIS STUDY, I WAS REALLY
INTERESTED IN LOOKING AT OTHER
FORMS OF MEASURING NETWORK
COMMUNICATION.
SO IN THE PRIOR CITY WHAT I
REALLY SHOWED YOU WAS THAT WHEN
ONE REGION IS ACTIVATED THERE'S
INCREASED ACTIVITY IN OTHER SETS
OF REGIONS THAT SORT OF
INFLUENCE ACTIVITY, BUT HERE I
REALLY WANTED TO LOOK AT SORT OF
THE INFORMATION FLOW BETWEEN
REGIONS, SO NOT JUST IF YOU GO
UP, THIS OTHER REGION GOES UP
BUT SORT OF HOW IS INFORMATION
TRAVELING, SO THINKING ABOUT
LIKE A WIFI NETWORK OR ANY OTHER
SORT OF LARGER NETWORKS HERE.
SO THESE ANALYSES USE THEORY
GRAPH METRICS AND PARTICULARLY
WAS INTERESTED IN GLOBAL
EFFICIENCY, A MEASURE OF HOW
EFFICIENTLY A NETWORK IS WORKING
OND HOW QUICKLY INFORMATION IS
PASSING THROUGH THAT NETWORK,
AND WHAT'S IMPORTANT IN THE
NETWORK NEURAL SCIENCE
LITERATURE AND NETWORK ACTUALLY
SCIENCE IN GENERAL IS
UNDERSTANDING THAT THERE IS SORT
OF A NEED TO BALANCE EFFICIENCY
WITH COSTS.
SO I THINK IT'S HELPFUL TO HAVE
THESE DEPICTIONS A LITTLE BIT
HERE, BUT LET'S SAY THIS IS --
THESE ARE BRAINS AND THE LITTLE
RED DOTS ARE NODES OR PARTICULAR
REGIONS WITHIN THE BRAIN.
SO WHAT WE SEE HERE ON THE LEFT
MOST IMAGE, THESE IMAGES WERE
BASED OFF SOME OF THE BEAUTIFUL
WORK THAT BULLMORE AND SPORENCE
HAS PUT TOGETHER.
SO SHOUT OUT TO THEM.
SO ON THE GRAPH ON THE LEFT, YOU
SEE THAT THIS BRAINNET WORK OR
THIS GRAPH HAS VERY LOWY LOW
EFFICIENCY.
SO IN ORDER FOR ME TO GET TO THE
NODE AT THE VERY FRONT OF THE
BRAIN TO THE NODE OR RED DOT ALL
THE WAY AT THE BACK OF THE
BRAIN, I HAVE TO PASS THROUGH
EACH INDIVIDUAL PATH THERE,
WHICH AS YOU CAN IMAGINE IS VERY
SLOW AND VERY INEFFICIENT.
VERSUS THE BRAIN HERE ON THE
RIGHT, IN ORDER FOR ME TO GET TO
THE NODE AT THE FRONT OF THE
BRAIN TO THE BACK OF THE BRAIN,
IT'S A LOT EASIER BECAUSE THERE
ARE LONGER RANGE CONNECTIONS TO
MAKE -- TO BE ABLE TO SORT OF
CUT THROUGH TRAFFIC IN THAT WAY.
SO I LIKE TO SORT OF THINK OF IT
AS LOCAL STREETS VERSUS
HIGHWAYS.
BUT WHAT'S ALSO IMPORTANT TO
CONSIDER IS THAT IT TAKES --
IT'S VERY EXPENSIVE ON THE BODY
TO BE ABLE TO UPHOLD AND SORT OF
MAMAINTAIN THESE VERY LONG-RANGE
CONNECTIONS.
WE NEED MORE RESOURCES, MORE
GAS, IF YOU WILL, IN ORDER TO
MAKE THESE LONGER DISTANCES.
HOPEFULLY THAT MAKES A LITTLE
BIT OF SENSE HERE, BUT THAT'S
SORT OF MY THINKING AROUND
EFFICIENCY.
SO IN THIS SPOILER HERE, WE HAVE
SOCIOECONOMIC POSITION ON THE X
AXIS, AND ON THE Y AXIS, WE HAVE
THE GLOBAL EFFICIENCY OF THIS
NETWORK HERE.
SO WHAT WE SEE IS THAT AT LOWER
LEVELS OF SOCIOECONOMIC POSITION
AS MEASURED VIA INCOME AND
EDUCATION, WE'RE SEEING HIGHER
LEVELS OF GLOBAL EFFICIENCY, WE
IS REALLY INTERESTING
PARTICULARLY IN THE COGNITIVE
NEUROSCIENCE LITERATURE, BECAUSE
HIGHER EFFICIENCY IS OFTEN
RELATED WITH HIGHER
INTELLIGENCE, AND SORT OF MORE
SOPHISTICATED COGNITIVE
PROCESSING, SO THIS POTENTIALLY
GOES AGAINST OR IS
COUNTERINTUITIVE OR SOME FOLKS
ARE LIKE, THAT'S VERY
COUNTERINTUITIVE.
BUT IT'S POTENTIALLY NOT,
BECAUSE, ONE, THIS FINDING
SUGGESTS THAT THIS INFORMATION
IS TRAVELING MORE QUICKLY
THROUGHOUT THIS NETWORK FOR
THOSE OF LOWER SOCIOECONOMIC
POSITION, WHICH IS IMPORTANT IF
YOU ARE CONSTANTLY NEEDING TO
SURVEY OR SORT OF MAKE SENSE OF
AMBIGUITY THROUGHOUT YOUR
ENVIRONMENT.
SO HAVING A NETWORK THAT IS FAST
ACTING, QUICK, AND IS ABLE TO
RESPOND AND MOBILIZE RESOURCES
FOR THOSE PROCESSES IS REALLY
GREAT AND IMPORTANT.
BUT AS YOU CAN IMAGINE, SORT OF
THE SUSTAINED ACTIVITY OR THE
SUSTAINED ACTIVATION OF THIS
HIGH EFFICIENCY COULD BE
METABOLICALLY COSTLY.
NOW, ALL OF THESE SORT OF IDEAS
ARE SORT OF THE TRAJECTORY IN
WHERE I HOPE TO GO WITH MY
RESEARCH AND BEING TO REALLY BE
ABLE TO PROBE SORT OF THE ENERGY
UTILIZATION.
THERE IS SOME WORK THAT I'VE
PUBLISHED ALSO THAT'S LOOKED AT
REGIONS WITHIN THIS NETWORK AND
HOW IT RELATES TO INFLAMMATION
AND HOW THAT'S ALSO RELATED TO
CHANGES AS WELL.
SO GENERALLY WE'RE SEEING
THERE'S NEURAL SENSITIVITY TO
AFFECTIVE CUES BASED OFF OF SORT
OF PEOPLE'S PRIOR EXPERIENCES,
THE CONTEXT IN WHICH THEY'VE
GROWN UP, AND THAT THAT COULD
POTENTIALLY BE METABOLICALLY
COSTLY SO WE NEED SOME WORK TO
BE ABLE TO EXPLORE THESE
QUESTIONS.
AND JUST TO BRIEFLY WRAP UP
HERE, I JUST WANTED TO GIVE YOU
SOME SORT OF OVERALL CONCLUS
CONCLUSIONS, RIGHT?
SO OKAY, GREAT, WHAT DO WE DO
WITH THIS?
SO I WANT TO SORT OF COMMENT
THAT BY SETTI STUDYING THE BRAIE
CAN START TO TEASE APART AND
UNDERSTAND HOW THESE SOCIAL
FACTORS CAN BE CONTRIBUTING TO
HEALTH INEQUITIES AND HOW IN THE
MOMENT PROCESSES MIGHT BE
AFFECTING PHYSIOLOGICAL
PROCESSES, AND THEN ALSO
PROVIDING -- THIS IS SORT OF
WHAT I JUST SAID IN TERMS OF
THAT STUDYING WITH AN AFFECTIVE
CONTEXT IS REALLY IMPORTANT IN
SORT OF EXTENDING BEYOND JUST
BASELINE LEVELS OF BRAIN
ACTIVITY.
I THINK LOTS OF THE SCIENCE THAT
WE HAVE HAS PROBABLY LOOKED AT
RESTING SAFE DATA IN WHICH FOLKS
ARE NOT REALLY DOING ANYTHING IN
THE SCANNER BUT THE AMOUNT OF
VARIABILITY THAT'S HAPPENING IN
THE SCANNER DURING THAT TIME, IT
MAKES IT MORE DIFFICULT TO DRAW
CONCLUSIONS ABOUT SORT OF
RELEVANT PROCESSES THAT COULD BE
AFFECTING US IN OUR DAY TO DAY.
AND I'M EXCITED TO BE ABLE TO
ESTABLISH THAT THE SYSTEM IS
ASSOCIATED WITH SOCIAL
EXPERIENCES AND PRIOR WORK WITH
INFLAMMATION, AND REALLY
THINKING ABOUT THE COMMUNICATION
BETWEEN NETWORKS I THINK IS A
REALLY IMPORTANT NEXT STEP FOR
THIS AREA OF RESEARCH, AND
REALLY THINKING ABOUT NOT JUST
THESE REGIONS MATTER, BUT HOW IS
IT THAT THE COMMUNICATION AND IN
WHAT SPACES THESE REGIONS ARE
ACTIVATING THAT MAY BE REALLY
IMPORTANT FOR THINKING ABOUT
PHYSIOLOGICAL PROCESSES.
THANK YOU SO MUCH FOR BEARING
WITH ME THROUGH ALL OF THE FUN
BRAIN DATA THAT I PRESENTED AND
I ALSO WANT TO THANK MY M
GRADUATE ADVISER, KEELY
MUSCATELL AS WELL AS ALL OF THE
FUNDERS AND GROUPS OF FOLKS WHO
HAVE SUPPORTED ME THROUGHOUT
THIS PROCESS.
[APPLAUSE]
>> PERFECT, GABBY.
WHILE ANA GETS SET UP, THEY
ALREADY -- SPEAKERS ALREADY
KNOW, BUT I THOUGHT I'LL ADVISE
YOU THAT THEY HAVE FIRST DIBS ON
PROVIDING COMMENTS AND QUESTIONS
TO ONE ANOTHER, AND THEN WE'LL
TURN IT OVER TO YOU ALL.
THANK YOU.
>> ALL RIGHT.
HI, EVERYONE.
MY NAME IS ANA DIALLO, CURRENTLY
ASSISTANT PROFESSOR AT VIRGINIA
COMMONWEALTH UNIVERSITY SCHOOL
OF NURSE, AND IT'S AN HONOR TO
BE HERE NEXT TO ANOTHER AFER ROW
AFROLATINA.
I'M A NURSE, A COMMUNITY HEALTH
NURSE BUT AT THE SAME TIME ALSO
A PUBLIC HEALTH RESEARCHER AND
REALLY THESE TWO ARE THE DRIVERS
OF WHAT I DO, AND I'M VERY
EXCITED AND HONORED TO BE HERE,
HEARING ABOUT EXPERTISE IN AN
AREA OF SCIENCE THAT IS NEAR AND
DEAR TO MY HEART.
SO I AM GOING TO TALK ABOUT
TODAY THE USE OF HEALTH EQUITY
IN INVESTIGATING SOME OF THE
BIOLOGICAL AND SOCIOECONOMIC
MARKERS THAT ARE INFLUENCING
METABOLIC RISK FACTORS AND
PRIMARILY I WILL BE LOOKING AT
DYSLIPIDEMIA.
SO HEALTH EQUITY IS BASICALLY
TRYING TO ADDRESS THE
DIFFERENCES IN -- TRYING TO
ADDRESS THE BARRIERS THAT ENABLE
AN INDIVIDUAL TO ACHIEVE THE
OPTIMAL HEALTH THAT THEY DESERVE
AS HUMAN BEINGS.
AND WE ALL KNOW THAT HEALTH
INEQUITIES AFFECT INDIVIDUALS
FROM MINORITY GROUPS AT A HIGHER
RATE AND IT'S PERVASIVE IN OUR
COMMUNITY.
SO WHAT WE AT THE SCHOOL OF
NURSING IN PARTNERSHIP WITH THE
VCU SCHOOL OF PHARMACY IS WE
CAME TOGETHER AS CLINICIANS AND
RESEARCHERS, DECIDING TO USE
HEALTH EQUITY AS A WAY TO
ADDRESS THOSE HEALTH INEQUITIES
IN THE COMMUNITY.
I HAVE BEEN USING THREE AREAS,
THREE APPROACHES TO REALLY
ADDRESS THAT, AND ENSURE THAT WE
ARE LOOKING AT THOSE DRIVERS OF
HEALTH OUT COME THROUGH THE
HEALTH EQUITY LENS.
THESE THREE AREAS ARE LISTED
HERE, AND FIRST STARTING ABOUT E
SOCIAL CONTEXT, SOCIAL
DETERMINANTS OF HEALTH, ALSO
LOOKING AT BEHAVIORS AND HOW
THOSE TWO INTERSECT WITH
BIOLOGICAL PATHWAYS.
AND AS AGAIN LIKE I SAID, AS A
NURSE IN THE COMMUNITY, THE
FIRST THING YOU WANT TO DO IS
GET TO KNOW THE COMMUNITY.
AND BY GETTING TO KNOW THE
COMMUNITY AND BEING THERE, YOU
BUILD THAT PARTNERSHIP, AND
THAT'S THE PARTNERSHIP THAT
LEADS TO TRUST WHICH THEN LEADS
TO INDIVIDUALS REALLY WANTING TO
BE PART OF THE RESEARCH.
AND BY JUST DOING THAT, WE ARE
ALREADY ADDRESSING AN ASPECT OF
HEALTH INEQUITY, WHICH IS
UNDERREPRESENTATION OF MINORITY
GROUPS IN RESEARCH.
AND ONCE WE HAVE THEM ENGAGED IN
RESEARCH, THEN WE ARE ABLE TO
COLLECT THE DATA, THE
INFORMATION, THE TRENDS THAT
WILL LEAD TO THE DESIGN OF
TAILORED INTERVENTION THAT
ADDRESS THE NEED OF THOSE
COMMUNITIES.
SO THIS IS THE FRAMEWORK WHAT WE
ARE USING THAT IS GUIDED BY THE
HEALTH EQUITY LENS.
SO FIRST IS GETTING TO KNOW THE
COMMUNITY.
AS A CLINICIAN IN THE COMMUNITY,
I HAVE BEEN PRIVILEGED TO BE
PART OF THE MOBILE HEALTH AND
WELLNESS PROGRAM, WHICH WAS USED
TO BE KNOWN AS THE MOBILE -- THE
RICHMOND HEALTH AND WELLNESS.
SO THE MOBILE HEALTH AND
WELLNESS IS A COMMUNITY-BASED
PROGRAM THAT HAS SERVED FOR THE
PAST 12 YEARS INDIVIDUALS IN THE
COMMUNITY.
WE STARTED BY LOW INCOME
INDIVIDUALS LIVING IN HIGH RISE
BUILDINGS AND NOW WE HAVE
EXTENDED TO OTHER URBAN AREAS
OUTSIDE OF THE RICHMOND AREA,
AND ALSO IN THE RURAL AREAS.
AND MOST OF THE INDIVIDUALS WE
SERVE ARE PRIMARILY WOMEN, IN
THEIR LATE '50S/EARLY 60s, AND
LOW INCOME INDIVIDUALS WHO
REALLY FACED CHALLENGES MANAGING
THEIR CHRONIC DISEASES BECAUSE
THEY HAVE MORE THAN ONE FOR MOST
OF THE PART.
AND USUALLY IT'S A COMBINATION
OF HYPERTENSION, TYPE
2 DIABETES, AND EVEN MENTAL
HEALTH OR PULMONARY DISEASES.
ON AVERAGE, AND IT'S UNFORTUNATE
THIS ALWAYS BREAKS MY HEART TO
SAY THAT MOST OF THESE
INDIVIDUALS HAVE TO MANAGE MORE
THAN 11 MEDICATIONS PER DAY.
EVERY DAY.
SO WHEN SERVING THESE
INDIVIDUALS, ONE OF THE THINGS
THAT WE NOTICE IS THAT FOOD
INSECURITY OR THE ABILITY TO
ACCESS HEALTHY FOOD AND CONSUME
IT WAS SOMETHING THAT WAS COMING
ALL THE TIME WHEN W WE WERE THEE
BECAUSE WE SERVE THEM WEEKLY AT
THESE SITES.
SO I'M ALWAYS WITH NURSING
STUDENTS, PHARMACY STUDENTS AND
SOMETIMES EVEN LAW STUDENTS.
AND WHAT WE NOTICE IS THAT WHEN
THESE INDIVIDUALS WERE COMING,
WTHEY DIDN'T WANT TO TALK ABOUT
THEIR HYPERTENSION AND HOW THEY
WERE DEALING WITH THEIR
MEDICATION.
THEY WANTED US TO HELP THEM,
BECAUSE WE DO CARE COORDINATION,
WHICH IS CONNECTING THEM WITH
RESOURCES IN THE COMMUNITY, THEY
WANTED TO KNOW HOW TO GET ACCESS
TO FOOD.
SO WITH THAT, BEFORE EVEN I
JOINED VCU AND THE MOBILE HEALTH
AND WELLNESS CLINIC, WHAT MY
COLLABORATORS HAVE DONE WAS
FIRST LET'S GET TO KNOW HOW BAD
THIS IS.
SO THEY DID WHAT WE CALL -- THEY
SCREENED FOR FOOD INSECURITY BUT
THEY DID IT THE COMMUNITY HELP
WAY, WHICH INTRINGING FOOD.
IS BRINGING FOOD.
SO WE BROUGHT FOOD TO THESE
COMMUNITY SITES AND WHILE THEY
WERE ENGAGING IN SOCIALIZATION
AND ALL THAT WE SCREENED FOR
FOOD INSECURITY.
SO THAT'S WHERE THE HEALTHY MEAL
PROGRAM STARTED, THIS PROGRAM
THAT WAS RUN BETWEEN 2018 --
2016 TO 2019, WHERE INDIVIDUALS
WERE SCREENED FOR FOOD
INSECURITY AND SOCIAL ISOLATION,
AND OUT OF 790 PARTICIPANTS
WOULD WERE SCREENED FOR FOOD
INSECURITY, 782, TWO WERE
SCREENED FOR FOOD INSECURITY,
LESS THAN ONE-THIRD OF THESE
INDIVIDUALS WERE FOOD-INSECURE.
AND OUT OF THESE INDIVIDUALS,
WHAT WE DID WAS THEN CONNECTING
THEM WITH RESOURCES, SO THE
FIRST THING WAS HELPING THEM GET
SOME SNAP BENEFITS AND ANY OTHER
FEDERALLY FUNDED RESOURCES THAT
CAN HELP FACILITATE DELIVERY OF
FOOD, ACCESSING FOOD, AND THEN
THE REST OF THE INDIVIDUALS WERE
ALSO REFERRED TO TO LOCAL PANTRS
FOR EMERGENCY ACCESS TO FOOD
SOURCES.
AND THEN THE THIRD ONE, WHICH
WAS A BEAUTIFUL PARTNERSHIP THAT
WE HAD BUILT WITH A FARM-BASED
ORGANIZATION LOCAL TO RICHMOND
CITY, FARMERS WERE COMING TO OUR
SITE AND OFFERING FRESH PRODUCES
TO OUR INDIVIDUALS AT DISCOUNTED
PRICE.
SO FOR 1 TO $3, THESE
INDIVIDUALS WERE RECEIVING A
HUGE BAG OF KALE AND OTHER
PRODUCES.
SO THAT HAD BEEN GOING ON UNTIL
2019, AND WE PUBLISHED ABOUT
THESE STUDIES.
BUT THEN THIS GOT ME THINKING,
IF OLDER ADULTS IN THIS -- IN
THESE BUILDING SITES ARE FACING
FOOD INSECURITY, WHAT ABOUT THE
REST OF THE COMMUNITY?
WHAT'S GOING ON THERE?
SO I RECEIVED FUNDING TO SCREEN
FOR FOOD INSECURITY IN THE
COMMUNITY SURROUNDING THIS
BUILDING, AND THROUGH TWO
FUNDING SOURCES, I WAS ABLE TO
IDENTIFY THAT FOOD INSECURITY
WAS PREVALENT.
AND WE ALSO MEASURED FOR OTHER
SOCIAL DETERMINANT OF HEALTH
INCLUDING DISCRIMINATION AND
TRANSPORTATION AND OTHER
MEASURES, BUT WITH THAT SPECIFIC
STUDY, FOOD INSECURITY WAS THE
MAJOR DRIVER OF DIET QUALITY.
AND AS YOU CAN SEE IN THIS
TABLE, FOOD INSECURE INDIVIDUALS
HAVE -- WERE MORE LIKELY TO EAT
HIGHLY PROCESSED FOOD INCLUDING
FAST FOOD AND GRAIN.
MY OTHER STUDY WHICH WAS FUNDED
BY THE PRIDE CVD THROUGH THE
NHLBI WAS TRYING TO GATHER
INFORMATION ABOUT WHAT DRIVE
FOOD INSECURITY.
THAT'S WHERE I WAS ABLE TO
IDENTIFY THAT INDIVIDUALS WHO
WERE FACING CHALLENGES WITH
DISTANCE, WHERE THEY WERE LIVING
WAS FAR AWAY FROM A STORE
SELLING HEALTHY FOOD,
TRANSPORTATION AND AFFORDABILITY
WERE THE MAJOR DRIVER OF THEIR
LIKELIHOOD OF ACCESSING AND
CONSUMING HEALTHY FOOD.
THOSE FINDINGS AGAIN IN
COLLABORATION WITH MY CLINICIAN
COLLABORATORS WHO WERE STILL IN
THE COMMUNITY, WE CAME TOGETHER
AND DEVELOPED THIS INTERVENTION,
THIS COMMUNITY-BASED
INTERVENTION IN 2022, STARTING
IN 2022, WHICH IS THE
PRESCRIPTION PRODUCE PROGRAM.
SO FROM THE HEALTHY MEAL PROGRAM
WHERE WE ONLY HAD ABOUT 6% OF
THE INDIVIDUALS WHO WERE FOOD
INSECURE INTERESTED IN ACCESSING
HEALTHY FOOD, THEY WERE
INTERESTED AND THEY WERE ASKING
FOR IT, OVER AND OVER.
I DON'T WANT TO GO TO THE FOOD
PANTRY, I WANT YOU TO BRING ME
VEGETABLES.
SO WITH THAT, WE WERE ABLE TO
COLLABORATE WITH FUNDERS LOCALLY
TO HAVE SHALOM FARM COME TO OUR
SITE, STARTING WITH TWO AND NOW
IN 2024, WE ARE PLANNING FOR
FIVE MORE SITES WHERE WE BRING
EITHER WEEKLY OR BIWEEKLY FOR
SIX WEEKS OR 12 WEEKS FRESH
PRODUCE, AND THE FUNDING IS
COVERING FOR THE VEGETABLE BAG
SO WE ARE SUPPORTING LOCAL
ORGANIZATIONS, BUT THEN WE'RE
ALSO SUPPORTING INDIVIDUAL EAT
HEALTHY.
SO OVER THE THREE YEARS STARTING
IN 2022 TO NOW, THE EVALUATION
OF THE PRESCRIPTION PRODUCE
PROGRAM HAS CONSISTENTLY SHOWN
THAT INDIVIDUALS WHO ARE
PARTICIPATING IN THE PROGRAM HAD
A DECREASED FOOD INSECURITY
SCORE, THEY WERE MORE LIKELY TO
INCREASE THEIR FRUITS AND
VEGETABLE INTAKE, AND WE ALSO
SAW CLINICAL SIGNIFICANCE IN --
DECREASE IN BLOOD GLUCOSE.
AND THIS WAS EXCITING FOR US
CLINICIANS, BECAUSE WE WERE
LIKE, OKAY, WHEN YOU SEE THAT IN
A MATTER OF SIX WEEKS OR 12
WEEKS, JUST BY GIVING ONE
VEGETABLE -- ONE BAG OF
VEGETABLE, WE WERE ABLE TO SEE A
15-POINT DECREASE IN THE BLOOD
GLUCOSE LEVEL, THAT'S EXCITING.
THAT'S SOMETHING TO CELEBRATE.
BUT THAT' AS A RESEARCHER THAT'O
SOMETHING TO DIG INTO.
SO REALLY WHAT HAVE BEEN LESSONS
LEARNED FROM THIS?
BECAUSE BEFORE EVEN DIGGING INTO
THE BIOLOGICAL PATHWAY, WE HAVE
TO UNDERSTAND THE COMMUNITY,
RIGHT?
THIS IS THE FIRST STEP IN THIS
HEALTH EQUITY APPROACH THAT WE
HAVE TO RESEARCH.
SO THE FIRST LESSON WE LEARNED
WAS BE OFFERING SERVICES OVER
TIME FOR THE PAST 12 YEARS,
THESE INDIVIDUALS SAW US, SAW
OUR STUDENTS, THESE INDIVIDUALS
SAW HOW THEM SITTING WITH OUR
STUDENTS WAS HUMBLING TO THE
STUDENTS WHO THOUGHT THEY KNEW
EVERYTHING.
WE HAD NURSING STUDENTS, WE HAD
OT, PT, MEDICAL STUDENTS.
LAW STUDENTS.
JUST SITTING QUIET AND LISTENING
TO THEM SAY, NO, NO, NO, I'M NOT
HERE TO TALK AGAIN ABOUT MY
STATINS OR MY INSULIN.
I'M HERE TO TELL YOU THAT I AM
STRUGGLING TO HAVE FOOD AT THE
TABLE.
AND THAT WAS HUMBLING TO THE
STUDENTS.
BUT IT WAS ALSO SOMETHING THAT
LED US TO BUILD TRUST, AND BY
BUILDING THE TRUST, THEY WERE --
THESE PARTICIPANTS WERE EXCITED
TO GET INTO THE RESEARCH,
BECAUSE WHAT WE WERE DOING WAS
ALSO GOING BACK TO THE COMMUNITY
WHENEVER WE HAD THE RESEARCH
FINDINGS.
AND WE ARE IN PREPARATION RIGHT
NOW TO PREPARE THE COMMUNITY,
THE COMMUNITY EVENT WHERE WE
WILL BE SHARING THE EVALUATION
OF OUR PRESCRIPTION PRODUCE
PROGRAM.
THE NEXT THING THAT WE LEARN IS
THAT DIET-RELATED SOCIAL
DETERMINANTS OF HEALTH INCLUDE
FOOD INSECURITY AND PRIMARILY
FOOD INSECURITY, AFFORDABILITY.
EVERYBODY HERE MIGHT KNOW ABOUT
SOMEONE STRUGGLING RIGHT NOW,
ESPECIALLY RIGHT NOW AFTER THE
INFLATION AND THE COVID ERA
POLICIES THAT WERE FACILITATING
ACCESS TO MORE FRUITS AND
VEGETABLE, HOW THEY'RE
STRUGGLING TO MAINTAIN A HEALTHY
LIFESTYLE BY ACCESSING HEALTHY
FOOD.
AND THEN THE BUILT ENVIRONMENT,
WHERE ALL MAJOR FACTORS DEFINING
DIET QUALITY.
THEN WHAT WE HAVE ALSO LEARNED,
BY FACILITATING ACCESS AND
CONSUMPTION TO HEALTHY FOOD, WE
SAUDI CREASED FOOD INSECURITY
AND IMPROVE DIET QUALITY AND WE
SAUDI CREASING BLOOD SUGAR.
HOWEVER, THERE'S ALWAYS A BUT
HERE, WHAT WE WERE NOTICING WHEN
WE WERE TALKING TO THESE
INDIVIDUALS, ES PESH LITTLE IN
OUR FOLLOW-UP AND EVALUATION AT
EITHER 6, 12 MONTHS AND THE
3 MONTHS FOLLOW-UP, THEY KNEW
AND CAN EASILY TELL YOU HOW SALT
IS ASSOCIATED WITH THEIR
HYPERTENSION, HOW SUGAR IS
ASSOCIATED WITH THEIR DIABETES,
BUT THEY WERE STRUGGLING IN KIND
OF ESTABLISHING THAT
RELATIONSHIP BETWEEN HEALTHY
DIET AND CHOLESTEROL, AND
ESPECIALLY HOW CHOLESTEROL IS
PLAYING A ROLE IN THEIR
CARDIOVASCULAR EVENT.
AND ALL OF THEM WERE MAINLY
SAYING -- I SAY ALL OF THEM BUT
THAT'S NOT A SCIENTIFIC WAY OF
SAYING IT, BUT A LOT THEM
REPORTED SAYING, YOU KNOW, IT
RUNS IN THE FAMILY.
YOU JUST HAVE TO WATCH WHAT YOU
EAT.
AND THAT'S IT.
SO THAT REALLY LED ME TO DIG
DEEPER INTO WHAT WAS GOING ON
THERE.
SO WHAT THIS BEAUTIFUL IMAGE BY
CAAMARIO AND TEAM IS SUMMARIZING
WHAT I WAS LOOKING FORWARD -- I
WAS DISCUSSING THE ROLE OF DIET
IN DYSLIPIDEMIA, AND BIOLOGICAL
MARKERS ASSOCIATED WITH
DYSLIPIDEMIA.
IS THAT A HIGH LEVEL OF FOOD
INSECURITY AND ALSO A HIGH LEVEL
OF SOCIOECONOMIC VARIABLES WERE
ASSOCIATED WITH CONSUMPTION OF
LOWER PRICED FOOD BUT THOSE
LOWER PRICED FOOD ARE WHAT'S
HIGH IN CARBOHYDRATES, AND
ULTRAPROCESSED, WHICH THEN ARE
ASSOCIATED TO INCREASE IN
INSULIN AND GLUCOSE, TO A LEVEL
THAT IS UNHEALTHY.
SO DYSLIPIDEMIA?
THE MAJOR DRIVER OF
CARDIOVASCULAR DISEASES.
ALMOST ONE-THIRD OF U.S. ADULTS
HAVE DYSLIPIDEMIA.
AND REALLY WHAT WE CAN SEE IN
THIS MAP ON YOUR LEFT IS THAT
INDIVIDUALS THAT ARE MOST
AFFECTED BY DISLIP D DYSLIPIDEMN
THE SOUTHERN UNITED STATES.
AND THESE ARE AREAS WHERE,
AGAIN, INDIVIDUALS HAVE FACED A
LOT OF RACISM, DISCRIMINATION
AND MARGINALIZATION.
AND REALLY FIRST DYSLIPIDEMIA IS
ELEVATED LIPID LEVEL, SOME LIPID
LEVEL, SO WE DEFINE IT
DISORDERED LIPID LEVEL.
AND WHAT WE WERE ENCOUNTERING IS
BESIDES THESE DISPARITIES BASED
ON RACE AND ETHNICITY AND
GEOGRAPHICAL AREA IS THAT WE
ALSO NOTICE SOME DIFFERENCES.
IT WAS REPORTED IN THE
LITERATURE THAT THESE
DIFFERENCES WERE ALSO BASED ON
SEX.
SO INDIVIDUALS, FEMALE
PARTICIPANTS, ESPECIALLY FEMALE
PARTICIPANTS IN MINORITY GROUPS
INCLUDING BLACK AMERICANS, HAD
HIGHER TENDENCY TO HAVE
DYSLIPIDEMIA, BUT ALSO WERE
CHALLENGED BY MANAGING -- BY
RECEIVING MANAGEMENT BUT
RECEIVING TREATMENT FROM THEIR
HEALTHCARE PROVIDERS AND HITTING
THE GOALS THAT WE WANT THEM TO
REACH WHEN THEY HAVE ELEVATED
CHOLESTEROL.
SO I WAS FORTUNATE ENOUGH TO
RECEIVE FUNDING THROUGH THE
BIRCH K-12 AND THE INSTITUTE OF
WOMEN'S HEALTH AT VCU SPONSORED
BY THE OFFICE OF RESEARCH, THE
NIH OFFICE OF RESEARCH IN
WOMEN'S HEALTH.
AND MY K TELL ALLOW -- REALLY
ENABLED ME TO HAVE PROTECTED
TIME TO DIG DEEPER INTO THE ROLE
OF DIET QUALITY AND SEX
DIFFERENCES, NOT ONLY IN LIPID
LEVEL BUT ALSO LIPID PROTEIN
PARTICLES LEVEL.
BECAUSE MORE AND MORE EVIDENCE
ARE COMING UP THAT LOOKING AT
THE LOW DENSITY LIPOPROTEIN
CHOLESTEROL AND HDL TRIGLYCERIDE
IS NOT ENOUGH.
THE SMALL PARTICLE, LDL, SMALL
LDL LIPOPROTEIN PARTICLES ALSO
KNOWN HAVE BEEN SHOWN TO BE
ASSOCIATED WITH CARDIOVASCULAR
EVENTS XZ AND WHILE THE LARGE
DENSELY POE PROTEIN PARTICLES
ASSOCIATED MORE WITH THE PRO
PROTECTED -- INCREASED
LIKELIHOOD OF HAVING
CARDIOVASCULAR EVENTS.
SO I USED THE JACKSON HEART
STUDY, WHICH IS BASED IN
MISSISSIPPI, RIGHT IN THE MIDDLE
OF THIS AREA OF THE SOUTHERN
UNITED STATES, WHERE INDIVIDUALS
ARE STRUGGLING WITH
CARDIOVASCULAR DISEASES, AND
IT'S LARGE COHORT OF AFRICAN
AMERICAN INDIVIDUALS WHO WERE
ENGAGED IN THE RESEARCH AND
INVESTIGATING CARDIOVASCULAR
DISEASE AND OTHER RENAL DISEASE,
HEALTH OUTCOMES SMS .
SO THESE WERE MY TWO AIMS.
BASICALLY I WANTED TO SEE
WHETHER -- IF AND HOW SEX
DIFFERENCE WAS PLAYING A ROLE IN
THE ASSOCIATION BETWEEN DIET
QUALITY AND DISL DYSLIPIDEMIA, D
ALSO EXAMINING HOW THAT WAS
DEFINED.
SO THE MAJOR MEASURES OF
INTEREST WAS DIET QUALITY SCORE
USING THE DASH SCORE, THE
DIETARY APPROACHES TO STOP
HYPERTENSION, AND THEN I ALSO
USED A CARDIOPROTECTIVE SCORE
WHICH IS A SCORE THAT IS KIND OF
REFLECTIVE OF THE MEDITERRANEAN
SCORE, AND THE MAIN REASON WHY I
WAS INTERESTED IN THAT IS
BECAUSE, AGAIN, AS A PUBLIC
HEALTH RESEARCHER, I WANTED TO
THINK ABOUT MY NEXT STEP.
SO JACKSON HEART WAS MY FIRST
COHORT, BUT NOT MY ONLY COHORT
THAT I WAS INTERESTED IN, AND I
WANTED TO HAVE A MEASURE OF DIET
QUALITY THAT COULD BE EVEN
INTERNATIONAL.
AND THIS PROJECT, PROTECTIVE
DIET SCORE WAS USED BY
RESEARCHERS USING THE UK BIOBANK
DATA.
SO THESE WERE THE TWO DIET SCORE
BUT I ALSO LOOKED AT STATIN
THERAPY, WHICH IS A LIPID
LOWERING THERAPY THAT HAS BEEN
SHOWN FOR THE PAST TWO OR THREE
DECADES ON BEING VERY EFFECTIVE
IN MANAGING DYSLIPIDEMIA.
HOWEVER, INDIVIDUALS, ESPECIALLY
BLACK AMERICANS, ARE LESS LIKELY
TO BE PRESCRIBED STATINS AND
LESS LIKELY TO ADHERE TO THEIR
MEDICATION AND LESS LIKELY TO
OBTAIN OPTIMAL LEVEL OF LIPIDS
WHILE USING THE STATINS.
AND THEN I USED THE
ATP3 GUIDELINE TO DEFINE WHAT
THE DYSLIPIDEMIA STATUS WAS.
SO THIS IS OUR BASIC RESULT.
THAT TITLE SHOULD SAY BASELINE
CHARACTERISTICS BASED ON SEX.
SO ON THE TABLE ON YOUR RIGHT,
WE CAN SEE THAT THERE ARE
SIGNIFICANT DIFFERENCES BASED ON
SEX IN THIS POPULATION OF A
LITTLE OVER 5,000 INDIVIDUALS.
MOST OF THEM WERE IN THEIR UPPER
50s, WHICH IS MY POPULATION OF
INTEREST, SO THAT WAS
INTERESTING TO SEE THAT THEY
WERE ABLE TO RECRUIT INDIVIDUALS
IN THAT AGE GROUP.
BUT LET'S LOOK AT THE INCOME
LEVEL.
FOR BOTH INCOME -- FOR BOTH
GROUPS FEMALE AND MALE, THE
INCOME LEVEL, WAS IN THEIR
30s, SO LOOKING AT LOW INCOME
LEVEL, AND INCOME WAS DIFFERENT,
SIGNIFICANTLY DIFFERENT BETWEEN
FEMALE AND MALE, WITH FEMALE
ALMOST $2,000 LESS THAN MALE ON
ANNUAL INCOME.
OTHER SIGNIFICANT DIFFERENCES
WERE NOTED IN THE HEALTHY DIET
WHICH WAS THE CARDIOPROTECTIVE
DIET THAT WE DICHOTOMIZED.
WITH MALE PARTICIPANTS -- FIRST
OFF, 90%, OVER 90% OF THE SAMPLE
WERE NOT CONSUMING A HEALTHY
DIET BASED ON THE
CARDIOPROTECTIVE DIET.
THAT WAS A SHOCKER.
I WOULD EXPECT IT BUT NOT OVER
90%.
WHEN WE LOOK AT THE DASH SCORE,
AND THE DASH SCORE IS THE HIGHER
THE SCORE, THE BETTER IT IS,
THESE SCORES WERE LOW, AND AGAIN
HERE TOO, WE SAW THAT MALE
PARTICIPANTS TENDED TO HAVE A
HIGHER AVERAGE DASH SCORE
COMPARED TO FEMALE.
THIS, TO ME, WAS VERY
INTERESTING.
I MEAN, WHEN I THINK ABOUT MY
DAD AND MOM, I WOULDN'T EXPECT
MY MOM TO EAT LESS HEALTHIER
THAN MY DAD, BUT AGAIN, THIS IS
WHAT THE DATA SHOWS.
AND WHEN WE LOOKED AT CARDIAC
EVENT, MALE PARTICIPANTS TENDED
TO HAVE A HIGHER INCIDENCE OF
CARDIAC EVENTS.
WHEN WE LOOK AT THE
DISTRIBUTION, BECAUSE AGAIN, THE
COHORT TENDED TO BE IN THE LOWER
END -- LOWER ADULT, WE WANTED
TO -- WE WERE INTERESTED IN
LOOKING AT THE DISTRIBUTION OF
CARDIOPROTECTIVE DIET SCORE
BASED ON AGE, AND WHAT WE WERE
SEEING IS THE OLDER THE
INDIVIDUAL PARTICIPANTS WERE,
THE HEALTHIER THE DIETS WERE.
SO WHEN WE LOOKED AT THE LIPID
PROFILE, LIPID PROFILE BASED ON
SEX, THE WHOLE TABLE IS RED,
MEANING THAT THERE WERE
SIGNIFICANT DIFFERENCES BASED ON
SEX, BUT MOST LIPID PROFILES IF
NOT ALL LIPID PROFILE, BUT I
WANT YOU TO LOOK AT THE
DYSLIPIDEMIA LINE, THAT LEFT
LINE.
DYSLIPIDEMIA WAS PRESENT ON
ALMOST 70% OF OUR INDIVIDUAL.
YET LIPID MEDICATION WERE
REPORTED BEING TAKEN IN ONLY
ABOUT 14% OF OUR -- OF THE
COHORT.
SO THAT THE DISPARITIES IS
THERE.
AND NOW WE CAN SEE IT WITH THIS
LARGE DATASET.
SO WHEN WE LOOK AT THE DIET
SCORE AND DYSLIPIDEMIA
ASSOCIATION, WE DID A
GENERALIZED LINEAR MODEL AS
INDEPENDENT VARIABLE.
AND THE ASSOCIATIONS WERE
ADJUSTED FOR AGE, EDUCATION
LEVEL AND PHYSICAL ACTIVITY, AND
WHAT WE CAN SEE IS THE CPD WHICH
WAS THE CARDIOPROTECTIVE DIET
WAS NOT ASSOCIATED WITH
DYSLIPIDEMIA.
HOWEVER, IN THE DASH SCORE, DASH
WAS ASSOCIATED -- THE DASH SCORE
WAS ASSOCIATED WITH
DYSLIPIDEMIA, SO THE HEALTHIER
THE DASH SCORE, THE LESS LIKELY
YOU HAD DYSLIPIDEMIA, ONLY MALE.
SO THEN WHAT WE INTENDED TO DO
WAS, LIKE, WHAT ELSE IS GOING ON
HERE, AND WE KNOW THAT
DYSLIPIDEMIA IS HIGHLY
HERITABLE.
IT'S GENETIC.
SO WHAT WE WERE POSITING IS THAT
IT HAS BEEN ESTABLISHED IN THE
LITERATURE THAT THE TYPE OF DIET
QUALITY CONSUMED HAS AN IMPACT
ON GENE EXPRESSION.
SO WITH MY MENTOR AT NIH, WE
INTENDED TO LOOK AT WHAT ARE
THESE MARKERS, WHAT ARE THESE
GENES THAT ARE IMPACTED BY LDL
AND SMALLER LDL, SO THOSE
LIPOPROTEIN PARTICLES AND LARGE
LDL, AND WHAT ARE THE GENES THAT
ARE COMMONLY ASSOCIATED WITH
THESE MEASURES TOGETHER, AND ARE
THESE -- THIS ASSOCIATION
BETWEEN LDL AND GENE EXPRESSION
INFLUENCED BY ANY OF THOSE SMALL
OR LARGE LIPOPROTEIN PARTICLES?
SO WHAT WE DID WAS USING ONE OF
THE COHORT THAT THE -- HAD
ACCESS TO, A LARGE NUMBER, ABOUT
122 GENES WERE EXPRESSED BY BOTH
CONCENTRATION OF SMALL LDL AND
LDL, WHICH IS ESTABLISHED AS THE
BAD CHOLESTEROL AND WHAT WE SAW
IS OUT OF THOSE 122, ABOUT A
LITTLE OVER 40% OF THESE GENES
BEING EXPRESSED, THEIR
EXPRESSION WAS INFLUENCED BY
SMALL LDL.
SO THE ASSOCIATION BETWEEN LDL
AND THESE GENES WAS INFLUENCED
BY SMALL LDL FOR ABOUT 44% OF
THE CASES, AND ABOUT 20% --
28 -- 40% OF THE CASES FOR LARGE
DENSE LDL.
AND WHAT WAS VERY SURPRISING TO
US IS LOOKING AT THE FIGURE ON
YOUR LEFT, IS THAT THE
ASSOCIATION WITH LDL WITH
THOSE -- WITH CERTAIN GENES WERE
SIGNIFICANTLY INFLAWNSED.
INFLAWNSED.
INFLUENCED.SO IF WE ADDED SMALLL
PARTICLES FOR EXAMPLE IN THAT
ASSOCIATION, THERE WAS 95%
DECREASE EFFECT OF THE GENE
BEING EXPRESSED.
SO THAT SAYS A LOT ABOUT THE
FIELD AND HOW WE CAN REALLY LOOK
AT THESE INDIVIDUAL GENES AT THE
MOST SPECIFICALLY SPECIFIC LEVS
IS FELLING US SOMETHING ABOUT
HOW WE ARE EXPOSED TO THE
ENVIRONMENT WHICH THEN INCREASES
THE LIKELIHOOD OF HAVING LDL,
BUT WE MUST LOOK AT OTHER MARCS
INCLUDING SMALL AND LARGE LDL
LIPOPROTEIN PARTICLES TO REALLY
HAVE A BETTER PICTURE, MORE
HOLISTIC PICTURE OF THE
BIOLOGICAL PATHWAYS.
SO THESE ARE THE GAPS AND NEXT
STEPS IN MY RESEARCH, WHERE
REALLY THE PROJECT THAT WE'VE
WITHIN DOING WITH THE HELP OF MY
COLLABORATORS AND MENTORS,
UNDERSTANDING INDIVIDUALS'
NEEDS, VALUES AND REALITIES IS A
MUST TO HELP ADDRESS INEQUITIES
THAT ARE ASSOCIATED WITH RMD.
WHAT WE ALSO SEE THAT IS VERY
RELEVANT TO A CLINICIAN IS THAT
GOING BEYOND LDL, HDL AND TRY
GLIS ROID AND SO FORTH IS ALSO
LOOKING AT THOSE LIPOPROTEIN
PARTICLES AND MORE IS BEING DONE
THERE WITH THAT.
WHAT THIS IS TELLING US IS THAT
WHILE IT IS IMPORTANT TO
ESTABLISH THOSE BIOLOGICAL
PATHWAYS, IT IS ALSO VERY
IMPORTANT TO BE IN THE
COMMUNITY, AND ADDRESS THOSE
CHALLENGES BY SOMETIMES LIKE
WHAT WE ARE DOING, THE
PRESCRIPTION PRODUCE PROGRAM,
FACILITATING ACCESS TO HEALTHY
FOOD.
AND HOPEFULLY THIS IS SOMETHING
THAT IS GETTING MORE AND MORE
TRACTION WITH FOOD AS MEDICINE
AND THE WHITE HOUSE CONFERENCE
THAT HAPPENED TWO YEARS AGO WITH
THE PROMOTION OF HEALTHY FOOD.
SO THIS IS AN EXCITING TIME TO
BE, AND I HOPE TO SEE THAT IN MY
LIFETIME, WE'LL BE ABLE TO BRING
TOGETHER ENOUGH EVIDENCE TO
INFLUENCE POLICIES IN HEALTHY HG
INDIVIDUALS ACCESS HEALTHY FOOD
WHICH WILL LEAD TO HOPEFULLY
HEALTHY OUTCOMES FOR ALL,
BECAUSE I DO BELIEVE THAT FOOD
SECURITY IS A HUMAN RIGHT, AND
WE ALL DESERVE TO BE EATING
HEALTHY.
THANK YOU.
[APPLAUSE]
>> THANK YOU SO MUCH, ANA.
I LEARNED SO MUCH FROM YOU BOTH
AND LOOK FORWARD TO TALKING WITH
YOU AFTERWARDS.
PERHAPS, GABBY, YOU MIGHT START
WITH COMMENTS, THEN ANA, AND
THEN WE'LL TURN THINGS OR TO DR.
>> I JUST WANT TO THANK YOU FOR
ALL OF THE WORK THAT YOU'VE BEEN
DOING.
I THINK IT WAS REALLY WONDERFUL
TO SORT OF SEE SORT OF THE
INTEGRATION OF THE SORT OF
COMMUNITY ENGAGEMENT AND ALSO
THE INCORPORATION OF BIOLOGICAL
VARIABLES, AND ALSO THE EXCITING
SORT OF GENETIC COMPONENT AS
WELL AND SORT OF GETTING AT THAT
MECHANISM.
SO MY COMMENT IS THANK YOU, AND
REALLY EXCITING TO SEE ALL OF
THIS WORK BEING DONE.
I'M ALSO CURIOUS IF THERE
WERE -- MORE SO FROM LIKE AN
IMPLEMENTATION AND I'M CURIOUS
WHAT SOME OF YOUR CHALLENGES
WERE IN SORT OF BEING ABLE TO
WORK THROUGH --
>> SO THANK YOU.
I ALSO GOT VERY EXCITED ABOUT
YOUR TALK BECAUSE WHEN YOU
MENTIONED GLUCOSE AND THE
GAPS -- I KNOW THE GAPS.
AND I SEE -- I SEE THE OUTCOMES
OF -- IT MAKES SENSE, THE WAY
YOU WERE PRESENTING HOW SOME OF
YOUR WORK AND HOW IT'S BEING
DONE IN THE OUT KOMS THAT YOU'RE
SEEING WERE VERY INTERESTING TO
ME.
SO GOING BACK TO YOUR QUESTION
ABOUT THE CHALLENGES WITH
IMPLEMENTATION, I HAVE TO SAY
THAT THE PRIMARY CHALLENGE IS
FUNDING.
AND THE MAIN REASON, AGAIN, IS
BECAUSE COMMUNITY HEALTH WORK IS
IMPORTANT, IT TAKES TIME TO
BUILD THE RELATIONSHIP.
BUT AS ASSISTANT PROFESSORS IN
THE TENURE TRACK, TIME IS NOT IN
OUR DN -- ON OUR SIDE, RIGHT?
THE CLOCK IS TICKING.
SO FOR ME, THE CHALLENGE, AND
I'M FORTUNATE ENOUGH TO BE IN AN
ENVIRONMENT THAT HAS FOSTERED A
LOT OF SUPPORT TO DO MY WORK,
ESPECIALLY WITH SMALL GRANTS AND
INTERNAL FUNDING AND SUPPORT
FROM MY CHAIR AND OTHERS, BUT I
SEE THAT -- I SAW HOW IMPORTANT
IT IS TO HAVE FUNDING.
BUT REALLY, I PERSONALLY THOUGHT
THE CHALLENGE WOULD HAVE BEEN IN
THE COMMUNITY, AND IT WASN'T.
BECAUSE WHEN THE COMMUNITY SEE
THAT YOU'RE THERE TO SERVE THEM,
THAT YOU'RE THERE WITH THEIR
INTEREST IN MIND, THEN THEY ARE
SUPPORTIVE OF YOU.
THEN THEY INQEUR ABOUT YOU.
INQUIRE ABOUT YOU.
SO REALLY IT'S KIND OF BRIDGING
THIS GAP.
I WISH I HAD SAID IT IN MY
ENDING SLIDE, IS THAT MAYBE
WHAT'S HAPPENING AT THE FUNDING
AND THE POLICY LEVEL IS NOT
REALLY MATCHING WITH WHAT THE
REALITY IS.
SO FOR EXAMPLE, ONE THOUGHT WE
IS THAT MAYBE THE
CARDIOPROTECTIVE DIET MAYBE
AREN'T REFLECTIVE OF THE
REALITY.
I MEAN, WITH $30,000 A YEAR, I
DO SEE THE STRUGGLE INDIVIDUALS
MIGHT HAVE TO CONSUME THREE
SERVINGS OF VEGETABLES AND FRUIT
AND LESS THAN TWO SERVINGS PER
WEEK OF PROCESSED MEAT.
SO THERE IS THIS DISCONNECT AND
THAT'S WHERE THE CHALLENGE IS.
THE OTHER CHALLENGE IS WITH
RESEARCH METHODS.
SO WE NEED TO DO RANDOMIZED
CONTROL TRIAL TO ESTABLISH RIGOR
AND SO ON.
THAT'S ALMOST IMPOSSIBLE WITH MY
FRIENDS IN THE COMMUNITY BECAUSE
THEY ALL TALK.
WE TALK AND THAT SUPPORT NETWORK
THAT WAS MENTIONED IN THE EARLY
PANEL EXISTS.
SO YOU WILL SEE A LOT OF, HEY,
DR. DIALLO IS RUNNING THIS
STUDY.
WHY DON'T YOU COME DOWNSTAIRS
AND WE'LL GET IT TOGETHER.
OH, LET ME CALL MY DAUGHTER,
BECAUSE NOW YOU'RE INTERESTED IN
ADULTS.
SO THE RESEARCH METHOD IN ORDER
TO ESTABLISH THE EVIDENCE IS
ALSO THE OTHER CHALLENGE THAT I
HAVE.
>> THANKS.
>> THANK YOU BOTH.
THE IMPORTANCE OF MEETING
COMMUNITY NEEDS AND ALSO
INCLUDING BIOPSYCHOSOCIAL, SCIO
NEURAL IMMUNOLODGE KABUL
VARIABLES LOGICAL VARIABLESARE N
BE COLLECTED CON CURRENTLY.
DR. NORTON.
>> SO JUST ONE QUESTION.
SO TALKING ABOUT -- YOU
MENTIONED THE NEED FOR SUPPORT
AND THEN THINKING BACK TO LISA'S
TALK EARLIER THIS MORNING ABOUT
HOW WE BUILD IN SOCIAL SAFETY
INTO OUR SYSTEMS.
YOU KNOW, ONE OF THE WAYS IN
WHICH WE CAN SUPPORT OUR
COMMUNITY IS MONEY, WHICH WE
KNOW.
BUT I ALSO WONDERED HOW WE COULD
BUILD IN A LITTLE BIT MORE
SOCIAL SAFETY FOR OUR
RESEARCHERS, JUST GETTING BACK
TO THAT COMMENT, ESPECIALLY OUR
JUNIOR RESEARCHERS AND MAKING
SURE WE KNOW NOT ALL MENTORS ARE
GOOD MENTORS OUT THERE IN THE
COMMUNITY, BUT IT'S NOT ALWAYS
SOMETHING WE CAN DIRECTLY
INFLUENCE.
OR EVEN SOMETIMES WE MIGHT NOT
BE AWARE.
AND SO THINKING ABOUT HOW WE CAN
BUILD SAFETY SYSTEMS FOR OUR
YOUNG RESEARCH COMMUNITY, I JUST
WONDER IF YOU GUYS HAVE ANY
THOUGHTS ON THAT OR ANY ADVICE
FOR MYSELF AND MY COLLEAGUES.
>>
[LAUGHTER]
>> UM, WELL, I TREMENDOUSLY
BENEFITED FROM, FOR EXAMPLE, THE
PRIDE CVD, WHICH IS SPONSORED BY
NHLBI.
AND IT'S A FELLOWSHIP THAT IS A
TWO-YEAR FELLOWSHIP WHERE WE ARE
EXPOSED -- JUNIOR FACULTY ARE
EXPOSED TO THE LATEST IN
RESEARCH, BUT NOT ONLY IN
CARDIOVASCULAR HEALTH
DISPARITIES BUT ALSO THE WHOLE
CONCEPT OF THE SOCIAL
DETERMINANTS OF HEALTH OF THE
SOCIAL DETERMINANTS WAS LIKE,
WAIT A MINUTE, YES!
SO IT HAVING THIS AHA MOMENT
BECAUSE YOU ARE IN DIRECT
CONVERSATION -- WELL, IN ZOOM
CONVERSATION BECAUSE IT WAS
DURING THE PANDEMIC BUT YOU ARE
IN CONVERSATION WITH EXPERTS.
SO IF THERE ARE ANY WAYS TO
FACILITATE THAT CONNECTION WITH
EXPERT IN THAT FIELD, FOR MORE
LONGER PERIOD OF TIME, NOT ONLY
FOR A CONFERENCE, BUT FOR -- YOU
KNOW, WE HAD IT FOR TWO WEEKS
BUT THEN FOR THE TWO YEARS,
ALMOST EVERY TWO, THREE MONTH,
WE WERE MEETING, AND THE
FACULTY, SO THOSE MENTORS AND
EXPERT WERE IN THE ROOM, IN THE
ZOOM ROOM, HEARING US, HOW WE
WERE REPORTING ON THE PILOT
STUDIES THAT WE WERE DOING, AND
FACING THE CHALLENGES ESPECIALLY
DURING COVID WHERE THEY WERE
GIVING FEEDBACK AND THEY WERE
REACHING, THEY WERE AVAILABLE,
SO IT'S FACILITATING THE
AVAILABILITY OF NIH-FUNDED
EXPERT TO JUNIOR FACULTY IS -- I
THINK IS PERSONALLY THE WAY THAT
I GREW, AND ALSO IF MY K12 IS
KIND OF THE SAME THING WHERE
SOMETIMES I CAN'T BELIEVE I'M
SITTING WITH SUPERSTARS, AND I
SOMETIMES AM INTIMIDATED OF
ASKING FOR, YOU KNOW, COMMENTS,
FOR THEM READING MY PROPOSALS,
AND THEY NEEDED RESPONSES, I
HAVE BLOCKED SOMETIMES FOR HOURS
FOR YOU TO REVIEW YOUR PROPOSAL,
JUST SEND IT MY WAY.
SO HAVING THAT CONNECTION AND A
DIRECT CONNECTION IS KEY.
AND IF THERE IS ANY WAYS THAT
YOU CAN FACILITATE THAT, I THINK
THEY ARE THERE.
THOSE FUTURE SCIENTISTS FROM
UNDERREPRESENTED MINORITY GROUPS
ARE THERE.
THEY WANT TO BE PART OF THE
DISCUSSION.
IT'S JUST REACHING OUT, AND
BEING ABLE TO FACILITATING THAT
CONNECTION.
>> I'LL QUICKLY ANSWER.
I THINK MAYBE I'LL ANSWER FROM A
PERSONAL APPROACH.
ULTIMATELY, I THINK WHAT WOULD
SORT OF HELP TO FACILITATE MY
SENSE OF SAFETY IS SORT OF
HAVING POLICY AND NATIONAL-LEVEL
POLICY THAT CAN SUPPORT MY
FAMILY AND MY COMMUNITIES AND
THE FOLKS THAT I CARE ABOUT.
I THINK I AS A JUNIOR FACULTY
SORT OF BEING THE ONE FROM THE
FAMILY THAT HAS BEEN UPWARD LIMO
BILE, THERLYMOBILE, THERE HAS BF
PRESSURE TO FINANCIALLY,
EMOTIONALLY, INSTITUTIONALLY
REALLY PRY THAT SUPPORT IN
ADDITION TO SORT OF THE PRESSURE
OF THE TENURE TRACK PROCESS AS
WELL, AND ALSO MY SENSE OF
TRYING TO ACHIEVE WITHIN THIS
VERY SHORT TIME WINDOW, SO MY
DAYS AND MY RESOURCES ARE
LIMITED.
I THINK THAT HAVING SORT OF
SUPPORT BEYOND ME AS A
RESEARCHER IS PROBABLY THE MOST
IMPACTFUL FOR HELPING ME TO FEEL
SAFE WITHIN ACADEMIA.
PARTICULARLY EVEN THINKING ABOUT
FUNDING AND POLICY WITHIN THE
INSTITUTION AS WELL.
SO I GET THE WHOLE, LIKE, WE
WANT TO ELIMINATE THESE
DISPARITIES AND WE WANT TO SHIFT
POLICIES, BUT ALSO EVEN WITHIN
SORT OF MY DEPARTMENT AND OUR
INSTITUTIONS, IT'S ALSO THIS
SUSTAINED DEMONSTRATED EFFORT
AND COMMITMENT TO THESE
APPROACHES.
I THINK THAT FOLLOWING GEORGE
FLOYD, THE PANDEMIC, 2020, THERE
WAS A LOT OF MOBILIZATION FOR
THESE SORT OF WORKSHOPS AND
PROGRAMS, AND I THINK A LOT OF
FOLKS, BOTH ANECDOTALLY AND SORT
OF -- HAVE SORT OF COMMUNICATED
THIS SENSE OF UNCERTAINTY ABOUT
HOW LASTING THIS WILL BE AND HOW
SORT OF IMPORTANT THIS WORK WILL
BE, AND THE SENSE OF AMBIGUITY
AND UNCERTAINTY OF, LIKE, WILL
THIS END SOON, SORT OF WILL
PEOPLE GET TIRED OF THESE
QUESTIONS AND WILL THIS FALL OUT
OF FAVOR.
SO I THINK FOR ME WITHIN AN
ACADEMIC INSTITUTION, I THINK
CONTINUED SUSTAINED SUPPORT IN
THESE EFFORTS AND MENTORSHIP
WILL BE REALLY IMPORTANT MOVING
FORWARD.
>> I LOVE THAT ANSWER.
AND THANK YOU SO MUCH FOR SAYING
THAT, BECAUSE ACTUALLY THE TIME
HAS ALREADY COME WHERE THE
FEELING OF UNSAFE IS THERE.
AN EXAMPLE IS FOR THE STATE OF
VIRGINIA, WHERE THE GOVERNOR HAS
ASKED TO -- TWO INSTITUTIONS
INCLUDING VCU, WHAT ARE THEIR
DEFINITION OF DIVERSITY, EQUITY
AND INCLUSION AND HOW IS IT
PRESENTED IN THEIR CURRICULUM.
SO THAT'S HAPPENING AND THAT
SAFETY IS THERE.
IN CONVERSATION WITH MY FELLOW
COLLEAGUES IS, SOMETIMES THE
EXPECTATIONS ARE NOT BIL BUILT R
US, FOR PEOPLE WHO LOOK LIKE US.
SO YOUNG MOTHERS LIKE MYSELF,
IT'S THE INTERSECTIONALITY OF
ALL THESE EXPECTATIONS THAT ARE
SOMETIMES PERSONAL, YOU WANT TO
SUCCEED, YOU HAVE THESE
AMBITIONS, BUT ALSO MATCHING THE
EXPECTATION OF A SYSTEM THAT
INITIALLY WAS NOT BUILT FOR --
NEVER HAD IN MIND US IS
IMPORTANT.
SO HAVING THAT SAFETY NET IS
KEY.
SO THANK YOU FOR THAT, GABBY.
>> THANK YOU BOTH FOR BRINGING
YOUR FULL INTELLECT AND YOUR
FULL SELVES TO THIS PANEL.
I HAVE LEARNED SO MUCH, AND I
LOOK FORWARD TO TALKING WITH YOU
BOTH LATER AND PERHAPS FOSTERING
YOUR CAREER TRAJECTORIES.
WON'T YOU ALL HELP ME THANK OUR
TWO PANELISTS.
>> SO THANK YOU AGAIN FOR THAT
EXCELLENT PANEL.
NOW I KNOW I STAND BETWEEN YOU
AND FOOD, AND WE'RE A LITTLE
BEHIND.
SO I'M GOING TO JUST VERY
BRIEFLY GIVE US A CHARGE FOR OUR
BREAKOUTS.
SO AFTER LUNCH, AT 1:15, WE'LL
BE HEADING TO OUR BREAKOUT ROOMS
SO YOU DON'T NEED TO COME BACK
TO THIS ROOM.
I'LL SHOW YOU THE ACTUAL ROOMS,
BUT REALLY QUICKLY, THESE
BREAKOUTS ARE OUR OPPORTUNITY TO
HEAR FROM EVERYBODY, BOTH IN THE
IN-PERSON ROOM AND THE VIRTUAL
ROOM.
WE'VE ALREADY LEARNED SO MUCH
FROM OUR SPEAKERS AS WELL AS
FROM PARTICIPANTS VIA THE
QUESTIONS THAT HAVE BEEN ASKED
BUT WE JUST REALLY WANT TO GET
INPUT FROM EVERYBODY WHO'S BEEN
PARTICIPATING YESTERDAY AND
TODAY TO REALLY TRY AND IDENTIFY
AND DISCUSS WHAT ARE THE
RESEARCH OPPORTUNITIES AND
STRATEGIES IN THIS SPACE, WHAT
ARE CHALLENGES AND POTENTIAL
SOLUTIONS SO WE CAN THINK MORE
EFFECTIVE ABOUT HOW TO MOVE THIS
RESEARCH AREA FORWARD.
SO I'M NOT GOING TO GO THROUGH
ALL THESE QUESTIONS FOR TIME BUT
JUST IN CASE YOU HAVEN'T
SELECTED A BREAKOUT ROOM YET,
AND THESE QUESTIONS ARE
AVAILABLE AT THE DESK IF YOU
NEED TO LOOK AT THEM AGAIN, BUT
OUR FIRST WILL BE TALKING ABOUT
HOW TO MODEL RACISM,
MARGINALIZATION AND
DISCRIMINATION THROUGH
EXPERIMENTAL SCIENCE INCLUDING
ANIMAL MODELS.
OUR SECOND BREAKOUT WILL BE
FOCUSED ON ADDRESSING
MEASUREMENT AND ANALYTICAL
CHALLENGES.
OUR THIRD WILL BE THE PATHWAY TO
INTERVENTIONS, HOW DO WE TAKE
WHAT WE'RE LEARNING HERE TODAY
AND ACTUALLY MAKE PEOPLE'S LIVES
BETTER.
THE FOURTH BREAKOUT GROUP WILL
BE ON TRA TRANSGENERATIONAL AS L
AS LIFE COURSE IMPLICATIONS FOR
THIS RESEARCH AND FINALLY THE
FIFTH BREAKOUT WILL BE HOW DO WE
SUPPORT AND BUILD THE WORKFORCE
NEEDED IN THIS SPACE.
SO HERE ARE -- THIS IS AN OLDER
VERSION, SO APOLOGIES.
WE DO HAVE SOME ROOM
CORRECTIONS.
SO BREAKOUT 1 WAS ORIGINALLY
GOING TO BE IN THIS ROOM.
THAT ROOM WILL BE NOW -- ALISON,
CAN YOU HELP ME?
I'M SORRY THE SLIDES DIDN'T GET
UPDATED.
>> PERHAPS WE COULD JUST --
PEOPLE COULD CHECK THE SCREEN
LATER.
>> YES, I WILL GET THE CORRECT
ROOM ASSIGNMENT WHILE YOU GO GET
LUNCH.
THAT'S A GREAT SUGGESTION, BILL.
AND THEN THE OTHER THING I JUST
WANTED TO FLAG FOR FOLKS IS THAT
ON THE AGENDA, WE'LL BE STARTING
BACK UP HERE AT 2:45 IN THIS
MAIN ROOM.
SO JUST THINK ABOUT WRAPPING UP
YOUR BREAKOUT GROUPS TO TRY TO
END BY 2:30 JUST TO GIVE
YOURSELVES A LITTLE BIT OF TIME
TO MAKE YOUR WAY BACK UP HERE,
USE THE BATHROOM AND ALL THAT,
AS WELL AS TO GIVE OUR
MODERATORS A QUICK SECOND TO GET
THEIR THOUGHTS TOGETHER FOR
COMING BACK AND SHARING WHAT WE
HEARD IN THE BREAKOUTS.
SO THANK YOU, EVERYBODY, AND WE
WILL SEE YOU IN YOUR BREAKOUT
ROOMS AT 1:15 AND WE WILL HAVE
CORRECTED INFORMATION UP ON THE
SLIDE AS WELL AS AT THE DESK FOR
YOU.
WELCOME BACK FROM THE BREAKOUT
SESSIONS.
I HOPE EVERYBODY HAD SOME VERY
PRODUCTIVE DISCUSSIONS.
YOU'RE WELCOME TO COME UP.
I DON'T KNOW IF WE HAVE SEATS
FOR ALL OF THE MODERATORS BUT WE
MIGHT.
>> THERE WILL BE NOBODY IN THE
AUDIENCE.
[LAUGHTER]
>> EVERYBODY UP, EVERYBODY UP.
OKAY.
SO AS I SAID, I HOPE EVERYBODY
HAD PRODUCTIVE DISCUSSIONS IN
THE BREAKOUT.
WE HAVE 10 BREAKOUTS TO HAVE
REPORT-BACKS ON, FIVE IN PERSON
AND FIVE VIRTUAL.
SO WE'LL HEAR FROM EACH BREAKOUT
TOPIC TWICE.
SO I'M GOING TO ASK -- I'M GOING
TO SWITCH OFF BACK AND FORTH
BETWEEN VIRTUAL - GOING FIRST AD
IN-PERSON GOING FIRST TO MAKE
THINGS EQUAL, BUT I'M GOING TO
ASK THE PERSON WHO REPORTS OUT
SECOND JUST TO SAVE TIME IF THE
FIRST BREAKOUT ROOM SAID
SOMETHING ALREADY, YOU DON'T
NEED TO RE-SAY IT, YOU CAN JUST
KIND OF SAY THAT AND, AND JUST
ADD NEW INFORMATION TO SAVE TIME
FOR THESE REPORT-BACKS BECAUSE
I'D LIKE TO ALLOW SOME TIME FOR
REACTION AND DISCUSSION OF WHAT
WE HEARD ACROSS THE BREAKOUT.
SO WITH THOSE NOTES, I'M GOING
TO PASS IT OFF TO TRACY, WHO WAS
THE MODERATOR AND REPORTER IN
PERSON.
BREAKOUTONE IN PERSON.
>> THANK YOU, JENNA.
WE HAD A VERY SMALL GROUP.
THERE WAS FOUR OF US.
SO W CARRINGTON, IS SHE STILL
HERE?
IS SHE OUTSIDE IN THE HALLWAY
MAYBE?
SHE WAS ABSOLUTELY DELIGHTFUL
AND HAD SOME AMAZING, INCREDIBLE
INSIGHT AND OFFERED A LOT TO US.
YOU HAVE THE SLIDES.
DO I HAVE SLIDES?
NO.
THAT'S ME.
SO OUR SESSION WAS TASKED WITH
DISCUSSING WHETHER WE COULD
MODEL EXPERIMENTALLY EITHER IN
OTHER SPECIES OR IN HUMANS WAYS
TO ASK ABOUT BIOLOGICAL
MECHANISMS.
SO FROM MEMORY, I'LL JUST GET
STARTED.
SO THE FIRST POINT WAS CAN YOU,
ARE THERE -- IS THERE A WAY
ACTUALLY -- I THINK THIS WAS
INITIALLY REFERENCED AS IN OTHER
SPECIES, SUCH AS MOUSE MODELS,
RATS, ET CETERA, CAN YOU
MODEL -- THERE YOU GO.
THE BIOLOGICAL CONSEQUENCES SO
WE USED THAT AS KIND OF OUR
KEYWAY TO LOOK AT THIS QUESTION
OF WHAT ARE THE BIOLOGICAL
CONSEQUENCES AND THEN CAN YOU
MODEL THEM.
TRYING TO PULL UP OUR SLIDE -- I
WILL TELL YOU THAT AS A RO RODET
RESEARCHER, ONE OF I THINK VERY
FEW RODENT RESEARCHERS IN THE
ROOM, YOU CAN LOOK AT THE STRESS
RESPONSE, YOU CAN LOOK AT THE
IMMUNE SYSTEM, ALSO VERY SIMILAR
IN MANY WAYS, YOU CAN LOOK AT
DIABETES SORTS OF READOUTS, ET
CETERA, BUT OBVIOUSLY THE
PSYCHOLOGICAL ASPECT OF THE
PERVASIVE RACIST AND
MARGINALIZATION AND
DISCRIMINATION EFFECTS IN THOSE
KINDS OF SPECIES LIKE MICE, THEY
JUST DON'T HAVE THE COGNITIVE
ABILITY.
AND WE TALKED A LITTLE BIT TO
THIS POINT ABOUT OTHER
EXPERIMENTAL WAYS YOU MIGHT
ADDRESS IT, SO GOING BACK,
STAYING WITH THE HUMANS AND
OTHER DIFFERENT EXPERIMENTAL
TYPES OF WAYS YOU CAN BRING
HUMAN SUBJECTS INTO THE
LABORATORY, DO THINGS LIKE TAKE
OUT IMMUNE CELL POPULATIONS AND
SORT THEM AND ASK ABOUT
ACTIVATIONAL STATES, DOING
IN-LAB TYPES OF STRESSES IS
ANOTHER WAY, YOU COULD
EXPERIMENTALLY ASK ABOUT
DIFFERENCES.
I THINK THE GIST OF THIS
QUESTION WAS, YOU'RE LOOKING FOR
DYNAMIC STATE, WAYS TO GET A
RESPONSE RATHER THAN SINGLE TIME
POINTS AS READOUTS, IF MY MEMORY
SERVES ME CORRECT.
WHAT ASPECTS CAN WE NOT MODEL?
CERTAINLY, LIKE I SAID, YOU
CANNOT MODEL THE PSYCHOLOGICAL
IMPACT AND EFFECT OF TRAUMATIC
EVENTS OR THE EFFECT OF RACISM,
MARGINALIZATION AND
DISCRIMINATION AS MICE DO NOT
HAVE THE COGNITIVE ABILITY, OF
COURSE, TO EXPERIENCE THAT.
THOUSANOW I DON'T REMEMBER WHATE
OTHER QUESTIONS WERE.
THANK YOU, JOHN.
QUESTION ONE, QUESTION TWO.
I ALREADY DID THAT.
QUESTION THREE, CAN SUCH MODELS
BE USED BETTER TO UNDERSTAND THE
DIFFERENTIAL IMPACT OF RMD
EXPOSURES WITHIN POPULATION
GROUPS?
WE STRUGGLED A LITTLE BIT WITH
THIS ONE, NOT KNOWING EXACTLY
HOW WE MIGHT THINK ABOUT
POPULATION GROUPS.
OBVIOUSLY RODENTS, THAT'S NOT
GOING TO HAPPEN BECAUSE WE'RE
ISOLAISOLATED IN CAGES.
THERE ARE SOME LABS THAT DO
LARGER SORTS OF SETTINGS, I
THINK IF NOAH WAS STILL HERE, HE
COULD SPEAK TO SOMETHING ABOUT
PRIMATE MODELS, BUT WE DID
ADDRESS THIS, IN HUMAN STUDIES,
IF YOU HAVE A POPULATION WITH
SOME INDEX OF GREATER STRUCTURAL
RACISM THAN NOT THEN YOU COULD
EVALUATE SOME OF THESE QUESTIONS
WITHIN A POPULATION
EXPERIMENTALLY.
ONE OF THE MOST PROMISING
EXPERIMENTAL MODELS THROUGH
WHICH BETTER TO UNDERSTAND THE
BIOLOGICAL CONSEQUENCES OF RMD
AND WHAT ARE THEIR STRENGTHS AND
LIMITATIONS.
WE TALKED ABOUT THIS A LITTLE
BIT AGAIN BY GOING ALL THE WAY
DOWN TO RODENT MODELS, THERE
ARE, OF COURSE, AGAIN, AND I
WANTED TO REITERATE, RODENTS
CANNOT EXPERIENCE ANYWHERE CLOSE
TO THE LEVEL OF TRAUMA OF RMD
AND PERVASIVENESS ACROSS THE
LIFESPAN THAT IT ENTAILS, BUT AT
THE LEVEL OF A CELL, THE
BIOLOGICAL SIGNALS RELEVANT TO
THOSE EXPERIENCES, YOU VERY MUCH
CAN STUDY, AND SO THINGS LIKE
CHRONIC STRESS CAN PRODUCE THOSE
SAME LEVELS OF STRESS HORMONES,
GLUCOCORTICOIDS, CATECHOLAMINES,
OR SOCIAL DEFEAT IS ONE OF THE
OTHER MODELS.
THE OTHER ADVANTAGE OF DOING
STUDIES IN ANIMALS IS YOU CAN DO
THINGS LIKE LOOK AT SPECIFIC
ORGANS AND PROCESSES AND
DISTINGUISH BETWEEN BRAIN
EFFECTS AND PERIPHERAL EFFECTS
IN A WAY THAT OBVIOUSLY WE
CAN'T.
THE TIMING ALSO IS SOMETHING
THAT WE TALKED ABOUT THAT YOU
CAN DO IN AN ANIMAL MODEL OR YOU
CAN LOOK AT PRECONCEPTION EVENTS
AS THEY IMPACT PREGNANCY
OUTCOMES, OR EARLY LIFE EVENTS
OR TIMING SPECIFICITY IN A WAY
THAT'S VERY DIFFICULT WITHOUT A
PROSPECTIVE COHORT IN HUMANS TO
STUDY.
AND SO YES, SO HE CALLED IT --
WE CAN DO THE PRECONCEPTION TO
DEATH IN THE TIME SPAN OF A
GRANT IN ANIMALS.
WE CANNOT IN HUMANS.
IT'S A GOOD POINT.
>> IN HUMANS, OF COURSE,
PARADIGMS THAT YOU COULD USE TO
EVALUATE SOCIAL REJECTION STRESS
CAN BE EXAMINED, YOU CAN ALSO
CAPTURE APPRAISAL TO ASSESS
DIFFERENTIAL IMPACTS OF RMD
WITHIN GROUPS.
ARE THE APPROPRIATE TECHNIQUES
AND METHODOLOGIES AVAILABLE,
WHAT NEEDS TO BE DEVELOPED?
WE TALKED ABOUT IN CONTROLLED
HUMAN STUDIES, WAYS TO DO DEEP
PHENOTYPING COMBINED WITH
ASSESSMENT OF BIOLOGICAL
SAMPLES, AND THEN YOU CAN TAKE
REPEATED ASSESSMENTS IN HOME
SETTINGS.
I THINK, AGAIN, THAT WE DISCU
DISCUSSED THE PEOPLE'S RESPONSE
IF THEY'RE IN THE HOME SETTING
IS GOING TO BE VERY DIFFERENT
THAN IF YOU'RE BRINGING THEM IN
TO THE LABORATORY, SO THINGS
LIKE MONITORING, HAVING IPHONE
SURVEYS AND INPUTS ON A
REGULAR -- WHEN THEY'RE IN THEIR
NATURAL ENVIRONMENT INSTEAD OF
BRINGING THEM IN, DAILY DIARIES,
ET CETERA.
AND THEN WE ALSO TALKED ABOUT
REVERSE TRANSLATION, AND I THINK
THIS IS CRITICALLY IMPORTANT,
THAT -- WAYS IN WHICH
RESEARCHERS IN THE HUMAN SPACE
INFLUENCING WHAT IS DONE IN
BENCH RESEARCH, AND THAT THE
BENCH RESEARCH FINDINGS MAKE
THEIR WAY BACK IN TO THE TESTED
INTO -- IF THOSE OUTCOMES ARE
RELEVANT, AT THE LEVEL OF THE
HUMAN.
AND THAT IS IT.
>> THANKS, TRACY.
GO AHEAD.
WE WERE FORTUNATE ENOUGH TO HAVE
ABOUT 10 PEOPLE IN OUR VIRTUAL
ROOM.
SHANNON GIBBON BRADLEY,
CHRISTINE, BILL KAHN AND NOAH
SNYDER-MACKLER THAT WANTED TO
STAY BUT NEEDED TO CATCH A
PLANE.
TO COMPLEMENT SOME OF OUR THEMES
OBVIOUSLY OVERLAPPED WITH WHAT
TRACY HAD TO SAY, BUT ONE THING
WE ALL AGREED ON WAS THIS
PRINCIPLE THAT WHETHER IT IS
BASIC RESEARCH WITH MODEL
ANIMALS OR FUNDAMENTAL DESIGN
WITH HUMANS, THE GUIDING
QUESTION TO ASK FOR ALL OF THEM
IS, WHAT DOES THIS MEAN FOR
PEOPLE?
SO WHETHER YOU ARE CONDUCTING
RESEARCH WITH MICE, ZEBRAFISH,
NON-HUMAN PRIMATES, MAPPING BACK
ONTO WHAT IS THE QUESTION OR THE
OUTCOME FOR PEOPLE IS OF UTMOST
IMPORTANCE.
BECAUSE LIKE THE FIRST GROUP, WE
ALL AGREED THAT THERE IS NO
PERFECT MODEL ANIMAL.
HUMANS ARE COMPLEX.
YET RESEARCH ON A SPECIFIC
CONDITION OR TIME ACROSS THE
LIFESPAN, WHETHER IT'S DURING
PREGNANCY, OLD AGE, ANYWHERE
BETWEEN, THE LIFESPAN OF A MODEL
ANIMAL AND THE REDUCTIONIST
PERSPECTIVE ON A SPECIFIC
DISEASE, LIFE COURSE, ORGAN, ET
CETERA, CAN HELP US INVESTIGATE
THINGS IN A SHORTER COURSE OF
TIME THAN AMONG HUMAN BEINGS.
NUMBER THREE, WHICH --
INTERDISCIPLINARITY.
WE'RE ALL HERE TOGETHER BECAUSE
NIDDK AND ITS PARTNER INSTITUTES
RECOGNIZE THAT IT'S A TRANS-NIH
EFFORT, IT'S A WHOLE-PERSON
EFFORT, AND THAT ALL THE
DISCIPLINES THAT INFORM HUMAN
HEALTH RESEARCH NEED TO COME
TOGETHER TO ANSWER AND RESPOND
AND RESOLVE THESE COMPLEX
ISSUES.
AND ONE WAY TO DO THAT MIGHT BE
MORE T32s THAT ARE
TRANSDISCIPLINARY.
NOAH CAME OUT OF ONE, I THINK
IT'S AT DUKE, AND THEIR
POPULATION RESEARCH CENTER, IN
WHICH THERE WERE BIOLOGISTS AND
PHYSICIANS AND SOCIAL SCIENTISTS
ALL WORKING TOGETHER TO ADDRESS
MANY OF THESE QUESTIONS.
TWO MORE POINTS.
HOW AND WHETHER THE CONSEQUENCES
OF RMD ARE REVERSIBLE AND, IF
SO, WHEN IS IT POSSIBLE OVER THE
LIFE COURSE, AND WHEN IS IT NOT?
FINALLY, WE TALKED A LOT IN EACH
THEME THROUGH OUR ENTIRE TIME
TOGETHER ABOUT THE NEED FOR
CLEAR COMMUNICATION BETWEEN
SCIENTISTS AND THE LAY PUBLIC,
BETWEEN PEOPLE IN DIFFERENT
KINDS OF DISCIPLINES, BETWEEN
MODEL ANIMAL RESEARCHERS AND
INTERVENTIONISTS.
AND HOW IMPORTANT THAT WAS.
WE TALKED ABOUT MANY WAYS TO
ADDRESS IT.
MANY OF WHICH YOU'VE HEARD
BEFORE.
BUT WE HAD ONE NOVEL IDEA TO
SHARE WITH YOU, AND THAT IS
COMMUNITY ADVISORY BOARDS ALL
ACROSS THE BOARD.
BECAUSE WHO BETTER TO -- WHO
BETTER UNDER STANDS THE
PROBLEMS, THE POTENTIAL
RESOLUTIONS OF RMD-RELATED
ISSUES THAN THE PEOPLE WHO
EXPERIENCE THEM AND KNOW THEM
BEST?
OVER THE LAST TWO DAYS, WE HAVE
HEARD ALL KINDS OF -- WELL, I'VE
LEARNED SO MUCH, AND ONE OF THE
THINGS THAT MANY OF US HAVE SAID
TO ONE ANOTHER IS HOW SMART AND
KNOWLEDGEABLE OUR RESEARCH
PARTICIPANTS ARE ABOUT THEIR
EXPERIENCES, ABOUT THE HEALTH
CONSEQUENCES, AND WHAT THEY
THEMSELVES BELIEVE AND KNOW THEY
NEED TO HELP MAKE THINGS BETTER.
AND SO INVOLVING THEM IN SOME
MODEL ANIMAL RESEARCH, IN BASIC
RESEARCH, AND IN MODELING CAN
PERHAPS PROVIDE US WITH NOVEL
PERSPECTIVES ON RESEARCH
TRAJECTORIES GOING FORWARD.
THANK YOU.
>> WE'RE GOING TO GO A LITTLE
OUT OF ORDER JUST TO ACCOMMODATE
SOME FLIGHTS OUT.
SO NEXT WE'RE GOING TO JUMP TO
BREAKOUT FOUR, STARTING WITH THE
VIRTUAL SESSION.
SYLVIE WILL BE PRESENTING, SO
THANK YOU, SYLVIE.
>> HEY, EVERYBODY.
OUR GROUP HAD ALL THE ANSWERS.
[LAUGHTER]
NO.
I WISH WE HAD.
I WISH.
SO I WAS PART OF BREAKOUT GROUP
FOUR, INTERGENERATIONAL AND
TRANS GENERATIONAL AND LIFE
COURSE IMPLICATIONS.
WE HAD A TOTAL OF SIX PEOPLE,
HALF OF WHICH CAME FROM THE NIH.
BUT IT WAS A GREAT GROUP.
WE HAD SOME GREAT DISCUSSIONS.
SO THE FIRST QUESTION WE TACKLED
WAS HOW MIGHT THE BIOLOGICAL
CONSEQUENCES OF RACISM,
MARGINALIZATION AND
DISCRIMINATION ACCUMULATE OVER
THE LIFE COURSE?
AND WE TALKED MORE ABOUT --
YEAH, SO YOU CAN SEE ALL OUR
NOTES THERE.
WE TALKED ABOUT WAYS HOW TO
STUDY THIS, SO WE TALKED ABOUT
THE NEED TO CONDUCT LONGITUDAL
STUDIES OF COHORTS, STARTING
PRENATALLY -- PEOPLE OF
DIFFERENT AGES SO YOU DON'T NEED
TO WAIT FOR 70, 80 YEARS TO SEE
WHAT THE IMPACT IS GOING TO BE
CUMULATIVELY OVER TIME.
WE ALSO TALKED ABOUT THE
DIFFICULTY GETTING
INFORMATION -- WE SAID WHAT
ABOUT CROSS-SECTIONAL DESIGN,
CAN WE GET THESE CUMULATIVE
EFFECTS USING CROSS-SECTIONAL
STUDIES?
WE TALKED ABOUT HOW WE COULD FOR
SOME ASPECT OF THE EXPERIENCES,
MAYBE THOSE THAT CAN BE MEASURED
MORE OBJECTIVELY SUCH AS GETTING
HISTORY, LIVING HISTORY OF
PEOPLE, WHERE THEY LIVED, FOR
HOW LONG, AND THEN GETTING
OBJECTIVE INFORMATION ON
ENVIRONMENTAL EXPOSURES SUCH AS
AREA DEPRIVATION INDEX, MAYBE
ENVIRONMENTAL POLLUTANTS, MAYBE
POVERTY, THINGS LIKE THAT.
SO THAT COULD BE DONE.
EITHER CROSS-SECTIONALLY,
RETROSPECTIVELY, OR SELF-REPORT
MEASURES, FOLLOWING PEOPLE
LONGITUDELY OVER TIME WOULD BE
PREFERABLE, AND AS WELL WE CAN
MEASURE THE BIOLOGICAL
CONSEQUENCES OVER TIME, USING
MEASURES THAT WE HAVE BEEN
DISCUSSING FOR THE LAST TWO DAYS
SUCH AS -- ALLOSTATIC LOAD,
EPIGENETIC MARKERS.
SO MOVING ON.
NEXT SLIDE, YES.
WE ALSO TALKED ABOUT THE NEED TO
MEASURE SOCIAL SAFETY, SO WHAT
LISA DIAMOND TALKED ABOUT IN HER
TALK, MEASUREMENT DIFFICULTIES
THAT MAY COME WITH THAT,
IMPORTANT TO CONSIDER
INTERSECTIONALITY, AND THE
CUMULATIVE IMPACT, AND MEASURE
ALL DISCRETE EXPERIENCES OF
SYSTEMIC DISCRIMINATION AS WELL
AS THE OVERALL LEVELS OF
VIGILANCE.
NEXT QUESTION, HOW CAN WE BEST
MEASURE OR ADDRESS POTENTIAL
ACCUMULATION THROUGH RESEARCH?
SO WHAT WE GRAPPLED WITH, HOW
CAN WE -- I DON'T THINK WE ARE
AT THAT LEVEL OF SPECIFICITY
WHERE WE COULD LINK SPECIFIC
EXPERIENCES, DISCRIMINATION, BUT
SPECIFIC BIOMARKERS, AND AGAIN,
I THINK WE NEED TO DO MORE
RESEARCH, MAYBE START
CROSS-SECTIONAL STUDIES TO TRY
TO PINPOINT THAT.
AGAIN WE TALKED ABOUT THE NEED
TO MEASURE DIFFERENT TYPES OF
ADVERSE EXPERIENCES, SO NOT JUST
RACISM AND DISCRIMINATION BUT
OTHER RELATED TYPES OF
ADVERSITIES.
SUCH AS POVERTY, LACK OF
RESOURCES.
LOW ACCESS OR LOW UTILIZATION OF
HEALTHCARE.
BECAUSE ALL OF THOSE WILL
ACCUMULATE IN TERMS OF THE
BIOLOGICAL IMPACT.
WE ALSO TALKED ABOUT THE NEED TO
CAPTURE WHAT PREVIOUS GENERATION
EXPERIENCED, AND THE IMPORTANCE
OF CULTURE AND HOW THINGS
PSYCHOLOGICALLY EXPERIENCES
TRANSMIT THROUGH GENERATIONS,
THROUGH CULTURE AND THROUGH
STORIES THAT PEOPLE TELL.
SO WE TALKED A LOT ABOUT THE
IMPORTANCE OF STORIES.
SO WHAT ARE THE PARENTS AND THE
GRANDPARENTS TELLING, WHAT
STORIES ARE THEY TELLING, HOW IS
THAT A PART OF THE TRANSMISSION
OF SOME OF THESE EXPOSURES BOTH
IN TERMS OF ADVERSE EXPOSURES AS
WELL AS SOURCE OF RESILIENCE.
ALSO, SOMETIMES WHEN PEOPLE
EXPERIENCE TRAUMA, THEY WILL NOT
TALK ABOUT IT, SO WHAT ARE THE
STORIES THAT ARE NOT BEING TOLD,
HOW DOES THAT -- YOU KNOW, HOW
CAN YOU MEASURE THAT, HOW WOULD
THAT IMPACT THE NEXT GENERATION.
WE TALKED ABOUT HOW THE
INTERGENERATIONAL TRANSMISSION
OF THE HYPERVIGILANCE MAY LOOK
LIKE, HOW MIGHT THAT HAPPEN,
THAT IT COULD BE MODELED THROUGH
BEHAVIORS, IT COULD BE MODELED
AGAIN THROUGH STORIES OR
MESSAGES, THE PARENTS OR OTHER
PEOPLE TELL CHILDREN, DO NOT
TRUST THESE KINDS OF PEOPLE, DO
NOT TRUST OTHER PEOPLE, AND HOW
THAT COULD THINK ABOUT
BIOLOGICAL IMPACT.
AND THE NEED FOR MIXED METHODS
DESIGN, SO ALSO LISTEN TO THE
STORIES, ASK PEOPLE TO TELL
THEIR STORIES.
MOVING ON TO QUESTION THREE.
WHAT SPECIFIC TIME PERIODS
ACROSS THE LIFE COURSE MAY BE
PARTICULARLY IMPORTANT FOR
UNDERSTANDING THE BIOLOGICAL
CONSEQUENCES OF RACISM,
MARGINALIZATION AND
DISCRIMINATION?
SO OVERALL, THIS APPEARS TO BE
ASSOCIATED WITH RAPID BRAIN
DEVELOPMENT AND HORMONAL
DEVELOPMENT, SO PREMAY TALL,
EARLY CHILDHOOD, THAT WHOLE
PERIOD OF DEVELOPMENT FROM
PRENATAL TO YOUNG ADULTHOOD
BECAUSE THE BRAIN IS STILL
DEVELOPING.
WE TALKED ABOUT MEASURING
INFLAMMATION, DNA METHYLATION,
TELOMERE LENGTH OVER TIME DURING
THESE DIFFERENT CRITICAL
PERIODS.
WE TALKED ABOUT THE HEALTHCARE
SYSTEM AND PHYSICIAN
INTERACTIONS AS A POTENTIAL
SOURCE OF RACISM AND
DISCRIMINATION.
WHICH ALSO INCLUDES SAY NOT
GETTING PRENATAL CARE OR THEY
ARE NOT RESPECTED DURING THE
EXPERIENCE, DISCRIMINATION.
WE TALKED ABOUT THE IMPACT ON
THE CAREGIVER AND HOW THAT --
WITH CAREGIVER BOND OR
ATTACHMENT.
AND AGAIN, HOW THIS IS ALL
EMBEDDED WITHIN CULTURES AND HOW
WE LOOK AT ALL THOSE PIECES.
WE TALKED ABOUT THE IMPORTANCE
OF INVOLVING OR REALLY STUDYING
THE WHOLE FAMILY, NOT JUST THE
MOTHER A AND THE CHILD AS IT
TYPICALLY DONE, BUT WHAT ABOUT
OTHER CHARACTERS, WHAT ABOUT
FATHERS, EXTENDED FAMILY?
ALL OF THOSE ARE INVOLVED IN
RAISING CHILDREN SO THEY ARE
PART OF THE INFLUENCES THAT WILL
ACCUMULATE AND BIOLOGICAL --
CUMULATIVE BIOLOGICAL IMPACT.
AGAIN, WE CAME TO THE QUESTION
OF -- SILOS AND CULTURAL
PRACTICES AND HOW THOSE MIGHT BE
PART OF OR MODERATE THE EFFECTS
OF RMD.
AND THE QUESTION OF IDENTITY, WE
TALKED ABOUT HOW WITH THE
ADOLESCENT MAYBE COMES FROM A
MIXED RACE FAMILY, HOW THAT
COULD BE DIFFICULT TO NAVIGATE,
YOU KNOW, WHAT IDENTITY AM I.
AND WE TALKED ABOUT HOW -- EVEN
AT THE ROOLT OF ALL THESE
PROBLEMS IS THE DIVISIONS THAT
WE CREATE, THAT WE SNEAK UP AND
CATEGORIZE PEOPLE INTO THESE
CATEGORIES.
IF YOU FOCUS ON THESE DIVISIONS,
IF WE COULD FOCUS ON THE THINGS
THAT COULD UNITE US, THAT WOULD
BE -- EXPERIENCES.
NEXT SLIDE.
BUT IT A CHALLENGE.
HOW DO YOU CREATE A SOCIETY WITH
NO DIVISIONS, WHERE EVERYBODY IS
EQUAL, WHERE EVERYBODY IS
RESPECTED?
SO THE RESEARCH SHOWS THAT --
INTERACTIONS WITH PEOPLE WHEN
GROUPS OF PEOPLE WORK TOGETHER
TO PURSUE A COMMON GOAL, THAT'S
WHAT BRINGS PEOPLE TOGETHER AND
YOU CAN SEE THE SIMILARITIES
THROUGHOUT THE DIFFERENCES.
I THINK THAT'S A CHALLENGE FOR
ALL, HOW CAN WE CREATE THAT IN
THE SPACES THAT WE OCCUPY, AND
HOW CAN WE INCLUDE IT IN OUR
RESEARCH AND MAKE IT --
INTERVENTIONS.
LAST QUESTION, HOW MIGHT THE
BIOLOGICAL CONSEQUENCES IN
RACE -- RMD PASS FROM PARENTS TO
CHILDREN?
WE TALKED A LOT ABOUT PARENTING
STYLE.
THERE IS RESEARCH ON HOW STRESS,
ALL SORT OF STRESS, IMPAIRS
PARENTS' ABILITY TO BE
SENSITIVE, RESPONSIBLE PARENTS.
AND AGAIN THE IMPORTANCE OF
THE -- NETWORK, IF THERE'S MORE
CAREGIVERS INVOLVED, IF THERE'S
A BROADER SOCIAL MAP, THAT MIGHT
HELP.
WE TALKED ABOUT PERSISTENCE OF
EPIGENETIC CHANGES ACROSS
GENERATIONS.
WE NEED MORE RESEARCH TO
UNDERSTAND THOSE BETTER.
ARE SOME BRAIN AREAS
DIFFERENTIALLY AFFECTED ACROSS
GENERATIONS, DIFFERENT TYPES OF
ADVERSITY, DO THEY HAVE
DIFFERENT CONSEQUENCES, WHAT
ABOUT SOME THAT ARE MORE DISTAL,
MORE SYSTEMIC, ARE THERE ANY
DIFFERENTIAL EFFECTS AND DO THEY
PASS DIFFERENTIALLY THROUGH
GENERATIONS?
AGAIN THE ROLE THESE STORIES
PLAY IN THE INTERGENERATIONAL --
AND IN TERMS OF WHEN YOU TALK
ABOUT HOW CAN YOU -- GREAT BOOK
BECAUSE SOME PEOPLE -- THOSE
SETTINGS.
AND ARE THERE DIFFERENCES,
INDIVIDUAL DIFFERENCES IN THE
PHENOTYPIC EXPRESSIONS OR
BIOLOGICAL CHANGES?
ARE THESE CHANGES REVERSIBLE,
WHICH WE HAVE SEEN IN SOME OF
THE TALKS THAT THEY ARE, AT
LEAST IN SOME CIRCUMSTANCES, SO
THAT WOULD BE IMPORTANT TO STUDY
IN LONGITUDAL RESEARCH, AND THE
IMPORTANCE WHEN LOOKING AT
CULTURE OR DIFFERENT GROUPS, YOU
KNOW, NOT TREATING ALL HISPANICS
AT THE SAME GROUP BECAUSE IT'S A
VERY DIVERSE POPULATION WITH
LOTS OF CULTURAL DIFFERENCES.
AND HOPE PERHAPS TO MEASURE --
MAY VARY FROM ONE GROUP TO
ANOTHER.
SO THIS IS A LOT OF FOOD FOR
THOUGHT FROM ALL OF US.
THANK YOU.
>> IN-PERSON BREAKOUT, NANA?
IF YOU JUST WANT TO SAY DITTO,
WE CAN.
DITTO?
OKAY.
THAT'S FAIR.
OKAY.
SO THEN WE'LL JUMP BACK UP TO
IN-PERSON BREAKOUT GROUP TWO.
>> WE DIDN'T GET THROUGH ALL OUR
QUESTIONS BECAUSE WE HAD THE
MOST QUESTIONS OF ALL THE
BREAKOUT GRAWPS, BUT IN OUR
INITIAL DISCUSSION, IT TURNS OUT
THAT WE BASICALLY ANSWERED THREE
OF THE QUESTIONS IN ANSWERING
QUESTION ONE.
SO THE THREE QUESTIONS THAT WE
TALKED ABOUT WERE UNDERSTANDING
THE POTENTIAL ADDITIVE
MULTIPLICATIVE EFFECTS OF RMD IN
PEOPLE WITH MULTIPLE
INTERSECTING IDENTITIES, AND
UNDERSTANDING DIFFERENTIAL
IMPACTS OF RMD WITHIN POPULATION
GROUPS AND THE EXTENT THAT
REPORTED MEASURES CAPTURE
CHANGES.
IN RMD EXPERIENCES OVER
TIME.
SO FIRST OFF, WE STARTED OUT THE
DISCUSSION TALKING ABOUT MOVING
BEYOND LINEAR INTERACTION TERMS
IN STATISTICAL ANALYSES AND THAT
ADDITIVE MODELS ARE NOT
PARTICULARLY USEFUL SINCE YOU'RE
JUST GETTING INDEPENDENT EFFECTS
AND NOT ACTUALLY INTERSECTIONAL
EFFECTS.
FOR MULTIPLICATIVE MODELS, THAT
CAN TELL US WHETHER OR NOT THERE
ARE DISPARITIES BUT NOT
NECESSARILY WHY THERE ARE
DISPARITIES.
SO WE SORT OF TALKED ABOUT MORE
COMPREHENSIVE APPROACH TO REALLY
UNDERSTANDING INTERSECTIONALITY.
SO LOOKING AT USING QUANTITATIVE
AND QUALITATIVE DATA, MIXED
METHODS DATA, AS WELL AS DOING
BOTH BETWEEN-GROUP COMPARISONS,
SO HAVING A COMPARATIVE
REFERENCE GROUP OUTSIDE OF THE
GROUP THAT WERE INTERESTED BUT
ALSO REALLY MOVING MORE TOWARDS
WITHIN GROUP ANALYSES SO THEN WE
HAVE BOTH -- MORE STATISTICAL
POWER OVER TIME, IF WE CAN
FOLLOW THE SAME PEOPLE, AS WELL
AS BETTER EXCHANGEABILITY IN OUR
MODELS.
WE ALSO TALKED ABOUT HOW WITH
MEASURES OF RACISM, WE TEND TO
USE THE SAME MEASURES IN
DIFFERENT CONTEXTS AND THAT THAT
MIGHT NOT ACTUALLY BE CAPTURING
WHAT WE WANTED TO CAPTURE.
SO THINKING MORE BROADLY ABOUT
HOW WE MIGHT WANT TO ACTUALLY
MEASURE RACISM JUST IN DIFFERENT
SITUATIONS.
AND OF COURSE SAMPLE SIZE IS
ALWAYS THE NUMBER ONE CHALLENGE
WITH INTERSECTIONAL RESEARCH,
AND LEAST QUANTITATIVELY, SO WE
DISCUSSED A NUMBER OF STRATEGIES
THAT MIGHT BE HELPFUL AROUND
THIS, SO THINKING JUST ABOUT
MORE NUANCED ANALYTIC ANALYSES
BEYOND JUST DISCRIMINATION,
RACE, INTERACTION TERM.
SO THINKING ABOUT COMBINED
REPORTING.
OF GROUPS.
AGAIN, WITHIN-GROUP COMPARISONS.
AND THEN WE HAD TALKED -- WELL,
OKAY, LISA AND KEN TALKED ABOUT
PLANNED MISSINGNESS BY DESIGN
AND THE RETI REST OF US HAD LOTF
QUESTIONS BUT NOT ENOUGH TIME TO
DISCUSS IT ALL, BUT BASICALLY
FROM WHAT I GATHERED, AGAIN TO
OVERCOME THE SMALL SAMPLE SIZISH
YOU'LL, BUT WITH THE MISSINGNESS
BY DESIGN, THEN WE CAN USE
MULTIPLE IMPUTATIONS TO SORT OF
FILL IN SOME OF THE GAPS AND
IMPROVE OUR MODELS THAT WAY.
AND THEN THERE WAS ALSO A
DISCUSSION, A BRIEF DISCUSSION
OF CLUSTERS OF NATURAL
COMMUNITIES AND A MORE FLEXIBLE
STUDY DESIGN IN ORDER TO ASSESS
INTERSECTIONALITY BETTER.
KEN MENTIONED THAT THE
FLEXIBILITY IN DESIGN IS NOT
NECESSARILY WHAT STUDY SECTIONS
EXPECT, BUT WE DON'T NECESSARILY
HAVE TO CATER TO THEM.
AND THEN -- YEAH, AND THEN JUST
THE WITHIN GROUP.
AND THEN FOR THE QUESTION, ONE
THAT WE HAVEN'T CAPTURED YET, SO
THAT ONE IS LOOKING AT THE
TENSION BETWEEN SOCIETAL LEVEL
RACISM AND -- VERSUS INDIVIDUAL
LEVEL BIOLOGIC PROCESSES.
SO WE TALKED ABOUT MULTILEVEL
MODELING, AND OF COURSE WITHIN
THAT, THEN, THERE WERE ISSUES
AROUND MEASUREMENT ERROR AND
PRECISION, AND JUST TRYING TO
EXPLORE VARIABILITY ACROSS ALL
OF THE LEVELS.
BASICALLY WE JUST NEED BETTER
MEASURES ACROSS THE BOARD.
THERE IS A GROWING CONCERN ABOUT
JUST RELYING ON INDIVIDUAL-LEVEL
SELF-REPORTED DATA AS PEOPLE ARE
GETTING MORE ACCUSTOMED TO
TAKING SURVEYS, PEOPLE ARE -- A
LOT OF RESEARCHERS ARE
EXPERIENCING ISSUES WITH BOTS
COMPLETING SURVEYS ONLINE, SO
THAT COULD INCREASE THE
POSSIBILITY OF HAVING BAD DATA
GOING INTO OUR MODELS.
SO JUST BEING MORE COGNIZANT OF
THAT.
AND TRYING TO BE MORE CREATIVE
ABOUT WAYS TO MEASURE AREA LEVEL
RACISM, SO THERE WAS A BRIEF
DISCUSSION ON POTENTIALLY USING
WEARABLE TECHNOLOGY TO CAPTURE
POTENTIALLY DIFFERENT ASPECTS OF
RACISM, SO SOMETHING LIKE
VIGILANCE, AND JUST THOSE
DEVICES CAN THEN ALSO HELP US
CAPTURE MORE DAY TO DAY DATA.
AND THEN WE TALKED BRIEFLY ABOUT
THIS IDEA OF PRECISION EQUITY,
SO TRYING TO FIGURE OUT IN A
LARGER POPULATION WHO NEEDS WHAT
AND THAT -- WHILE ALSO
RECOGNIZING THAT INDIVIDUAL
PEOPLE ALSO NEED INDIVIDUAL
THINGS, SO SORT OF FINDING THAT
BALANCE IN ORDER TO DEAL WITH
THE VARIABILITY WITHIN THE
GROUPS.
AND THAT'S THE FOUR QUESTIONS.
>> SO I THINK WE HAD THE BEST
GROUP.
I ACTUALLY WOULD LIKE TO BORROW
THEM AND WHEN I WRITE MY NEXT
GRANT, CONSULT WITH THEM.
BUT HOPEFULLY THESE
RECOMMENDATIONS CAN BE
AVAILABLE, JENNA, RIGHT?
>> YES.
>> OKAY.
SO WE HAD, GIVE OR TAKE, SIX TO
NINE PEOPLE GOING IN AND OUT.
OH, MY.
I CAN'T READ THAT.
SO THE FIRST ONE -- OH, AND
THANKS TO MELISSA FOR TAKING
NOTES.
SO ANY SPECIFIC MEASUREMENT AND
ANALYTIC CHALLENGE TOPICS THAT
YOU'VE BROUGHT UP TO DISCUSS.
SO WE STARTED OFF WITH THIS
GENERAL QUESTION, AND SO A LOT
OF THE THINGS, NICOLE ALREADY
MENTIONED, BUT ONE OF THE THINGS
THAT WE BROUGHT UP WAS UNIFORM
MEASUREMENTS.
SO HOW DO WE NOT ONLY DEFINE
THEM BUT HOW DO WE MEASURE
THOSE.
SO THERE'S BASICALLY A LACK OF
CONSENSUS AND CLARITY ON
DEFINITIONS FOR STRUCTURAL
RACISM, AND WHAT IS NIH'S ROLE
IN THIS.
SO WE BRIEFLY TALKED ABOUT HOW
NIMHD HAS THE PHOENIX TOOLBOX
FOR MEASURING SOCIAL
DETERMINANTS OF HEALTH, BUT IT'S
PRETTY COMPREHENSIVE, IT'S A
LITTLE BIT OVERWHELMING, SO WHO
ALL SHOULD BE INVOLVED IN MAYBE
COMING UP WITH THESE CONSISTENT
DEFINITIONS AND WHAT'S THE VOICE
OF VALIDATION.
AND ALSO WE TALKED A LITTLE BIT
ABOUT A PROXY MEASURE, SO I KNOW
IN TALKS THIS MORNING, THEY
TALKED ABOUT MAYBE SES AND RACE
AND ETHNICITY BEING USED AS
PROXIE MEASURES, SO REALLY
FOCUSING ON PICKING THE MOST
APPROPRIATE MEASURES AND METRICS
ACCORDING TO THE RESEARCH
QUESTION.
AND THEN STAYING ABREAST AND
CONSCIOUS OF THE EVOLVING
VOCABULARY AND SOCIAL CONTEXT,
SO WHAT MIGHT BE APPLICABLE
TODAY MIGHT BE DIFFERENT
TOMORROW, SO ONE EXAMPLE THAT
WAS BROUGHT UP WHICH IS REALLY
PHENOMENAL IS THE CONSENSUS OF
THE RACE AND ETHNIC DEFINITION
FOR MEAN OF POPULATION WHICH
DIDN'T EXIST, SO THAT WAS A
GREAT EXAMPLE OF A NEW
DEFINITION.
AND THEN ASSESSING RACISM SUCH
AS COMPOSITE MEASURES, SO NOT
JUST LOOKING AT ONE ASPECT.
THIS HAS BEEN A CONSISTENT THEME
AMONGST ALL THE GROUPS THAT HAVE
DISCUSSED THIS, SO LOOKING AT
THE INDIVIDUAL LEVEL, BUT THE
ENVIRONMENTAL LEVEL
INFRASTRUCTURE AND STRUCTURAL --
REVERSE INTERVAL.
AND THEN ALSO USING ANALYTICAL
MEASURES TO PARSE OUT THE PIECES
OF THE COMPOSITE MEASURES.
SO ONCE WE SAY THAT WE'RE GOING
TO COMBINE EVERYTHING, LIKE HOW
DO YOU ANALYZE THIS DATA, THAT
BECOMES ANOTHER BIG QUESTION.
AND THEN WE ALSO NEED MEASURES
TO ACCOUNT FOR CONFOUNDING
EFFECTS.
SO THE SYNDEMIC EFFECT,
SNOWBALLING EFFECT.
MOVING ON TO THE NEXT QUESTION,
HOW DO WE UNDERSTAND THE KNOW
TENSION ADDITIVE OR
MULTIPLICATIVE EFFECT OF RACISM,
MARGINALIZATION AND GY
DISCRIMINATION IN PEOPLE WITH
MULTIPLE INTERSECTING,
MARGINALIZED SOCIAL IDENTITIES.
A MEASURE CAN BE CREATED, SO
STUDIES TO ENROLL PATIENTS WITH
MULTIPLE IDENTITIES.
SO NOT LOOKING AT LIKE
HOMOGENEOUS, THIS WHOLE THING
ABOUT GENERALIZABILITY, SO
PEOPLE USUALLY TRY TO ENROLL
HOMOGENEOUS POPULATIONS BUT
MAYBE GETTING AT HETEROGENEOUS
POPULATIONS.
AND BE CONSCIOUS AND MINDFUL OF
THE POWER AND SAMPLE SIZE AND
ASK QUESTIONS IN A WAY THAT WE
CAN GENERALIZE AND ALSO ON TAPE
APPROPRIATE RIGOR.
I THINK THE COMMUNITY ENGAGEMENT
GROUP AND THE PATIENT GROUPS
ACTUALLY BROUGHT UP LIKE,
LISTEN, YOU KNOW, AND ASK
QUESTIONS IN A WAY WHERE WE CAN
THGET THAT INFORMATION.
AND THEN ALSO ASK QUESTIONS,
THIS WAS BROUGHT UP IN TODAY'S
TALK, LIKE HOW DO PEOPLE THRIVE.
SO MORE STRENGTH-BASED
INVESTIGATION IS NEEDED.
AND AN EXAMPLE, THE PERCEPTION
OF SAFETY AND LIVING WITH THE
EASE OF SAFETY IN PROMOTING MORE
UNIFYING, SOCIAL SAFETY
RESONATES WITH ALL GROUPS.
AND THEN HOW DO WE ACCOUNT FOR
THE TENSION BETWEEN THE SOCIETAL
LEVEL NATURE OF RACISM
MARGINALIZATION AND
DISCRIMINATION VERSUS THE
INDIVIDUAL LEVEL NATURE OF
BIOLOGICAL PROCESSES?
ENHANCE MEASUREMENT AT VARIOUS
LEVELS, WE'VE TALKED ABOUT THAT.
SO NOT ALL EPI DATA INCLUDES
LEVEL-SPECIFIC MEASUREMENTS.
AND THEN CONDUCTING MULTILEVEL
STUDIES MIGHT HELP, SO ALSO
BEING ABLE TO ACCESS MULTIPLE
COMPONENTS AT EACH SPECIFICALLY
LEVEL OF THE STUDY.
AND THEN GLEAN FROM OTHER
FIELDS, SO THIS WAS A BIG THEME
THROUGHOUT ALL OF OUR
DISCUSSIONS, WHERE WE TALKED
ABOUT, YOU KNOW, ENVIRONMENTAL
STUDIES, WHERE WE TALKED ABOUT
POLLUTION, WHERE WE'VE TALKED
ABOUT SMOKING, YOU KNOW, CHANGE
HAS HAPPENED IN THESE OTHER
FIELDS, SO HOW DO WE GLEAN FROM
THAT AND BE ABLE TO APPLY TO RMD
RESEARCH.
AND THE OTHER THEME THAT CAME UP
WAS THE TIMING, SOME THINGS ARE
SLOW AS MOLASSES, SO WE DIDN'T
REALLY HAVE AN ANSWER BUT AGA
AGAIN, -- FROM OTHER
DISCIPLINES, OTHER RESEARCH.
AND THEN WHO CAN WE WORK WITH TO
PROVIDE THE DATA TO?
SO WHAT IS THE PRACTICE OF
FEDERAL HANDOFF LOOK LIKE?
SO NIH CAN PROVIDE THE FUNDING
AND YOU DO THE DATA, BUT WE'VE
ALREADY HAD THIS DATA FOR
DECADES, YOU KNOW, TWO DECADES
THAT CAME UP, BUT WHAT CAN WE
DO, HOW CAN WE MAKE THE DATA
WORK AND THEN HOW DO WE HAND IT
OFF IN ORDER TO MAKE CHANGE
HAPPEN.
SO ALSO HOW DOES THE TIMING OF
EVIDENCE, VALIDATION OR FUNDING
CATCH UP TO REAL-LIFE ACTIVITY?
COMMUNITY INVOLVEMENT, WE
ALREADY TALKED ABOUT THAT.
IN ENHANCING LISTENING.
OKAY.
SO THE LAST ONE, HOW DO WE
UNDERSTAND THE DIFFERENTIAL
IMPACTS OF RACISM,
MARGINALIZATION AND
DISCRIMINATION EXPOSURES WITHIN
POPULATION GROUPS?
SO THE TALK YESTERDAY WITHIN MY
SESSION, WE TALKED ABOUT
OBTAINING REAL-LIFE DATA, SO
THERE'S A DIFFICULTY TO OBTAIN
IN THE MOMENT DATA, RIGHT?
BUT EVEN THOUGH WE DISCUSSED
THIS ON THE FLIP SIDE, WE
DISCUSSED, LIKE, WHO'S TO
BENEFIT FROM THIS?
MAYBE WE NEED TO BE FOCUSING ON
MORE POSITIVE MEASUREMENTS.
PEOPLE ALREADY ARE RESILIENT,
PEOPLE ARE SURVIVING, SO WE NEED
TO I FOCUS ON NOT REALLY TALKING
ABOUT THE NEGATIVE BUT MAYBE
MORE OF THE RESILIENCE AND THE
POSITIVE.
FOR EXAMPLE, WHAT ARE THE THINGS
THAT PROMOTE SAFETY?
AND THEN THIS IS A GLOBAL ISSUE.
SO AGAIN LOOKING AT THE SOCIAL
EPIDEMIC, WHICH IS A GLOBAL
ISSUE, SO THERE WERE A LOT OF
EXAMPLES OF, LIKE, WHETHER IT'S
RACE-BASED DISCRIMINATION OR
WHETHER IT'S NON-VISIBLE, LIKE
RELIGION OR SOMETHING ELSE.
, BASED DISCRIMINATION, SO HOW
DO WE BORROW FROM THAT.
THIS IS A GLOBAL EPIDEMIC, SO
PERHAPS THERE ARE ANALOGIES TO
RELIGION REFORM AND OTHER FIELDS
THAT WE COULD APPLY.
I THINK THAT'S IT.
>> THANK YOU.
THAT WAS GREAT.
SO NEXT UP, WE WILL GO TO
BREAKOUT THREE, SO I THINK
THAT'S YOU, TIFFANY.
>> SO OUR TASK WAS REALLY
TALKING ABOUT THE PATHWAYS TO
INTERVENTIONS, AND SO THE FIRST
QUESTION WAS HOW CAN WE LEVERAGE
FINDINGS FROM THIS LINE OF
RESEARCH TO REDUCE EXPOSURE TO
RACISM, MARGINALIZATION,
DISCRIMINATION AND MITIGATE ITS
EFFECTS.
AND SO A LOT OF WHAT WE FOCUSED
ON IN OUR DISCUSSION, WHICH WAS
VERY BROAD, SORRY, TO GIVE
CONTEXT AS FAR AS THE PEOPLE
THERE, THERE WERE NINE OF US
THERE.
DAVID CHAE WAS MYCO-MODERATOR. .
THANK YOU TO MAUREEN FOR BEING
OUR NOTE TAKER.
WE COVERED A LOT OF GROUND IN
OUR DISCUSSION, SO SHE DID A
FANTASTIC JOB IN KEEPING TRACK
OF WHAT WE WERE SAYING.
BUT IN TERMS OF LEVERAGING THE
FINDINGS, WE COVERED SEVERAL
THEMES.
SOME THAT HAVE BEEN TALKED ABOUT
ALREADY AROUND RESILIENCE AND
SAFETY OR LACK OF SAFETY FOR
COMMUNITIES, BUT THERE WAS A LOT
OF DISCUSSION ABOUT INTERVENING
AT DIFFERENT LEVELS, REALLY
THINKING MULTILEVEL, THINKING OF
POLICY, STRUCTURAL COMMUNITY
LEVEL INTERVENTIONS.
WE TALKED ABOUT SOME OF THE
INTERVENTIONS THAT EXIST ALREADY
IN SCHOOLS, BUT THINKING ABOUT
HOW DO YOU BUILD MORE
INTERVENTIONS IN THE SCHOOL
SETTING AROUND TRAINING AND
CONNECTING INDIVIDUALS WITHIN
THE COMMUNITY.
AND IN TERMS OF SAFETY, THERE
WAS A GREAT DEAL OF DISCUSSION
ABOUT THE LACK OF SAFETY THAT
SOME POPULATIONS MIGHT FEEL THAT
MAY LEAD TO THE BACKLASH THAT
WE'RE SEEING AGAINST DEIA
EFFORTS RIGHT NOW, SO THERE WAS
A LOT OF DISCUSSION OF HOW DO WE
ADDRESS THAT, HOW DO WE PREVENT
THAT TYPE OF BACKLASH, HOW DO WE
MAKE IT SO THAT THESE POLICIES
ARE APPLICABLE TO ALL
POPULATIONS BUT ALSO SOME OF THE
SUGGESTIONS WERE AROUND THE NEED
FOR MORE BUILDING EQUITY INTO
POLICIES, INTO INSTITUTIONS, AND
NOT JUST FOCUSING ON ONE
SPECIFIC AREA BUT REALLY
THINKING ABOUT THINGS THAT ARE
ACROSS LEVELS, ACROSS DIFFERENT
AREAS OF EDUCATION, OF
HEALTHCARE, AND THE LIKE, AND SO
ONE EXAMPLE THAT WAS GIVEN WAS
AROUND THE OBAMA ADMINISTRATION,
WHERE THEY INSTITUTIONALIZE
HEALTH EQUITY BY IMPROVING FOOD
QUALITY IN THE COMMISSARIES AND
SAW AN IMPROVEMENT IN NUTRITION
IN THE MILITARY, AND THAT WAS
AROUND IMPROVING ACCESS TO
HEALTHY FOODS.
THE OTHER THINGS AROUND SAFETY
OR THE LACK OF SAFETY WAS REALLY
THINKING ABOUT HOW DO WE
ACKNOWLEDGE THE SOCIAL
HIERARCHIES THAT EXIST IN THE
INTERVENTIONS THAT WE DEVELOP,
HOW DO WE CALL THOSE OUT, HOW DO
WE DEMONSTRATE AGAIN THAT IT
HURTS ALL POPULATIONS, NOT JUST
MINORITIZED POPULATIONS, HOW DO
WE TALK ABOUT THE POWER
DIFFERENTIALS WITHOUT -- MAKE
THOSE POWER DIFFERENTIALS
EXPLICIT AND DEFINE WHAT THEY
ARE, HOW DO WE ADDRESS
INTERSECTIONALITY IN TERMS OF,
FOR INSTANCE, RACISM WITHIN THE
LGBTQ COMMUNITY, DISPARITY
WITHIN POPULATIONS LIKE PUERTO
RICO EXPOSED TO THE RETURN,
NATHURRICANE,NATURAL DISASTERS,S
WITHIN FAMILY STRUCTURES.
ANOTHER BIG AREA IN LEVERAGING
OUR FINDINGS FOR INTERVENTION
WAS AROUND COMMUNITY ENGAGED
RESEARCH AND UTILIZING ASSETS
WITHIN THE COMMUNITY, AS MANY
PEOPLE HAVE TALKED ABOUT, AND
ACKNOWLEDGING THAT THERE ARE
COMMUNITIES OF COLOR THAT ARE
THRIVING, AND HOW DO WE
UNDERSTAND THOSE STRENGTHS.
THAT
MAY BE GENERALIZABLE TO OTHER
POPULATIONS.
SO IN THINKING ABOUT
INTERVENTIONS THAT MAY HAVE
WORKED, SOME OF THE PARTICIPANTS
TALKED ABOUT LOOKING OUTSIDE OF
THE UNITED STATES FOR POTENTIAL
RESEARCH THAT IS HAPPENING, FOR
INSTANCE, IN THE SCHOOL SYSTEMS
AND TRYING TO CHANGE ATTITUDES
AROUND RACE AND BIAS IN
AUSTRALIA.
BUT ALSO THINKING ABOUT HOW
POLICY CHANGES AND POLICY -- AND
SOCIAL MOVEMENTS CAN CHANGE
ATTITUDES WITH THE EXAMPLE OF
THE MARRIAGE EQUALITY LAWS
POTENTIALLY CHANGING ATTITUDES
AROUND -- ABOUT LGBTQIA
POPULATIONS.
AND IN TERMS OF THINKING ABOUT
OTHER STRUCTURAL INTERVENTIONS,
AGAIN IT WAS -- THERE WAS A GOOD
DEAL OF DISCUSSION ABOUT POLICY,
ABOUT PROVIDING ACCESS TO
RESOURCES AND OPPORTUNITIES FOR
POPULATIONS.
IT'S NOT JUST ABOUT -- KNOWING
ABOUT WHAT OPPORTUNITIES ARE OUT
THERE, BUT ALSO HAVING EQUAL
ACCESS AND HAVING POLICIES THAT
REMOVE BARRIERS.
AND SO, AGAIN, THINKING ABOUT
THOSE POLICY INTERVENTIONS THAT
CAN HAPPEN.
AND ONE PERSON BROUGHT UP THE
FACT THAT NO HEALTH PROBLEM HAS
REALLY NOT REQUIRED A MULTILEVEL
APPROACH, AND SO WE NEED TO --
RACISM, MARGINALIZATION AND
DISCRIMINATION IS NO DIFFERENT,
WE NEED TO INTERVENE AT MULTIPLE
LEVELS.
AND IN TERMS OF THE OTHER
DISCUSSION, IN TERMS OF QUESTION
TWO ABOUT HOW CAN WE LEARN FROM
THOSE EXPOSED TO RACISM AND
MARGINALIZATION BUT WHO DON'T
EXPERIENCE SEVERE CONSEQUENCES,
TO IDENTIFY OPPORTUNITIES TO
MITIGATE THE IMPACTS OF RACISM,
MARGINALIZATION AND
DISCRIMINATION.
THERE WAS SOME DISCUSSION ABOUT
SHIFTING AWAY FROM JUST STUDYING
MINORITIZED POPULATIONS TO
ACTUALLY STUDYING WHITE
SUPREMACY AND THE TACTICS THAT
PERPETUATE RACISM AND
MARGINALIZATION, AND HOW CAN WE
INTERVENE ON THOSE TACTICS, AND
SHIFT AWAY FROM THINKING ABOUT
INDIVIDUAL RESILIENCE TO
THINKING ABOUT LOOKING AT
COMMUNITIES, AS DR. DIAMOND
BROUGHT UP EARLIER, AND THINKING
ABOUT INTERVENTIONS WHERE WE
LOOK AT WHAT BUFFERS GROUPS
AGAINST RACISM AND EVEN
POTENTIALLY USING SOCIAL NETWORK
ANALYSES TO UNDERSTAND
EXPERIENCES THAT CAN MITIGATE
THE EFFECTS OF RACISM.
AND THEN IN TERMS OF QUESTION
THREE, WHICH WAS WHAT THIS LINE
OF RESEARCH POSE TO PEOPLE WHO
EXPERIENCE RACISM,
MARGINALIZATION, DISCRIMINATION,
HOW CAN WE MITT GR MITIGATE THE.
THE DISCUSSION AROUND BACKLASH
THAT WE'RE EXPERIENCING RIGHT
NOW, WHERE THERE'S A LOT OF WORK
TO UNDO THE CHANGES AROUND
DIVERSITY, EQUITY AND INCLUSION
WORK THAT'S HAPPENED, ESPECIALLY
IN THE LAST FOUR YEARS, AND SO
THAT'S WHERE THE IDEA OF MAKING
IT CLEAR THAT THESE ISSUES ARE
APPLICABLE ACROSS POPULATIONS,
ACROSS COMMUNITIES NOT JUST FOR
MINORITIZED POPULATIONS BUT ALSO
WE NEED TO THINK ABOUT THOSE
INSTITUTION-LEVEL INTERVENTIONS
THAT -- WHERE WE
INSTITUTIONALIZE EQUITY.
AND THEN OUR LAST QUESTION WAS,
HOW CAN WE ENSURE RESEARCH IN
THIS SPACE DRIVES TOWARDS
SOLUTIONS INSTEAD OF SIMPLY
ADMIRING THE PROBLEM?
AGAIN, BRINGING THE COMMUNITY TO
THE TABLE, MAKING SURE THAT THE
COMMUNITY IS A PART OF CREATING
INTERVENTIONS, CONSIDERING THE
CULTURAL ASPECTS OF COMMUNITY
AND BRINGING CULTURE INTO THE
INTERVENTIONS THAT WE CREATE,
CREATING MULTILEVEL
INTERVENTIONS, AND ACKNOWLEDGING
THE INTERSECTIONALITY AND
COMMONALITY OF -- THE
INTERSECTIONALITY OF THE ISSUES
BUT ALSO COMMONALITY OF OUR
STRUGGLES AND MOST OF -- AND THE
FACT THAT MOST OF US ARE NOT
BENEFITING FROM THE EXISTING
STRUCTURES, AND CULTIVATING A
GENERATION OF SCIENTISTS WITH
LIVED EXPERIENCE SO THAT THEY'RE
BRINGING THAT LIVED EXPERIENCE
TO THE DEVELOPMENT OF THESE
INTERVENTIONS.
THAT'S IT.
THANKS.
>> SO I WILL TRY NOT TO REPEAT A
LOT OF THE GREAT POINTS THAT WAS
MENTIONED JUST BEFORE.
AND I HOPE THIS IS OKAY WITH THE
REST OF THE GROUP.
WE HAD ABOUT -- WE WERE ABOUT 17
PEOPLE IN OUR GROUP, AND -- I
KNOW.
YES!
AND WE HAD FUN.
WE HAD FUN SHARING EXPERIENCES.
A LOT OF INDIVIDUALS WERE FROM
NIH, NIDDK, BUT WE ALSO HAD A
LOT OF COMMUNITY MEMBERS,
COMMUNITY ORGANIZATION
REPRESENTATIVES AND MEDICAL
DOCTORS, SO THE GROUP WAS MIXED
IN, REALLY A LOT OF FUN AND
INSIGHTFUL.
SO QUESTION ONE, I THINK -- I
THINK YOU GUYS IN BREAKOUT THREE
IN PERSON DID A WONDERFUL JOB
JUST SUMMARIZING THE SAME THING
THAT WE ALSO MENTIONED.
SO THE ONE THING THAT WAS
HIGHLIGHTED FROM THE BEGINNING
IS THE IMPORTANCE OF DEFINING
THE MEASURES WHEN WE WERE
TALKING ABOUT RACISM,
MARGINALIZATION AND
DISCRIMINATION, WHAT DOES IT
MEAN AT THE INDIVIDUAL LEVEL
FROM THEIR EXPERIENCE, BECAUSE
IT MIGHT BE DIFFERENT BASED ON
THEIR LIVED EXPERIENCE.
SO IT WAS MENTIONED THAT IT WAS
IMPORTANT THAT IN ORDER TO
MITIGATE SOMETHING, YOU FIRST
NEED TO UNDERSTAND WHAT WE ARE
TALKING ABOUT.
SO THEN THE OTHER IMPORTANT
THING THAT WAS ALSO MENTIONED
WAS THE WHOLE CONCEPT OF
SUPPORTIVE AND PROTECTIVE
ENVIRONMENTS, AND THAT HAS BEEN
A MAJOR RECURRENT THEME
THROUGHOUT THIS CONFERENCE, SO
IT'S REALLY ESTABLISHING SUPPORT
SYSTEMS THAT ENABLE AN
INDIVIDUAL TO BE BORN TO GROW IN
AN ENVIRONMENT WHERE THEY DON'T
FEEL THAT WE NEED TO EXPERIENCE
RMD SO EARLY.
HOWEVER, MAKING THEM AWARE OF IT
IS ALSO SOMETHING THAT WAS
MENTIONED AND IT'S A GREAT
POINT.
SO SUPPORTIVE WHILE TEACHING HOW
REALLY TO BE AWARE OF IT AND
UNDERSTANDING THE CONCEPTS
AROUND IT.
SO I'M GOING TO MOVE TO QUESTION
NUMBER TWO, WHAT MIGHT WE LEARN
FROM THOSE WHO ARE EXPOSED TO
RMD BUT DON'T EXPERIENCE AS
SEVERE CONSEQUENCES IN ORDER TO
IDENTIFY OPPORTUNITY TO MITIGATE
THE IMPACT OF RMD.
SO A GREAT DEAL OF CONVERSATION
WAS AROUND HAVING -- REALLY
CONVERSING WITH THESE
INDIVIDUALS AND TRYING TO NOT
ONLY IDENTIFY THE WAYS THEY WERE
ABLE TO EXPERIENCE THOSE SEVERE
CONSEQUENCES BUT A GREAT CONCEPT
WAS ALSO SHARED AS THEY ALL
AGREED AND WERE EXCITED ABOUT IT
IS THE SECOND POINT THAT IS
LISTED ON THE SLIDE, WHERE IT'S
THIS WHOLE IMAGE OF
IMMUNIZATION, THE CONCEPT OF
IMMUNIZATION.
SO YOU KNOW WITH VACCINE, YOU'RE
EXPOSED TO SOMETHING AND YOU
BECOME BETTER AND STRONGER AT
FIGHTING THE DISEASE THE NEXT
TIME AROUND, SO THAT WOULD BE
THE INDIVIDUAL -- IDENTIFYING
WAYS THAT THEY FACED AND
SUCCESSFULLY WENT THROUGH THE
EXPERIENCE, AND THEN LEARNING
FROM THERE AND TRYING TO
ESTABLISH -- TO ADAPT TO OUR OWN
CIRCUMSTANCES.
SO WE LOVE THAT IMMUNIZATION
CONCEPT.
NUMBER THREE, WHAT RISKS MIGHT
THIS LINE OF RESEARCH POSE TO
PEOPLE WHO EXPERIENCE RACISM?
AND LIKE BEFORE, IT WAS
BEAUTIFULLY SAID, THE RISK OF
INVALIDATING OR THE VOICE BEING
QUIET, SO THAT'S NOT SOMETHING
THAT I'M GOING TO GO THESE
POINTS BECAUSE I THINK THEY WERE
WELL SUMMARIZED.
AND LAST IS HOW CAN WE ENSURE
RESEARCH IN THIS SPACE DRIVES
TOWARDS SOLUTIONS RATHER THAN
SIMPLY ADMIRING THE PROBLEM?
IT'S TALKING -- REALLY LOOKING
AT WHERE MONEY COMES FROM.
SO TALKING THE MONEY TALK WILL
GET US MOVING FORWARD.
SO DR. HOPKINS, WHO WAS ALSO --
IS BASED IN CHICAGO HAS
MENTIONED HOW IT IS IMPORTANT TO
PARTNER WITH INSURANCE COMPANIES
AND FUNDERS TO SHOW THE RETURN
ON INVESTMENT BY ADDRESSING
SOCIAL DETERMINANTS OF HEALTH,
WHICH COULD BE REFRAMED AS
RACISM, MARGINALIZATION AND
DISCRIMINATION.
SO THERE WAS A GREAT
CONVERSATION ABOUT WHY ARE WE
USING SOCIAL DETERMINANTS OF
HEALTH RATHER THAN RACISM,
MARGINALIZATION AND
DISCRIMINATION, AND A FEW OF US
WERE SAYING THAT, WELL, SOCIAL
DETERMINANTS OF HEALTH IS MORE
PALATABLE TO FUNDERS AND TO
OTHERS, BECAUSE I NEED TO SHARE
THE EXPERIENCE WITH MY STUDENTS,
SO IT'S LESS INTIMIDATING TO
TALK ABOUT IT, BUT THEN ONCE WE
HAVE OUR PLACE AT THE TABLE, WE
HAVE THE OPPORTUNITY TO REFRAME
TO REALLY LINK SOCIAL
DETERMINANTS OF HEALTH TO RMD,
SO THAT'S ANOTHER APPROACH THAT
WAS MENTIONED.
AND THEN CREATING OPPORTUNITIES
TO AMPLIFY SUCCESSFUL
PARTNERSHIPS BETWEEN RESEARCHERS
AND CLINICIANS.
SO THAT WE ADVOCATE FOR THE
PATIENT TO BECOME ADVOCATES FOR
THEMSELF BUT NOT REALLY PUTTING
THE BURDEN ON THE RESEARCHER BUT
ALSO ON THE PATIENTS BUT ALSO ON
THE RESEARCHER TO INDICATE
THEMSELF ABOUT THOSE CONCEPTS OF
RMD BUT ALSO SOCIAL DETERMINANTS
OF HEALTH.
AND THEN COMMUNICATING RMD
CONCEPT AND MAKING HEALTH
DISPARITIES DIALOGUE PALATABLE
IS SOMETHING I MENTIONED.
CREATING REGISTRIES FOR
COMMUNITY-BASED ORGANIZATIONS
WAS ALSO SOMETHING THAT WAS
MENTIONED BECAUSE INDIVIDUALS
ARE SMART, THEY ARE RESILIENT,
THEY FIND SOLUTIONS EVEN BEFORE
US AS RESEARCHERS OR FUNDERS
EVEN RIZE THAT THE REALIZE THATA
PARTNPROBLEM THERE.
SO IT'S EASIER TO PARTNER WITH
THEM TO KNOW THAT THEY EXIST AND
REALLY PARTNER WITH THEM TO
ADDRESS THESE ISSUES.
AND WITH THAT, A LOT OF
PROPOSALS WERE MADE ABOUT
ENCOURAGING NIH TO ALSO MAKE IT
A REQUIREMENT AND FINDING WAYS
TO MAKE IT A REQUIREMENT FOR
COMMUNITY MEMBERS TO BE
CONSIDERED EQUAL PARTNERS IN THE
RESEARCH, SO TO BE CONSIDERED AS
RESEARCHERS, AND SO BECAUSE
AGAIN, THE FUNDERS MAKE THOSE
GUIDELINES EASIER THAN THE
ACADEMIC INSTITUTION WILL BECOME
MORE LENIENT TOWARDS IT AND WILL
FIND WAYS SO THAT IT'S NOT AN
UPSTREAM BATTLE BUT ALSO COMING
DOWNSTREAM.
THAT WAS SOMETHING THAT WAS SAID
ABOUT, YOU KNOW, HOW DO WE BUILD
COMMUNITY ENGAGEMENT IS BY
HAVING THE POLICY MAKERS AT THE
TABLE BECAUSE THOSE ARE THE
DECISION-MAKERS ULTIMATELY, BUT
ALSO HAVING THOSE INSTITUTIONS
THAT ARE LEADING IN TERMS OF
FUNDING AND RESEARCH, FINDING
WAYS TO DESIGN GUIDELINES SO
THAT COMMUNITY MEMBERS, THOSE
EXPERIENCING AMD, ARE CONSIDERED
EQUAL PARTNERS IN RESEARCH
DESIGN AND -- YES, IN RESEARCH
DESIGN.
I THINK THAT WAS ABOUT IT.
THANK YOU.
>> I CAN GO FIRST.
>> SURE.
>> SO I'M PINCH HITTING FOR THE
VIRTUAL ROOM FIVE, SO I'M JUST
GOING TO SHARE WHAT IS HERE ON
THE SLIDES.
NOT HAVING BEEN IN THE ROOM FOR
THE BEST THAT I CAN.
SO THE FIRST QUESTION, WHO NEEDS
TO BE AT THE TABLE, SO THERE WAS
DISCUSSION OF THIS WOULD NEED TO
BE SORT OF AN INTERDISCIPLINARY
OR TRANSDISCIPLINARY FIELD THAT
MUST BE INCLUSIVE, WHICH IS
GOING TO BE THE CHALLENGING PART
OF THIS EFFORT.
AND REALLY A NEW FIELD WITH NEW
SKILLS IS NEEDED TO BUILD ACROSS
MANY DISCIPLINES, SPECIFICALLY
ACADEMICIAN FROM THE BIOLOGICAL
SPACE, SOCIAL SCIENCE
RESEARCHERS, BEHAVIORAL SCIENCE
RESEARCHERS, CLINICAL TRIALISTS,
PATIENTS AND EVERYBODY ELSE, I
THINK THE LIST IS LONG AND I
THINK INCLUDES MANY OF THE
PEOPLE WE ENDEAVORED TO BRING
HERE TO THIS ROOM TODAY.
YOU KNOW, THE NEED TO UNDERSTAND
HOW THE BIOLOGICAL CONSEQUENCES
OF RACISM ARE MARGINALIZATION,
DISCRIMINATION AND DEVELOPING IN
THE REAL WORLD AND HOW THEY
INFLUENCE BEHAVIOR, AND IN TERMS
OF WHERE TO START THINKING ABOUT
HOW NIH ICs ARE SILOS AND SO
MAKING SURE WE'RE BREAKING
ACROSS THE SILOS AND BRINGING
THE DIFFERENT GROUPS TOGETHER.
SO MOVING TO THE SECOND
QUESTION, HOW DO WE ATTRACT AND
RETAIN ALL OF THESE GROUPS TO
THIS SPACE, SO THE NEED TO
INVEST IN THIS SPACE AND FUNDING
OPPORTUNITIES TO TRAIN THE
WORKFORCE, ESPECIALLY EARLY
STAGE INVESTIGATORS,
ACKNOWLEDGING THAT NOT ONE IC
CAN ACCOMPLISH ALL OF THESE
GOALS AND THERE NEEDS TO BE SORT
OF A COMING TOGETHER ACROSS THE
NIH INSTITUTES TO BRING THIS
SPACE FORWARD.
POTENTIAL PARTNERSHIPS WITH
ARPA-H WERE RAISED, THE USE OF
CHALLENGE.GOV TO PROMOTE
INNOVATION AND GIVE PRIZES TO
PEOPLE WHO HAVE IDEAS IN THIS
SPACE, AND ANALYSIS OF EXISTING
DATA IN THE RESPECTIVE FIELD AND
GENERATING NEW QUESTIONS.
MOVING ON TO QUESTION THREE,
WHAT SKILLS NEED TO BE
DEVELOPED/ENLANCED TO ADVANCE
RESEARCH IN THIS AREA.
DATA SCIENCE SKILLS FOR
ANALYSIS, AI, DISCUSSING
HETEROGENHETEROGENEITY OF DIABEL
OF THOSE IN CONTEXT OF THE
BROADER SET OF CONDITIONS THAT
MANY PEOPLE ARE LIVING WITH IN
OUTREACH SKILLS FOR RESEARCHERS
TO GET COMMUNITY MEMBERS TO THE
TABLE.
POTENTIALLY MISSING SKILLS,
AWARENESS OF HOW TO APPLY THESE
SKILLS.
SO ONCE YOU KIND OF ACKNOWLEDGE
THAT YOU NEED THEM, HOW DO YOU
ACTUALLY INTEGRATE THEM INTO THE
RESEARCH PROCESS?
FOR QUESTION FOUR, SOME EXISTING
MODELS WE MIGHT LEARN FROM
INCLUDE THE KIDNEY AND PRECISION
MEDICINE PROJECT, THE ALL-OF-US
PROGRAM, THE PRECI HOW DO WE ADS
BURNOUT IN THIS FIELD, YOU KNOW,
IT'S HARD TO BRING IT UP AT THIS
POINT BECAUSE IT'S SUCH A NEW
FIELD, MAYBE WE NEED MORE
EXPERIENCE AND TIME THERE.
SOME OF THE ROADBLOCKS WITH
GAINING FUNDING REPRESENTED
CHALLENGE AND INCREASED RISK FOR
BURNOUT, ENSURING REVIEW IN
STUDY SECTIONS HAVE -- INCREASE
ABILITY TO GET FUNDING.
THE INSTITUTION AND ENVIRONMENT
JUST MAKING THAT INSTITUTIONAL
ENVIRONMENT MORE SUPPORTIVE OF
THIS SPACE.
HAVING MORE COMMUNITY-LED
INTERVENTIONS, WHICH GIVE
SUPPORT TO THE COMMUNITY
THEMSELVES.
AND JUST GENERATING THE VALIDITY
OF STUDYING THESE ISSUES.
SO WITH THAT, I'LL PASS IT OFF
TO YOU, KAREN.
>> GREAT, THANK YOU.
I'M THE LAST, I'M GOING TO BE
QUICK.
THERE WILL BE SOME DITTO WITH
STUFF.
WE MIGHT HAVE MISINTERPRETED THE
TASK IN OUR GROUP.
BECAUSE WE DID GIVE
RECOMMENDATIONS THAT WEREN'T
JUST NIH-SPECIFIC.
>> THAT'S FINE.
>> OKAY, GREAT.
OKAY.
SO, ALSO WE WERE A VERY SMALL
BUT MIGHTY GROUP.
THERE WERE FOUR OF US.
SO WE HAD A GREAT TIME.
OKAY.
SO WHO NEEDS TO BE AT THE TABLE?
OF COURSE WE TALKED ABOUT
COMMUNITY MEMBERS, RESEARCHERS,
DIFFERENT DISCIPLINES.
POLICY MAKERS, GOVERNMENTAL
REPRESENTATIVES, FOLKS FROM
INDUSTRY, AND THEN FUNDING
ORGANIZATIONS.
IN TERMS OF HOW DO WE ATTRACT
AND RETAIN THESE GROUPS TO THE
SPACE, SO OF COURSE FUNDING IS
IMPORTANT, PEOPLE NEED TO BE
ABLE TO SEE THAT THEY CAN HAVE A
CAREER IN THIS AREA.
WE ALSO TALKED ABOUT THE NEED
FOR FAIR COMPENSATION,
PARTICULARLY FOR COMMUNITY
MEMBERS FROM THE VERY SORT OF
ONSET AND NOT JUST HAVING LIKE A
CAB THAT MEETS TWICE A YEAR.
WE ALSO TALKED ABOUT THINKING
ABOUT THE WAY THAT UNIVERSITIES
THINK ABOUT THINGS LIKE TENURE
AND PROMOTION, AND HOW
COMMUNITY-BASED COMMUNITY LED
RESEARCH IS VALUED AT
INSTITUTIONS, SO WE TALK A LOT
ABOUT KIND OF CHANGING THE
ENTIRE CULTURE OF SCIENCE AND
HOW THESE CONVERSATIONS HAVE
BEEN HAPPENING FOR DECADES, BUT
IN THIS KIND OF WORK, WE REALLY
NEED TO MAKE SURE THAT THIS TYPE
OF WORK IS BEING VALUED.
WE TALKED ABOUT THE NEED FOR
MENTORSHIP IN TERMS OF
ATTRACTING AND RETAINING FOLKS
AND THE SORT OF RESPECT FOR
WORK/LIFE BALANCE AND CHANGING
THE RAT RACE CULTURE, SO PEOPLE
WHO GET INTO SCIENCE OFTENTIMES
LEAVE BECAUSE OF THOSE
CHALLENGES.
AND THEN WE TALKED ABOUT
CREATING INCLUSIVE WORK SPACES,
AND THAT INCLUDES EVERYTHING
FROM, YOU KNOW, ALL-GENDER
BATHROOMS, TO RECOGNITION OF
PRONOUNS AND THOSE KINDS OF
POLICIES AND EVEN THE WAY THAT
BUILDINGS ARE NAMED OR STATUES
ARE NAMED AT INSTITUTIONS, THINK
ABOUT ALTHO ALL THOSE THINGS ASE
THINK ABOUT INCLUSIVE
ENVIRONMENTS.
AND THEN DR. NURU-JETER THIS
MORNING TALKED ABOUT THESE OTHER
WAYS OF KNOWING, AND SO WE WERE
TALKING ABOUT THAT, INCLUDING
THINGS LIKE HOW QUALITATIVE
RESEARCH IS SEEN AT NIH, HOW
INDIGENOUS KNOWLEDGE IS SEEN
WITHIN FUNDING INSTITUTIONS.
SO WHAT SKILLS, A LOT OF THESE
THINGS WERE ALREADY DISCUSSED SO
THINGS LIKE MEASUREMENT-RELATED
RESEARCH, COMMUNICATION, SO
REALLY HAVING PEOPLE WHO CAN
TRANSLATE WHAT WAS LEARNED IN A
STUDY BACK TO THE COMMUNITY AND
BACK TO THE GENERAL PUBLIC IN A
WAY THAT PEOPLE CAN UNDERSTAND.
SO WE TALKED ABOUT SORT OF MESS
MESSAGING.
WE ALSO TALKED ABOUT NEEDING
SKILLS IN POLICY AND STRUCTURAL
RELATED RESEARCH INCLUDING LARGE
DATA, DATASETS.
AND I'M ALMOST FINISHED.
OKAY, THE EXISTING MODELS, WE
WERE I THINK CONFUSED A LITTLE
BIT ABOUT THIS QUESTION.
THERE'S ACTUALLY A COUPLE THINGS
WE DIDN'T TALK ABOUT, BUT WE DID
TALK SOME ABOUT THE COMMON FUND
PROGRAM MODEL WE TALKED ABOUT
CANCER MOONSHOT AND HEAL, ALL AT
NIH, ALSO THINGS LIKE THE
CENTERS OF EXCELLENCE PROGRAM,
AND T32s, I THINK, COULD BE
REALLY IMPORTANT IN TERMS OF THE
WORKFORCE.
THOSE CAN BE CHALLENGING IN AN
AREA LIKE THIS THAT CROSSCUTS
MANY DIFFERENT DISEASE AREAS AND
HEALTH CONDITIONS, BUT TO SPORT
OF PULL TOGETHER TO DO MORE
CO-FUNDING ACROSS INSTITUTES
CENTER AND OFFICES THAT CAN BE
HELPFUL.
AND THEN WE TALKED A LITTLE BIT
ABOUT SOME OF THE OTHER THEORIES
AND MODELS THAT WOULD BE NEEDED
TO DO THIS WORK, WHICH YOU CAN
SEE HERE, THINGS LIKE CRITICAL
RACE THEORY, THE BIOPSYCHOSOCIAL
MODEL INTERSECTIONALITY.
THEN FINALLY, HOW DO WE ADDRESS
BURNOUT, SO KIND OF RETENTION OF
THE WORKFORCE, WE TALKED JUST
GENERALLY ABOUT WORK-LIFE
BALANCE IN SCIENCE, CREATING
INCLUSIVE WORK ENVIRONMENTS.
THE OTHER WAYS OF KNOWING,
PROMOTING SELF-CARE, GIVING
PEOPLE PERMISSION TO SAY NO TO
ADDITIONAL THINGS THAT PEOPLE
ARE TRYING TO PUT ON THEM.
AVOIDING TOKENISM, AND THAT GOES
FOR SORT OF THE COMMUNITY
MEMBERS INVOLVED IN THE RESEARCH
AND ALSO FOR, FOR EXAMPLE,
DIFFERENT DISCIPLINES.
COMING TO THE TABLE AT A
UNIVERSITY.
WE TALKED ABOUT COMMUNITY
EMPOWERMENT.
ONE OTHER THING WE TALKED ABOUT
IN THIS AREA IN TERMS OF BURNOUT
IS THAT OFTENTIMES PEOPLE SPEND
A LOT OF TIME WORKING ON THINGS
AND CHANGES MIGHT BE HAPPENING
IN AN INSTITUTION, BUT THAT'S
NOT COMMUNICATED BACK TO THEM,
AND SO MAKING SURE THAT THERE'S
SORT OF CONTINUOUS COMMUNICATION
BACK TO FOLKS, AND THEN WE ALSO
TALKED AGAIN ABOUT MENTORSHIP,
AS A WAY NOT TO JUST RETAIN AND
ATTRACT FOLKS BUT ALSO TO
PREVENT BURNOUT.
THAT'S IT.
THANK YOU.
>> SO WE ARE PRETTY MUCH AT
TIME, WHICH MAY BE GOOD BECAUSE
IT GIVES ME AN EXCUSE TO NOT
EVEN TRY TO SUMMARIZE ALL THAT
WE'VE HEARD OVER THE PAST TWO
DAYS BECAUSE I DON'T THINK I
COULD HAVE DONE IT JUSTICE EVEN
IF I HAD TIME.
SO I WILL SAY, I'M SORRY THAT WE
DIDN'T HAVE TIME TO HAVE A
LITTLE BIT OF DISCUSSION ABOUT
ALL OF THE GREAT FEEDBACK WE'VE
HEARD FROM THE BREAKOUTS, BUT I
HOPE THAT THIS WORKSHOP
REPRESENTS A START OF A
CONVERSATION IN THIS FIELD, AND
THAT PEOPLE WILL BE CONTINUING
TO MEET UP WITH FOLKS, YOU KNOW,
MAYBE THAT THEY MET BEFORE,
MAYBE THAT THEY MET HERE, BUT
HOPEFULLY TO SOME DEGREE SPURRED
BY THIS WORKSHOP TO CONTINUE
THESE CONVERSATIONS AND REALLY
MOVE THIS SCIENCE FORWARD, AND
OF COURSE I WANT TO THANK, YOU
KNOW, ALL OF OUR SPEAKERS, ALL
OF OUR PARTICIPANTS, OUR
MODERATORS, OUR BREAKOUT GROUP
LEADS FOR ALL OF YOUR FANTASTIC
CONTRIBUTIONS.
WE CERTAINLY COULDN'T HAVE DONE
THIS WITHOUT YOU, AND YOU GUYS
ALL REALLY MADE THIS MEETING A
SUCCESS, AND I KNOW I LEARNED A
LOT.
I'D ALSO LIKE TO THANK OUR
INSTITUTE LEADERSHIP, AS WELL AS
ALL OF THE CONTRIBUTING NIH
ICs AND EVERYBODY ELSE WHO
MADE THIS WORKSHOP HAPPEN.
OUR LOGISTICS SUPPORT TEAM AS
WELL WHO DID A LOT OF, YOU KNOW,
SIDESTEPPING AND MOVING AROUND
AND THINKING ON FEET TO ADDRESS
SOME OF THE CHALLENGES THAT
POPPED UP.
SO THANK YOU, EVERYBODY, I
REALLY APPRECIATE YOU TAKING THE
TIME TO BE WITH US OVER THE PAST
TWO DAYS AND WITH THAT, I WILL
LET EVERYBODY GO.
HAVE A GREAT REST OF YOUR DAY.
[APPLAUSE]