>> WELCOME TO NIMHD COUNCIL IT IS OPEN TO THE PUBLIC. COUNCIL MEMBERS PLEASE REMEMBER TO SPEAK SLOWLY AND DISTINCTLY. THE VIDEO CAST OBSERVERS AND NOTE TAKERS WILL BE LISTENING TO HEAR YOUR COMMENTS IN ORDER TO GET GOOD MINUTES. AFTER YOU ARE RECOGNIZED TO SPEAK DR. VOLBERG WILL PROMPT YOU. IN AN EFFORT TO CONSERVE BAND WIDTH DR. VOLBERG WILL LEAD THE ROLL CALL AND I DO REQUEST THAT ALL COUNCIL MEMBERS KEEP THEIR VIDEO ON BUT DO MUTE YOURSELVES IF YOU'RE NOT SPEAKING. >> THANK YOU. AS YOUR NAME IS CALLED PLEASE STATE YOUR NAME YOUR INSTITUTION INSTITUTION, ORGANIZATION A FILLATION AND A FEW INTERESTING TIDBITS. FIRST DR. BARNES. >> GOOD MORNING. I AM LISA BARNES, A PROFESSOR AND COGNITIVE NEURAL PSYCHOLOGIST IN CHICAGO. MY RESEARCH INTEREST IS IN HEALTH DISPARITIES OF CHRONIC DISEASES OF AGING WITH A PARTICULAR FOCUS ON ALZHEIMER'S DISEASE. HAPPY TO BE HERE TODAY. >> NEXT I'LL CALL UPON DR. KALAMAZOO. DR. KAHOLOKULA. >> AND DR. LONG. >> I'M JUDITH LONG I'M NOT SURE IF YOU CAN SEE ME. I THINK THE CAMERAS NOT WORKING. >> WE'RE GETTING A LOW BAND WIDTH SYMBOL ON YOUR NAME. SO MAYBE BETTER TO KEEP YOUR VIDEO OFF FOR NOW. >> OKAY. I TURNED OFF MY VIDEO. I'M THE CHIEF OF GENERAL INTERNAL MEDICINE AT THE UNIVERSITY OF PENNSYLVANIA AND I'M THE CO-DIRECTOR OF THE V.A. CENTER FOR HEALTH EQUITY RESEARCH AND PROMOTION. I DO RESEARCH PRIMARILY INTERVENTION TO SUPPORT BEHAVIORAL CHANGE AND ADDRESS SOCIAL DETERMINANTS OF HEALTH IN VULNERABLE POPULATIONS AND GLAD TO BE HERE. THANK YOU. >> DR. MANSON. >> GOOD MORNING. I'M A DISTINGUISHED PROFESSOR OF THE PUBLIC HEALTH AND PSYCHIATRY AT THE UNIVERSITY OF COLORADO. NO SURPRISE. MOST OF MY WORK IS IN MEDICAL ANTHROPOLOGIST AND FOCUS ON -- A MORE INTERESTING FACT "A" COMING TO YOU FROM MY RANCH IN RURAL COLORADO. A BEAUTIFUL LATE SPRING DAY. >> VERY NICE. OKAY. NEXT DR. -- MESTANSKI. >> AND DR. RAMIREZ. >> GOOD MORNING I'M A PROFESSOR AND CHAIR OF POPULATION HEALTH SCIENCES AT U.T. HEALTH SAN ANTONIO AND ALSO THE DIRECTOR THAT FOCUSES ON LATINO DISPARITIES IN GENERAL WITH A SPECIAL FOCUS ON CANCER. THANK YOU. >> DR. RESNICOW. >> DR. SHELL. I'M IN HEALTH SERVICES POLICY AND GLAD TO BE HERE FOCUSIN. GLAD TO BE HERE TODAY. THANK YOU. >> DR. SOUTHERLAND. >> GOOD MORNING. MY NAME IS BILL SUTHERLAND. I'M A PROFESSOR OF BIOCHEMISTRY AND ALSO THE PRINCIPLE INVESTIGATOR. >> DR. ZORILLA. >> GOOD MORNING. AT THE UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE. ALSO INTERIM DEAN. MOST HAS BEEN ON CLINICAL RESEARCH ON WOMEN LIVING WITH HIV. I'VE BEEN WORKING ON A LAB FOR TESTING AND ALSO VACCINE CENTER. >> THANK YOU. DR. CORBY SMITH. >> HI. MY NAME IS DR. CORBY SMITH. I DIRECT THE CENTER FOR HEALTH EQUITY RESEARCH AND SERVE AS SOCIAL PROVOST FOR RURAL INITIATIVES. >> THANK YOU. DR. JOHNSON. >> GOOD MORNING, EVERYBODY. I'M DR. KIMBERLY JOHNSON. I'M A PROFESSOR OF MEDICINE AT DUKE UNIVERSITY IN DURHAM, NORTH CAROLINA AND I DIRECT OR CENTER FOR RESEARCH ON MINORITY HEALTH AND HEALTH DISPARITIES. >> OKAY. NOW LET ME CIRCLE BACK TO SEE SOME PEOPLE WHO MAY HAVE JOINED LATE. DR. CHIN. MARSHALL WILL JOIN US LATER. DR. READE. DR. JOAN READE. SHOULD BE JOINING US LATER. >> DR. KNEEL CALL MAN. HAD A CONFLICT TODAY SO WILL NOT BE HERE IN TODAY'S OPEN SESSION. AT THIS POINT I WOULD LIKE TO MOVE TO NIMHD STAFF WHO ARE PRESENT. FIRST I'LL CALL UPON DR. HOOPER. >> GOOD MORNING. I'M MONICA WEBB HOOPER. DEPUTY DIRECTOR OF NIMHD. >> DR. STINSON. >> HI. I'M NATHAN STINSON THE DIRECTOR OF THE DIVISION OF COMMUNITY HEALTH AND POPULATION SCIENCE AT NIMHD. >> DR. MICHAEL SAYER. >> GOOD MORNING, EVERYONE. MIKE SAYER. >> LARISA -- VIA SANTA. ARE YOU THERE? >> NO. KIMBERLY ALLEN. ARE YOU THERE? NO. OKAY. AND HAVE WITH US DR. JENNIFER -- --AL DECEMBER AND RICHARD BERZON. >> GOOD MORNING. >> WITH THAT I'M TOM VOLBERG. AND DESIGNATED FEDERAL OFFICIAL FOR THIS COUNCIL. AT THIS TIME I WOULD LIKE TO MOVE TO THE REVIEW OF THE FEBRUARY 2021 COUNCIL MINUTES. THE MINUTES FROM THE FEBRUARY 2021 COUNCIL MEETING WERE POSTED. ING-- HAVING REVIEWEDTHE MINUTES ARE THERE ANY CORRECTIONS OR CONCERNS? NO. SEEING NONE IN THE CHAT BOX OR NOTHING VOICED IS THERE A MOTION TO APPROVE THE MINUTES FROM THE FEBRUARY COUNCIL? >> I MOVE TO APPROVE THE MINUTES IN THE FEBRUARY COUNCIL. >> SECOND THE MOTION. >> SECOND. >> OKAY. COULD YOU -- ALL OF THE MEMBERS THAT ARE PRESENT SUBMIT A Y IN THE TRACT BOX TO AGREE OR NO IF YOU DISAGREE. IT APPEARS THAT THE MOTION HAS PASSED UNANIMOUSLY. WITH THAT THE MINUTES FROM THE 2021 FEBRUARY ADVISORY COUNCIL MEETING ARE APPROVED. I WANT TO BRING YOUR ATTENTION TO FUTURE MEETING DATES. THESE ARE LISTED IN THE AGENDA. AFTER REVIEWING THE DATES PLEASE LET US KNOW IF THERE IS A DATE YOU CANNOT MAKE. IT IS IMPORTANT THAT WE HAVE A YOUR REALM IN ORDER TO CONDUCT THE BUSINESS OF THE INSTITUTE. OUR POLICY IS TO HAVE A COUNCILMEMBER HAVE ONE ABSENCE PER CALENDAR YEAR. THE FUTURE MEETING DATES IN SEPTEMBER WILL BE 9-10. IN 2022 FEBRUARY 3-4 ARE RESERVED. MAY 23-24 AND SEPTEMBER 1-2. IF YOU'RE ASKED TO SERVE ON A NIH PEER REVIEW PLEASE DECLINE THAT INVITATION FOR REASONS THAT YOU ARE A COUNCILMEMBER. I SEE THAT DR. MARSHALL CHIN HAS JOINED US. WOULD YOU LIKE TO INTRODUCE YOURSELF. >> I'M DR. MARSHALL CHIN. HELLO, EVERYONE. >> AND DR. JOAN READE ARE YOU THERE? NO. OKAY. SO WITH THAT ELISEO I TURN THIS MEETING BACK TO YOU. YOU'RE NEXT IN LINE. >> THANK YOU, TOM. AND JUST TO REMIND EVERYONE I'M EL SO PƒREZ-STABLE. WE DON'T HAVE A PACKED AGENDA TODAY FOR A CHANGE SO I'M GOING TO DO MY DIRECTOR'S REPORT AND THEN WE'LL HAVE A PRESENTATION FROM MARSHALL I BELIEVE. SO I'M GOING TO SHARE MY SLIDES AND LAUNCH RIGHT INTO IT. AND HOPEFULLY MAKE THIS TECHNOLOGY WORK. DOING THIS FIVE TIMES A WEEK YOU WOULD FIGURE I'VE LEARNED SOMETHING. RIGHT? I'LL START WITH UPDATES FROM THE DEPARTMENT -- HOPEFULLY SOME OF YOU FOLLOW THE NEWS. SECRETARY JAVIER -- BESERA WAS CONFIRMED IN MARCH. IT WAS MORE CON TINGE OURS THAN I WOULD HAVE EXPECT. HE IS THE FIRST LATINO TO HOLD THE OFFICE WHICH IS NOTEWORTHY. A 12 TERM CONGRESSMAN IN THE HOUSE OF REPRESENTATIVES PRIOR TO MOVING TO CALIFORNIA TO BECOME THE ATTORNEY GENERAL OF THE STATE AFTER NOW VICE PRESIDENT HARRIS WAS ELECTED TO THE U.S. SENATE. I HAD THE OPPORTUNITY TO MEET WITH HIM ON A COUPLE OF OCCASIONS EARLY ON IN HIS TENURE WHEN I WAS VISITING WASHINGTON WITH A GROUP ON MINORITY HEALTH ISSUES AND SUBSEQUENTLY AFTER I BECAME DIRECTOR AND I LOOK FORWARD TO WORKING WITH HIS STAFF AND SEEING HIS LEADERSHIP OF THE DEPARTMENT OVER THE NEXT FOUR YEARS. WE ALSO HAD THE CONFIRMATION OF ASSISTANT SECRETARY OF HEALTH RACHAEL LEVINE. CAME US TO FROM THE STATE OF PENNSYLVANIA WHERE SHE HAD BEEN THE SECRETARY OF HEALTH. SHE BECOMES THE 17th ASSISTANT SECRETARY OF HEALTH. SHE IS PROBABLY THE MOST IMPORTANT IF NOT THE HIGHEST RANKING PHYSICIAN WITHIN THE DEPARTMENT. I'VE BEEN IN A COUPLE OF MEETINGS THAT SHE HAS BEEN IN CHARGE OF. SHE IS AN IMPRESSIVE INDIVIDUAL AND I LOOK FORWARD TO WORKING WITH HER AS NIH AND OTHER HEALTH RELATED OPERATING DIVISIONS WITHIN THE DEPARTMENT WORK CLOSELY WITH THE ASH AS WE CALL IT. THE ASSISTANT SECRETARY OF HEALTH AND PROVIDES AN OVERSIGHT OVER THE MORE MEDICAL THINGS OR HEALTH RELATED ASPECTS OF THE DEPARTMENT PARTICULARLY WHEN THE SECRETARY IS AN ATTORNEY. WE ALSO HAVE THE RETURN OF VICE ADMIRAL VIVEK MURTHY. HE HAS COME BACK. HE HAS BEEN AN ACTIVE SUPPORTER OF THE BIDEN EFFORTS AND WE LOOK FORWARD AT NIH TO WORKING WITH HIM AS WELL. AND WE'LL GET TO SEE HIM ON CAMERA AT LEAST ON THURSDAY. OUR OWN COURTNEY ACKLAND WHO MOVED TO BUILDING ONE HAS NOW BECOME THE ACTING ASSOCIATE DEPUTY DIRECTOR FOR AT LEAST SIX MONTHS. SHE IS RESPONSIBLE FOR ALL KINDS OF PROJECTS WHICH OF WHICH I'M INVOLVED WITH AS WELL AS ALL STRATEGIC INTERACTIONS AND SHE WILL BE PARTICIPATING IN THE INSTITUTE DIRECTOR MEETINGS. DR. SWETZ WAS DRAFTED TO JOIN PRIMARILY TO WORK ON ISSUES AROUND -- RPAH. DR. CHRISTOPHER AUSTIN THE DIRECTOR OF NATIONAL CENTER FOR TRANSLATIONAL SCIENCES HAS DEPARTED TO BE A CEO AT FLAGSHIP PIONEERING. CHRIS EXPECTS TO REMAIN IN COMMUNICATION AND CONTACT WITH NIH. I THINK HAD A LOT OF POSITIVE INTERACTIONS WITH HIM OVER TIME. WE SAT ON A COUPLE OF SEARCH COMMITTEES TOGETHER BUT IN ADDITION TO THAT I THINK SHARED SOME SIMILAR PERSPECTIVES ON SOME OF THE STRUCTURAL ISSUES AROUND NIH. RUDDER WHO HAS BEEN A AT THE NATURALLAL COLLEAGUE WILL BE THE ACTING DIRECTOR OF NCATS. AND WE LOOK FORWARD TO HER CONTINUING THE EFFORTS AND THE EFFORTS THAT CHRIS MADE TO TRANSFORM THE CTSAs. YOU'VE ALL THINK BY NOW HEARD ABOUT THE COMMITMENT TO END STRUCTURAL RACISM. THIS GOES UNDER THE ACRONYM OF UNITE FOR FIVE COMMITTEES LISTED HERE. WE LAUNCHED THIS INITIALLY LAST FALL AND IT REALLY BECAME MORE OPEN AND PUBLIC AND CELEBRATED AS OF FEBRUARY OF THIS YEAR. MOST OF THIS IS INTERNAL. PRIMARILY A REFLECTION OF OUR OWN ORGANIZATIONAL STRUCTURES. SO, LISTENING TO STAKEHOLDER EXPERIENCES BOTH INTERNAL AND EXTERNAL ARE PART OF THIS. THINKING ABOUT HOW WE CAN IMPROVE OUR CULTURE FOR EQUITY, INCLUSION AND EXCELLENCE. BEING VERY TRANSPARENT FOR OUR INTERNAL AND EXTERNAL STAKEHOLDERS AND CONTINUE TO WORK ON THE RESEARCH ECHO SYSTEM. ESPECIALLY AROUND PROMOTING WORKFORCE DIVERSITY BUT ALSO ON CHANGING POLICY AND CULTURE AND STRUCTURE THAT HAS LED TO THE STRUCTURAL INEQUITIES THAT WE EXPERIENCE TODAY. PERHAPS THE NEWEST EMPHASIS IS ON ADVANCING RESEARCH ON HEALTH DISPARITIES, MINORITY HEALTH AND HEALTH INEQUITIES. WHETHER WE CALL IT NEW AND IMPROVED OR CONTINUED IS A SEPARATE ISSUE. SORRY ABOUT THE MOUSE MOVEMENT THERE. TWO OF OUR LEADERS AT UNANIMOUS NIMHD -- DIGESTING THE OVER 1,000 COMMENTS THAT CAME IN FOR REQUEST FOR INFORMATION. THIS CLOSED TOWARDS THE END OF APRIL. AND AS YOU SEE THEY HAVE A LOT OF WORK CUT OUT FOR THEM. THERE WAS ALSO A TOWN HALL ON APRIL 30th ON ACHIEVING RACIAL EQUITY. THERE WERE 7,000 LIVE VIEWS AT THE TIME OF THE TOWN HALL. IT WAS VERY WELL ATTENDED. GOOD DISCUSSION AND FOR THIS KIND OF A PLATFORM IT HAD A TREMENDOUS AMOUNT OF INTEREST. AND ANNAPOLIS OUR SCIENTIFIC DIRECTOR IS COCHAIRING THE COMMITTEE LOOKING AT NEW RESEARCH. HER PARTNERS ARE MICHELE EVANS. I THINK JEANINE CLAYTON FROM THE OFFICE OF RESEARCH AND WOMEN'S HEALTH. THE FIRST THING THAT CAME OUT OF THIS EFFORT WAS A COMMON FUND DEVELOPMENT FOR TRANSFORMATIVE RO1 RESEARCH TO ADDRESS HEALTH DISPARITIES AND ADVANCE HEALTH EQUITY AND IT WAS DESIGNED TO BE STRATIFIED. AND THERE ARE ALSO INITIAL DISCUSSIONS AND WORK GROUP FOCUSED ON STRATEGIC PLANNING FOR FISCAL YEAR 23 USING THE COMMON FUND MECHANISM. THERE ARE A NUMBER OF INTEREST OF RESEARCH COLLABORATIONS AND OPPORTUNITIES ON EXTRAMURAL AND INTEREST THA--AND INTRA MURAL. AS WELL AS OF COURSE NIMHD AND THE INSTITUTES. THERE ALSO HAS BEEN IN THE LAST YEAR FOR SURE SORT OF A GROUNDSWELL OF INTERNATIONAL IN THE SOCIAL DETERMINANTS OF HEALTH CREATING MORE STANDARDIZED MEASURES BOTH FOR OUR GRANTEES AND ALSO WITHIN NIH THE INTRAMURAL RESEARCH PROGRAMS AND ESPECIALLY IN THE CLINICAL CENTER AND FOCUSED ON WORKING WITH THE CLINICAL CENTER WHICH IS VERY RECEPTIVE TO CONSIDERING THIS AND HOW TO ADD THIS TO THE STANDARD DATA COLLECTION FROM PATIENTS WHO ARE AT THE CLINICAL CENTER. WE HAD A PRESIDENTIAL VISIT TO CAMPUS ON FEBRUARY 11th. I WAS INVITED TO JOIN THE MEGA BEING TESTED FOR SARS COVID. DR. FAUCI AND DR. COLLINS ACCOMPANIED PRESIDENT BIDEN IN HIS VISIT. AND WE WERE AT THE AUDITORIUM TO LISTEN TO A POLICY SPEECH. IT WAS ALSO NOTEWORTHY BECAUSE THIS WAS THE FIRST TIME I SAW AT LEAST TWO COLLEAGUE DIRECTORS IN PERSON IN A YEAR. AND THAT IS THE LAST TIME I SAW THEM. ON MARCH 16th I WAS INVITED TO JOIN FRANCIS AND DR. FAUCI AT THE WASHINGTON CATHEDRAL FOR A FAITH LEADER VACCINE CONFERENCE EVENT WHICH WAS QUITE BEAUTIFUL. IT WAS A PHYSICALLY DISTANCED ACTIVITY. THERE WERE ABOUT 50 OR SO FAITH-BASED LEADERS FROM ACROSS THE DISTRICT INCLUDING ALSO INDIVIDUALS FROM HOWARD AND OTHER LOCAL MEDICAL INSTITUTIONS, CHILDREN'S HOSPITAL AND THE LOCAL ACADEMIC CENTERS AND PUBLIC HEALTH OFFICIALS TO PROMOTE IMMUNIZATIONS AGAINST COVID-19 AND INSPIRE CONFIDENCE. IT WAS RELEVANT IN THE CONTEXT OF FAITH-BASED ENDORSEMENT GIVEN SOME OF THE PUSH BACK THAT HAS COME FROM THE INDIVIDUALS WHO ARE OPPOSED TO THE VACCINE SO IT WAS A VERY GOOD EVENT. SO ON TO NIMHD UPDATES. WE DON'T HAVE A BUDGET FOR FISCAL 22 YET ON THE TABLE. ALTHOUGH THAT WILL BE ANNOUNCED PUBLICLY THE PRESIDENT'S OPENING BID WILL BE ANNOUNCED PUBLICLY ON THURSDAY. SO FAR WE'VE JUST HAD SOME HINTS AND OF COURSE CONGRESS WILL BE THE ONE TO DECIDE. THIS IS THE PATTERN OF OUR BUDGET OVER THE LAST FIVE YEARS. YOU CAN SEE GOING BACK -- IN 2016 IT WAS AROUND 279 AND WE'VE BEEN ON A STEADY INCREASE AS ALL OF NIH HAS. WE BENEFITED FROM SOME TARGETED INCREASES FOR SOME PROGRAMS IN THESE YEARS AND THEN OF COURSE IN 20-21 WE RECEIVED A SIGNIFICANT INCREASE FOR THE MULTIPLE CHRONIC DISEASE RESEARCH CENTERS AND I'LL MENTION IT AGAIN LATER. IN TERMS OF OUR ABILITY TO GET GRANTS OUT IN TERMS COMPETING GRANTS OUT THIS COMPARES THE LAST FOUR FISCAL YEARS AND I THINK IN GENERAL WE'RE GETTING A LITTLE BIT BETTER AT GETTING AWARDS OUT . WE HAD DISCUSSIONS ABOUT FUNDING FOR THIS COUNCIL BOTH YESTERDAY AND TODAY AND WE'LL HAVE ANOTHER ONE NEXT WEEK. THE IDEA IS TO -- WE KNOW HOW MUCH MONEY WE HAVE. WE SHOULD GET THE AWARDS OUT AS SOON AS WE'RE MAKING A DECISION AND THEN WAIT AND SEE WHAT IS LEFT OVER FOR END OF YEAR FUNDING. IN THE TRAINING AREA I THINK AGAIN INCOMPLETE FOR 21 YET BUT YOU CAN SEE THE TREND IS GOING UP AND I EXPECT THIS TO CONTINUE TO BE INCREASED. AND LOOKING AT THESE COLOR CODES FOCUS ON THE K01-K23. YOU CAN SEE THE LARGE GROWTH THERE. AND THEN THE F GRANTS WHICH ARE REALLY PREDOCKER -- GRADUATE STUDENT AWARDS HAVE BEEN STABLE. AND WILL CONTINUE TO GROW I THINK THE K AWARD POT AS MUCH AS POSSIBLE. THERE WAS THE RENEWAL OF THE T37 MINORITY HEALTH AND HEALTH DISPARITY PROGRAM. THIS WAS FORMERLY FOCUSED ON INTERNATIONAL AND WE'VE MODIFIED IT MORE ON DOMESTIC EXPERIENCES AS WELL. AND SO THIS PROGRAM WAS RENEWED IN 19 -- THAT IS A TRAINING AWARD FOR UNDERGRADUATE OR GRADUATES STUDENTS AND POSTDOCS. THIS IS FROM THE LOAN REPAYMENT PROGRAM. WE CAN SEE WHAT IS HAPPENED OVER THE LAST FOUR YEARS. WE'VE HAD MODEST DECREASE AS NIMHD HAS DIVERSIFIED PRIORITIES IN TERMS OF FUNDING SCIENCE BUT WE REMAIN COMMITTED TO THE PROGRAM AND EXPECTED WE CAN INCREASE IT IF OUR BUDGET IS INCREASED. THE BIG CHANGE IN 2019-2020 WAS NOW ALL INSTITUTES ARE ABLE TO FUND THESE HEALTH DISPARITY RESEARCH APPLICATIONS IF THEY ARE APPROPRIATE FOR THEIR INSTITUTE. PRIOR TO THAT IMPLEMENTATION OF THE 21st CENTURY CURES CHANGE WE WERE THE ONLY INSTITUTE THAT WOULD ENTERTAIN HEALTH DISPARITIES RESEARCH APPLICATIONS. SO WE HAD THE LOWEST AWARD RATE OF ALL LOAN REPAYMENT APPLICANTS OFTEN AROUND THE 20-25% RANGE WHILE SOME WERE FUNDING 50%-60%. THERE IS A FEE CHARGED FOR EVERY APPLICATION AS WELL AS ADMINISTERING EVERY AWARD. WE DO AGREE THAT THIS IS A TERRIFIC PROGRAM THAT SHOULD BE CONTINUED AND IF ANYTHING EXPANDED. UPDATE ON CEAL. SOME OF YOU ARE INVOLVED IN THIS. WE HAD AN INITIAL GROUP OF ELEVEN STATES FUNDED. HERE ON THE 2020 LATE SUMMER BY SEPTEMBER AND THEN WE JUST MADE ABOUT NOT QUITE THREE WEEKS AGO NEW AWARDS TO THE -- CITIES AND STATES AND REGIONS OVER HERE ON THE RIGHT. ESPECIALLY NOTE PUERTO RICO RECEIVED AN AWARD AND WE ARE FOCUSED ON MAKING SURE NORTHEAST MIDWEST RECEIVED CEAL TEAM SO THE DC MARYLAND AND VIRGINIA AREA AS WELL AS BOSTON AND NEW YORK CITY AND CHICAGO AND THEN THE OTHER STATES THAT CAME IN. THESE WERE COMPETITIVE INTERNALLY REVIEWED. THIS IS MANAGED THROUGH THE NATIONAL HEART BLOOD LUNG INSTITUTE BUT WE'RE FULL PARTNERS AND CONTINUE TO WORK INTENSELY PARTICULARLY IN THE COMMUNICATION'S AREA AND ALSO IN THE OUTREACH TO THESE COMMUNITY ENGAGED AND FULL PARTNERSHIPS WITH COMMUNITY ORGANIZATIONS. 9 I WON'T BORE YOU WITH ALL OF THE DETAILS BUT THIS MORNING I WAS ON SPANISH LANGUAGE TV. FORGET WHICH NETWORK. I THINK TELEMUNDO FOR A LIVE INTERVIEW. I OFFERED EARLY ON TO DO MORE OF THIS IN SPANISH. THE SPANISH LANGUAGE MARKET IS NOT OFTEN PRIORITIZED BY THESE CAMPAIGNS AND I MAY BE ONE OF A HANDFUL OF PEOPLE AT NIH IN A POSITION OF LEADERSHIP WHO CAN FEEL COMFORTABLE SPEAKING IN SPANISH TO THE MEDIA. IT'S KIND OF FUN. AND THE MESSAGE IS SIMPLE AND REPEATED AND TRY NOT TO GET INTO CONTROVERSY AND MOST OF THE TIME THE JOURNALISTS I THINK ARE GENERALLY HAPPY. WE'VE BEEN VERY ACTIVE IN THIS SPACE. DR. GIBBONS AND I. DR. COOPER AS WELL. DR. MENTZA WE'RE RESPONDING TO THE EMERGENCY IN EVERY WAY POSSIBLE AND WE ARE PRESENTING OURSELVES AS INDIVIDUAL SCIENTISTS, CLINICIANS WHO CAN SPEAK FOR OUR COMMUNITIES NOT JUST WITH THE AUTHORITY OF THE FEDERAL GOVERNMENT OR OF THE SCIENTIFIC CREDIBILITY OF NIH. LOTS OF ACTIVITY AROUND THIS. YOU CAN SEE HERE THE VERY HIGHLY PROMOTED VISIT BY VICE PRESIDENT HARRIS ANDth SECOND GENTLEMAN TO THE CAMPUS. FRANCIS AND TONY GETTING VACCINATED IN LATE DECEMBER. DR. ROGERS GETTING VACCINATED EARLY ON AS WELL AND I WENT TO A WALMART PHARMACY A COUPLE OF MILES FROM WHERE I LIVE AT THE END OF JANUARY TO GET MY FIRST DOSE TO BE FULLY VACCINATED. NOT TO BE FORGOTTEN THE LONG EFFORT ON GETTING THE MINORITY HEALTH AND HEALTH DISPARITIES STRATEGIC PLAN OFFICIALLY PUBLISHED AT THE END OF MARCH HAPPENED. THIS WAS FINALIZED LAST OCTOBER WHEN NIH QUIETLY SENT IT OVER TO CONGRESS AND WE HAD TO INQUIRE ABOUT IT AND THEN OH, YEAH IT'S BEEN SENT TO CONGRESS SO THAT WAS THE FINAL STEP TO BE DONE. CONGRESS DOES NOT NEED TO APPROVE IT. THEY JUST NEED TO GET IT. IT WENT THROUGH MULTIPLE CLEARANCES BOTH WITHIN NIH. EVERY OFFICE AT NIH THAT YOU CAN THINK OF AND ALSO AT THE DEPARTMENT LEVEL TWICE WITH MULTIPLE EDITS BACK AND FORTH BUT IT DID GET FINALLY DONE. DR. DEBORAH DURAN WAS THE PRIMARY PRODUCER OF THIS EFFORT OVER THE COURSE OF THE LAST SEVERAL YEARS AND MANY MANY STAFF AT NIMHD AS WELL AS THE AGENCY CONTRIBUTED TO IT SO WE'RE VERY PROUD OF IT AND I POINT PEACH TO THE REACH GOALS TO SEE WHAT WE CAN DO ABOUT OUR COLLEAGUES FOLLOWING UP ON SOME OF THESE. ESPECIALLY NOW THAT THERE IS MORE FOCUS ON HEALTH DISPARITIES. DR. WEB HOOPER WAS RECOGNIZED IN NATIONAL WOMEN'S HISTORY MONTH BY THE OFFICE OF EQUITY, DIVERSITY AND INCLUSION AND ACKNOWLEDGED HER CONTRIBUTIONS AT NIH. WE'RE VERY PROUD OF ALL OF OUR LEADERS AND ESPECIALLY HAPPY TO HAVE BOTH MONICA ANNAPOLIS WITHIN THE LEADERSHIP. THE SCIENCE OF HEALTH DISPARITIES RESEARCH BOOK WAS PUBLISHED. THIS WAS A LONG TIME COMING. IT WAS A PROPOSAL WHEN A ARRIVED AS DIRECTOR AND AS IT TURNED OUT I'M THE ONLY ONE STILL AT NIMHD. AND GREAT DEBT OF GRATITUDE TO NOT JUST THE EDUCATORS OF THE BOOK WHO WORKED TIRELESSLY TO SEE THIS COME TO FRUITION BUT ESPECIALLY TO LEE -- AND RICHARD PALMER WHO TOOK ON THE FINAL EFFORT OF GETTING ALL OF THE DETAILS DONE. AND BELIEVE ME THERE WERE A LOT. WE HOPE THAT PEOPLE WILL USE THIS AS A REFERENCE POINT TO THINK ABOUT METHODS, RESEARCH METHODS. IT'S NOT MEANT TO BE AN ENSKY -- ENCYCLOPEDIA. WITH MONICA'S LEADERSHIP WE PUBLISHED A VIEWPOINT ON VACCINE HESITANCY AND DIFFUSION IN THE JOURNAL OF INTERNAL MEDICINE. JOINED BY ANNA NAP LESS. WE'LL CONTINUE TO POOL OUR EFFORTS ON THESE PARTICULAR ISSUES IN JOURNALS THAT OUR COLLEAGUES WILL LOOK AT. ON THE LEGISLATIVE FRONT THE MOST IMPORTANT THING IS THE LAST PART HERE AND MY ANXIETY LEVEL WILL GO UP BECAUSE TOMORROW I WILL BE PARTICIPATING IN APPROPRIATION HEARINGS FOR THE FIRST TIME AFTER FIVE AND A HALF YEARS OF BEING DIRECTOR HERE. THIS IS THE SENATE HEARING. THE BUDGET HEARING. IT WILL LOSE A LITTLE BIT OF LUSTER BECAUSE I'LL BE VIRTUAL. DR. COLLINS AND DR. FAUCI AND DR. DIO -- DION KEY WILL BE IN PERSON. -- YOU CAN SEE AROUND REQUESTS FOR A TOWN HALL THAT DIFFERENT REPRESENTATIVES HAVE -- WANTED TO HOST. THE ONE WITH ROSE INVENTORIES WAS INTERESTING AND DR. FAUCI JOINED US FOR PART OF IT AND IT WAS FOCUSED ON AGRICULTURE WORKERS WHICH IS A PARTICULAR GROUP OF ESSENTIAL WORKERS THAT MOST OFTEN ARE NOT INCLUDED OR NOTICED AS MUCH. BUT AROUND CEAL ACTIVITIES WE HAVE HAD A NUMBER OF THESE AND DON'T BE SHY ABOUT ASKING FOR OUR SUPPORT. NUMBER IT WAS NEW STAFF HAVE JOINED THE NIMHD. WE WOULD ASK THEM NOW TO STAND UP AND BE RECOGNIZED BY TRICIA GOLD PERSON JOINED US TO BE THE ETHIC'S PROGRAM SPECIALIST. -- VANESSA MARSHALL JOINED US IN THE OFFICE OF DIRECTOR TO WORK CLOSELY WITH DR. WEBB HOOPER. SHE IS REALLY NOT A PROGRAM OFFICER BUT MORE OF A PROJECT MANAGER. AND IN THE OFFICE OF ADMINISTRATIVE MANAGEMENT JULIE ANDERSON IS NOT THE CHIEF ADMINISTRATIVE OFFICER. TAMEIKA CARNEY WILL BE JOINING US SOONER WILL BE AND LEMEL JOHNSON TO BE A BUDGET ANALYST. AND IN THE REVIEW OFFICEY VAN NAVARRO HAS JOINED US AS A REVIEW OFFICER. WE SAID GOOD-BYE TO DERRICK TABOR. AT LEAST 16 YEARS. DERRICK I THINK REPRESENTED A LOT OF SPIRIT AND SOUL OF NIMHD. HE WAS A DEDICATED PROGRAM DIRECTOR ASSIGNED IN THE INTEGRATIVE BIOLOGICAL DIVISIONS WHEN WE STARTED THE FUNCTIONAL REORGANIZATION BUT IT HAD BEEN THE SCIENTIFIC CONTACT FOR THE PROGRAM AND PERSUADED ME TO GO TO ONE OF THEIR MEETINGS IN ORLANDO IN MY FIRST OR SECOND YEAR AS DIRECTOR. HE WAS ALSO THE MAIN PROGRAM DIRECTOR FOR THE RESEARCH CENTERS OF MINORITY AND INSTITUTIONS. AND HE WAS DEFINITELY ALSO VERY INSTRUMENTAL IN THE STRUCTURAL RACISM FUNDING OPPORTUNITY ANNOUNCEMENT THAT WAS PUBLISHED AS WELL AS SPECIAL ISSUES. SO HE HAD COME TO NIMHD FROM NIGMS AND DERRICK IF YOU'RE LISTENING AGAIN A WARM THANK YOU FOR ALL OF YOUR YEARS OF DEDICATED SERVICE. TWO OF OUR INVESTIGATORS -- FIRST HIRES IF YOU WISH BY DR. NAP LISS NAPOLES. BOTH SHERINE AND FAUSTINE ARE COMPLETING THEIR THIRD YEAR. THEY ARE TWO OF CURRENTLY FOUR SENIOR TRACT INVESTIGATORS AT NIMHD IN ADDITION TO OUR SENIOR INVESTIGATORS SO WE'VE GROWN THE PROGRAM INTO A SUBSTANTIAL ONE AND CONTRIBUTE TO THE DIVERSITY OF NIH INVESTIGATORS. NOTEWORTHY THAT WE JOINED THE MOSAIC PROGRAM LAST YEAR. THIS IS AN INITIATIVE LAUNCHED BY THE NATIONAL INSTITUTE ON GENERAL MEDICAL SCIENCES. WE FUNDED OUR FIRST TWO WARDS. MODEST K99R00s. YOU CAN SEE BECAUSE WE SIGNED UP THESE WERE ASSIGNED US TO. THEY WERE BOTH IN GOOD SCORES. DR. WHITE IS AN AMERICAN INDIAN INVESTIGATOR AND DR. AKENROYE IS AFRICAN-AMERICAN AMERICAN. AS PART OF RADx UP WE ALLOCATED A SIGNIFICANT AMOUNT OF FUNDING FOR A SAFE RETURN TO SCHOOL. ALTHOUGH BEING IN THIS CASE MANAGED BY PROGRAM OFFICERS AT NICHD AND WITH THE LEADERSHIP OF THE DEPUTY DIRECTOR THIS IS UNDER THE RADx UP UMBRELLA. IT WENT TO 8 PROJECTS OVER 10 INSTITUTIONS ACROSS EIGHT STATES. THE PHASE II APPLICATIONS ARE IN AND ARE BEING REVIEWED NOW. WE'LL HAVE A FUNDING DECISION WITHIN THE NEXT TWO TO THREE WEEKS. THE IDEA FOR THIS PROGRAM MEANS TO GENERATE DATA THAT WILL ALLOW RATIONAL DECISIONS ABOUT SAFE RETURN TO SCHOOL IN THE FISCAL WORK SPACE. WHICH WE CONSIDERED TO BE A CRUCIAL STEP IN RESPONSE TO THE EFFECTS OF THE PANDEMIC. AND HAVE DATA FROM THESE INITIAL EIGHT PROJECTS BY EARLY AUGUST. WE ARE PLANNING AN INTERNAL SCIENTIFIC WORKSHOP TO REVIEW THOSE IN ORDER TO INFORM SCHOOL DISTRICTS BY THE START OF FALL. AND SO WE SHALL SEE HOW THIS WILL PLAY OUT. WE'RE PAYING A LOT OF ATTENTION TO GEOGRAPHIC AND POPULATION DISTRIBUTION AND I THINK WE HAVE DONE A GOOD JOB AT LEAST IN THE INITIAL PHASE. THIS IS A MAP O -- RADx UP AWARDS. WE ARE NOW OPEN FOR PHASE II APPLICATIONS. WE COVER MOST OF THE COUNTRY. WITH SOME STUDIES BASED IN ONE INSTITUTION COVERING POPULATIONS IN ANOTHER STATE AND ONE PARTICULAR STUDY COVERING URBAN AMERICAN INDIANS AND ALASKAN NATIVES ACROSS THE COUNTRY. WE'RE PARTICULARLY PROUD OF THIS INITIAL SUCCESS OF RADx UP THERE ARE A LOT OF CHALLENGES THAT ARE ONGOING. WE'RE COLLECTING DATA AND WORKING CLOSELY WITH THE COORDINATION AND DATA COLLECTION CENTER BASED AT DUKE UNC WHICH HAVE DONE A SPECIFIC JOB OF WORKING WITH US ON GETTING THIS GOING. BUT THERE ARE MANY CHALLENGES AND A LOT OF HARD WORK AHEAD BUT I'M OPTIMISTIC WE'LL SEE LOTS OF PROGRESS. WE HAD A SPECIAL RAPID TURN AROUND FOR VACCINE HESITANCY AND UP TAKE INTERVENTIONS. THERE WAS SOME INITIAL DOUBT THAT WOULD THIS BE DONE IN TIME IN THE IDEA IS INCUBATED IN JANUARY AND WE HAD THE GRANT HELP BY THE END OF APRIL. MANY THANKS TO THE PROGRAM STAFF FOR PUTTING THIS TOGETHER. NIMHD FUNDED FIVE OF THESE GRANTS. YEAR ONE IS WITH SUPPORT FROM THE OFFICE OF THE DIRECTOR. SUBSEQUENT YEARS WILL BE ON OUR BUDGET. YOU CAN SEE THE GRANTS LISTED HERE. THEY INCLUDE INTERVENTIONS THAT ARE COMMUNITY-BASED. ADAPTING INTERVENTIONS THAT ARE USED IN OTHER BEHAVIOR CHANGE. CON TAX. TARGETING AFRICAN-AMERICANS, LATINOS, GENERAL LOW-INCOME POPULATIONS AND SO WE ARE OPTIMISTIC THAT THESE WILL HELP. WE'RE FAR FROM DONE WITH VACCINES. WE'RE APPROACHING 60% OF THE U.S. BEING FULLY VACCINATED. THE PRESIDENT HAS SAID JULY 4th IS THE TARGET TO HAVE 70% BUT WE OUGHT TO GET TO 90% TO FEEL BETTER OR AT LEAST 80 SO THESE CHALLENGES WILL BE ADDRESSED BY SOME OF THE PROJECTS. NOW -- REMEMBER LAST YEAR WE WERE GOING TO CELEBRATE OUR 10th ANNIVERSARY AS AN INSTITUTE AND ONE OF THE ACTIVITIES THAT WE WERE ABLE TO CONTINUE BECAUSE WE COULD DO IT ALL VIRTUAL WAS AN ART CON -- CONTEST. QUICKLY SHOWING YOU THE WINNERS. THESE ARE AGAIN THE IDEA CAME FROM STAFF -- A COMMITTEE FROM NIMHD STAFF THAT CARRIED THIS OUT AN AND WELL SHOW YOU THE WINNERS. IN ADULT AND TEEN CATEGORIES. THEY GOT REAL MONEY. WE CAN OFFER PRIZES WITHIN NIH AND SO I THINK THIS JUST ENJOY THESE IMAGES FOR A MINUTE. AS YOU CAN SEE. I THOUGHT THEY WERE QUITE -- THEY DID A WONDERFUL JOB BOTH THE ARTISTS AND OUR STAFF IN GETTING THESE SUPPORTED. SO I REALLY WANT TO THANK EVERYONE FOR DOING THIS. WE'LL HAVE TO HAVE A REDO OF OUR ANNIVERSARY YEAR IF AND WHEN WE GET BACK TO -- NOT IF BUT WHEN WE GET BACK TO THE PHYSICAL WORK SPACE IN SOME CAPACITY TO MARK MAYBE THE NEXT TIME WE HAVE AN ANNIVERSARY WE CAN CELEBRATE SOONER THAN WAITING FOR YEAR 20. THERE WAS AN IMMIGRANT HEALTH MEETING IN MARCH BROUGHT TOGETHER THE GRANTEES. 25 GRANTS THAT WE HAVE FURNISHEDDED IN THIS SPACE. THIS WAS ONE OF THE EARLY FUNDING OPPORTUNITY ANNOUNCEMENTS THAT CAME OUT OF NICHD STAFF -- OF WHAT WE OBSERVED WITH IMMIGRANTS GENERALLY ON THE PARADOX ASPECT OF IMMIGRANTS DOING BETTER THAN EXPECTED. AND THEN INTERVENTIONS TO ADDRESS OR SUSTAIN THE BETTER HEALTH OR TO BEGIN TO ADDRESS THE ISSUE THAT'S HAVE BECOME MORE PROBLEMATIC AND WHAT HAPPENS WITH TIME -- CONTINUES TO BE A CHALLENGE SCIENTIFICALLY AND FROM A POLICY PERSPECTIVE. AS YOU CAN SEE THE ORGANIZING COMMITTEE HERE I ATTENDED MOST OF THE PRESENTATIONS ALTHOUGH I DON'T THINK I LISTENED TO ALL OF THE DISCUSSIONS. IT WAS QUITE A GREAT MEETING AND I LOOK FORWARD TO CONTINUING THESE KIND OF ACTIVITIES. JUST LAST WEEK I THINK THIS ETHNICITY AND DISEASE -- STRUCTURAL RACISM AND DISCRIMINATION WAS PUBLISHED. WE HOSTED IN 2017 -- IT WAS PEER REVIEWED. SOLICITED ARTICLES THAT WERE LOOKED AT SELECTED FOR FULL ARTICLES. I THINK IT WAS A TWO TIER ASPECT AND THEN A FULL ARTICLE. DR. DAVID WILLIAMS AND NAY OPENEDY P -- PRIEST. AND THERE WAS AN EDITORIAL BY JENNIFER AND DERRICK AS WELL AS BY DAVID AND NAY OPENEDY AND MONICA -- AND MYSELF. * THERE IS GOING TO TO BE A WEBINAR TOMORROW. IN CASE ANYONE WAS NOT AWARE OF THIS THAT THEY CAN NOTE IT AND ATTEND THE WEBINAR ON THIS. AND ALSO ON THURSDAY THIS WEEK WE HAVE THE LECTURE SERIES FOR PUBLIC HEALTH LEADERSHIP. THIS HAS BEEN A LONG TIME IN DEVELOPMENT. POSTPONED A COUPLE OF TIMES. VICTOR ZOW WILL BE RECOGNIZED. DR. MURTHY WILL ATTEND. THEY WILL HAVE A FIRESIDE CHAT AFTER A BRIEF INTRODUCTION AND ENORMOUS CREDIT -- FOR ORGANIZING THIS. AS THIS IS REALLY HOSTED BY THE ASIAN-AMERICAN AND PACIFIC ISLANDER ORGANIZATION HERE AT NIMHD IN HONOR OF THE ASIAN-AMERICAN AND PACIFIC ISLANDER MONTH. WE HAVE HAD A NUMBER OF VISITORS FOR OUR DIRECTOR SEMINAR SERIES. ALLIE MOKDAD WAS HERE IN MARCH. HE WAS THE SECOND OF THE YEAR. WE HAD KAREN MANGIONE. AND WE'VE GOT CHAU TRINH-SHEVRIN AND THEN DELORES GARCIA. SHE IS MEXICAN AND IS BASED AT BRAN DICE * UNIVERSITY. -- BRANDEIS UNIVERSITY. OUR PROGRAM HAS RAISED THE BAR IN TERMS OF SCIENTIFIC SEMINARS ON A MONTHLY SCHEDULE. -- RELEVANT TALK ON DISPARITIES AND A TOPIC OF CONVERSATION THAT WILL CONTINUE OVER TIME. WE HAD AN INITIAL SET OF MEETINGS AND THIS IS ONGOING IN COLLABORATION WITH TIFFANY POWELL WILEY WITH HOWARD UNIVERSITY AS WE LOOK TO ESTABLISH PORCH A FOOTPRINT IN THE COMMUNITY. IT'S CALLED HOPE NET AS A WAY TO CREATE A PRESENCE BOTH FOR COMMUNITY ENGAGED RESEARCH IN OUR INTRAMURAL PROGRAM PARTICULARLY WITH THE CLINICAL COMPONENT WITH THE COMMUNITY CLINICS THAT EXIST IN DC. SO I LOOK FORWARD TO SEEING MORE OF THIS DEVELOP OVER THE NEXT FEW YEARS. WE WERE ABLE TO CELEBRATE OUR POST BACKS THIS YEAR VIRTUALLY. THESE ARE THE NIMHD POST BACKS WHO PRESENTED. ALSO INCLUDED HERE IS MY LAB -- WHICH IS TECHNICALLY AN NHLBI. AND IT WAS A WONDERFUL TO SEE ALL OF THESE YOUNG SCIENTIST ADVANCING THEIR WORK AMIDST THE CONTRIBUTIONS THAT WE'RE MAKING TO NIH SCIENCE INTRAMURALLY. SO LET ME THEN TURN TO SCIENCE ADVANCES AS WE WIND DOWN. THESE ARE MOSTLY ARTICLES THAT HAVE BEEN PUBLISHED THAT WERE NOMINATED BY STAFF AND THEN I CHOOSE TO PRESENT THEM TO YOU. AS PART OF PROGRESS THAT WE'RE MAKING. THIS PARTICULAR PAPER HAD A LOT OF GRANT SUPPORT. IC SEE THAT. LOOKING AT OVER 6500 HIV INFECTED PERSONS FROM THE RYAN WHITE PROGRAM IN MIAMI, FLORIDA. AND WHAT WERE THE ODDS OF ACHIEVING A SUSTAINED SUPPRESSION. YOU WERE SUPPRESSED YOU SHOULD HAVE A NORMAL LIFE EXPECTANCY BASED ON YOUR AGE AND YOU ARE NOT INFECTIOUS. THERE IS NEVER BEEN A CASE OF HIV INFECTION IN SOMEONE WHO'S VIRALLY SUPPRESSED SO THIS IS PRETTY GOOD . WE CANNOT CURE HIV YET. BUT I THINK THIS IS A GREAT GOAL TO BE IN AND BELIEVE ME IT'S TREMENDOUS PROGRESS. SO IF YOU HAVE ANY RISK FACTORS AND THEY WERE CATEGORIZED AS MENTAL HEALTH SYMPTOMS, SUBSTANCE ABUSE, MULTIPLE PARTNERS BEING A VICTIM OF OR A PART OF DOMESTIC VIOLENCE AND ALL OF THEM TOGETHER PLUS HOMELESSNESS AND AS YOU CAN SEE IF YOU HAVE ANY OF THESE COMPARED TO NO RISK FACTORS YOU'RE LESS LIKELY TO BE SUPPRESSED. SO NO SURPRISE. THE ONLY FACTOR THAT PRODUCED INCREASED LIKELIHOOD WERE OLDER THAN 50 WHICH IS FOR UNFORTUNATELY OR CONSISTENT OBSERVATION IN WHY THE WORK THAT WE'RE WORKING WITH THE YOUTH ON THESE RISK FACTORS IS SO CRITICAL AND THE MEMORY OF WHAT HIV DID TO THE COMMUNITY IS SORT OF WAY BACK THERE AT THIS POINT. NO GENDER DIFFERENCE. SOME BIRTHPLACE DIFFERENCE AND THEN SOCIOECONOMIC GRADIENT AS YOU MIGHT EXPECT. THIS IS A STUDY LOOKING AT A CULCULLAT ANY RATE -- -- CULTRATE -- AND WHETHER OR NOT THERE ARE OTHER STUDIES THAT HAVE SHOWN THERE IS VARIATION IN SLEEP QUALITY RELATED TO A NUMBER OF FACTORS INCLUDING AMONG LATINO NATIONAL ORIGIN GROUPS FROM HAINES THAT HAVE BEEN WRITTEN B. THIS IS AN INCREASING -- POINT OF INTEREST. THIS IS RELATED TO THE DEPRESSION, ANXIETY AND INTEREST IN MENTAL HEALTH RESOURCES. LOOKING AT HIGH SCHOOL STUDENTS WHICH ARE PRIMARILY SEXUAL AND GENDER MINORITIES IN DIFFERENT AREAS OF MASSACHUSETTS. IF YOU'RE MORE LIKELY TO BE RECEPTIVE TO RECEIVING INFORMATION AND RESOURCES ABOUT MENTAL HEALTH IN THESE GENDER SEXUAL ALLIANCES AS IN IDEAL VENUE FOR DELIVERING THESE INTERVENTIONS AMONG HIGH SCHOOL STUDENTS. NOW ONE OF THE THEMES OF THIS AGGREGATION OF RACE ETHNICITY IS MOST PROMINENT AMONG ASIAN AMERICANS. THIS IS A GOOD EXAMPLE OF WHY WE NEED TO DO THIS. OVER A COURSE OF 14 YEARS -- IT TAKES A LOT OF EFFORT TO DISAGGREGATE TO LOOK AT GI CANCERS WHICH INCLUDE ALL OF THESE KIND OF CANCERS LISTED HERE AND THE 6 LARGEST POPULATIONS -- AND IN AGGREGATE ASIAN AMERICANS HAVE A LOWER MORTALITY FROM GI MALIGNANCIES THAN WHITES AND THESE ARE THE RATES BY 100,000. 56 VERSUS 63 BUT IF YOU LOOK AT BOTH THE CANCER TYPES YOU CAN SEE THAT SOME OF THIS WAS DRIVEN BY SOUTH ASIANS HAVE A VERY LOW RATE. FILIPINOS HAVE A LOWER RATE BUT KOREANS HAD A HIGHER THAN WHITES AND JAPANESE WERE SIMILAR OR SLIGHTLY HIGHER THAN WHITES. WHITES HAD A HIGHER MORTALITY FOR COLORECTAL AND PANCREATIC CANCER. COLORECTAL IS MORE OF A CHRONIC DISEASE PARTICULARLY UP TO STAGE 3 BUT THEY WERE SIMILAR TO WHITES AND JAPANESE AMERICANS WHICH IS INTERESTING. AND LIVER CANCER AS YOU'VE HEARD BEFORE MAYBE ARE AWARE OF IS MORE COMMON IN ALL RACIAL ETHNIC MINORITIES PARTICULARLY MEN BUT IT WAS MUCH MORE COMMON IN THIS STUDY IN VIETNAMESE UP TO FOUR TIMES HIGHER THAN -- AND HIGHER IN ALL ASIAN POPULATIONS EXCEPT SOUTH ASIANS AND JAPANESE AMERICANS AND THIS WAS IN THE INTERNATIONAL JOURNAL OF CANCER. ANTIBLACK VIOLENCE -- THIS IS LOOKING AT SCANNING OF REPORTS OF ANTIBLACK VIOLENT INCIDENTS OVER THE COURSE OF FOUR YEARS. FOCUSED ON POLICE KILLINGS OF BLACK CIVILIANS AND I DID NOT MENTION EARLIER -- TODAY IS THE ANNIVERSARY GEORGE FLOYD'S MURDER. IT OCCURRED AT 8:00 IN THE EVENING IN MINNESOTA. SO WE'RE NOT QUITE EXACTLY AT THE ANNIVERSARY BUT JUST NOTE IT IS THE TERSE TERSE ON MAY 25th AND THEN THE TIMING AND LEVEL OF. -- I THINK THE POINT HERE IS -- THAT THESE EVENTS THAT ARE HAPPENING IN SOCIETY AS WE ALL HAVE BECOME PAINFULLY AWARE DO IMPACT INDIVIDUALS AND COMMUNITIES IN DIFFERENT WAYS. WHAT COVID HAS DONE TO OUR PSYCHE AND OUR MENTAL HEALTH AND OUR SUBSTANCE USE AND PHYSICAL ACTIVITY IS SOMETHING EVERYONE CAN RELATE TO BUT EXTERNAL EVENTS SUCH AS VIOLENCE AGAINST A PARTICULAR RACIAL ETHNIC GROUP IN THIS CASE AFRICAN-AMERICANS OR ASIAN AMERICANS OR LATINOS MEXICANS DO IMPACT THE COMMUNITIES ABOVE AND BEYOND THE IMMEDIATE EFFECTS OF FAMILY AND FRIENDS FOR THAT PARTICULAR COMMUNITY. AS THESE THINGS GET MAGNIFIED THROUGH MEDIA AND THIS IS AN A ANALYSIS OF IN HOSPITAL MORTALITY. LOOKING AT URBAN VERSUS RURAL. ONE INTERESTING THING WAS MOSTLY THE LACK OF DIFFERENCE BETWEEN RURAL AND URBAN. RURAL MORTALITY WAS GENERALLY BETTER THAN URBAN MORTALITY FOREST SCHEMEIC STROKES. -- * AND AFTER ADJUSTMENT THERE WAS A WEEKDAY VERSUS WEEKEND. SO DON'T GET SICK ON THE WEEKEND IS THE MESSAGE IF YOU CAN HELP IT AND YOU DO BETTER DURING THE WEEKDAY. BECAUSE OF WHAT STROKE TREATMENT HAS EVOLVED TO LIKE CARDIAC ISCHEMIA. THE EFFORT TO DO THERAPY. THIS IS FOR -- ISCHEMIC STROKE. IT MAY EXPLAIN SOME OF THE DIFFERENCE THAT TEAMS ARE NOT QUITE AS READY TO GO. ALTHOUGH LITTLE DIFFERENCE IN THE RURAL AREAS OR THE -- JUST -- ASSES SCHEMEIC STROKE HERE FOR THE URBAN AREAS. FOR HEMORRHAGEIC STROKE THERE WAS A DIFFERENCE. IT IS MUCH WORSE COMPARED TO --S SCHEMTO-ISCHEMIC STROKE. AND THERE WAS A WORSE OUTCOME IN THE RURAL AREA COMPARED TO THE URBAN AREA. THIS IS MORE OF A QUALITATIVE STUDY. FOCUS GROUPS WITH 36 AFRICAN-AMERICAN STAKEHOLDERS IN ALABAMA. BARRIERS TO COVID-19 PREVENTION. THE CHALLENGES OF APATHY. THE DIFFICULTY WITH SOCIAL DISTANCING EVEN THOUGH SOME OF THAT HAS BEEN MITIGATED NOW WITH THE RECOMMENDATION OF THE -- IF YOU'RE VACCINATED YOU CAN RELAX A LITTLE BIT. AND ISSUES ABOUT MIXED MESSAGES AND CONFUSING MISINFORMATION WHICH HAS BEEN I THINK THE BIGGEST CHALLENGE. THERE IS ALSO THIS BARRIER TO TESTING. THIS ISSUE OF FEAR. EVEN THOUGH AND UNDERSTANDING WHAT THAT IS ABOUT AND CONCERNS ABOUT WHETHER OR NOT OR IF I TEST POSITIVE WHAT IS IT GOING TO DO TO ME. RESTRICT ME OR QUARANTINE ME AND CERTAINLY THE CONCERNS WERE GREATER IN THE PAST THAN THEY ARE TODAY. AND THEN IMPACT OF CRIMINALIZATION IMMIGRANT POLICIES ON HEALTH KAREN EQUITIES. THIS IS LOOK AT STATE LEVEL IMMIGRANT CRIMINALIZATION POLICIES. DOES A STATE REALLY ALLOW LOCAL AUTHORITIES TO FULLY COLLABORATE WITH FEDERAL AUTHORITIES. DOES THE STATE REQUIRE THIS TO HAPPEN? TO CHECK PEOPLE'S LEGAL STATUS AT THE TIME OF STOP OR ARREST? THIS IS VARIED ACROSS THE COUNTRY AND WITHIN STATES ACCORDING TO WHO THE GOVERNOR IS OR THE CURRENT MOOD OF THE STATE IN TERMS OF POLICY AND ENFORCEMENT YOU HEAR ABOUT SANCTUARY CITIES WHERE THERE IS NO COLLABORATION OFTEN IN A NEGATIVE CONNOTATION IN THE PRESS BUT I THINK THIS IS ROUTINE TRAFFIC STOP OR INVESTIGATION FOR DOMESTIC VIOLENCE AND POLICE COME INTO A HOME AND CLEARLY THE ISSUES THAT NEED TO BE ADDRESSED BUT ARE THEY THEN ASKING FOR DOCUMENTATION AND IF NOT BASICALLY TAKE AWAY AN INDIVIDUAL. SO THESE POLICIES DO GET AFFECTED AND INCREASED LEVEL OF STATE CRIMINALIZATION POLICIES A ASSOCIATED WITH THE IMMIGRANT POPULATION LEVEL DECLINED IN ACCESS SO WHAT THESE POLICIES TEND TO DO IS DRIVE PEOPLE AWAY FROM SEEKING HEALTH CARE EVEN THOUGH WE SHOULD BE FULLY PROTECTED IN GETTING HEALTH CARE FROM IMMIGRATION ENFORCEMENT OF ANY KIND AND GENERALLY THAT IS THE CASE IN MANY PLACES BUT NOT ALL. WHEREAS SOMEONE TOLD ME AFTER A TALK WELL THEY ARE JUST WAITING OUTSIDE AND WHAT CAN YOU DO ABOUT THAT? AS OPPOSED TO GETTING RECORDS FROM CLINICAL SETTINGS BUT THERE ARE PROTECTIONS. PROTECTIONS FOR RESEARCH PARTICIPANTS AS WELL. THIS IS FROM OUR INTRA MURAL RESEARCH * PROGRAM AND LOOKING AT RISK OF COLORECTAL RISK PROFILES AND DIFFERENCES IN SURVIVAL -- LOWEST TO HIGHEST RISK LEVELS. HIGHEST RISK ARE -- HIGHEST SURVIVORSHIP WHITE MARRIED MEN. THIS IS THE AGE GROUP THAT IS A RECOMMENDATION TO SCREEN AS WAS RECENTLY UPDATED. AND THEN DOWN HERE 53 MONTHS -- SIGNIFICANT DIFFERENCE THERE OF ABOUT THREE AND A HALF YEARS. WOMEN WHO WHO ARE WIDOWED AND ARE WHITE AND OLDER THAN 76 AT DIAGNOSIS WHERE OTHER FACTORS MAY PLAY INTO SURVIVAL. AND THIS IS A VARIATION IN SUBSTANCE USE DISORDERS BY RACE ETHNICITY. IT WAS FOCUSED ON BOTH BEGINNING TO REALLY GENERATE DATA AS WE WERE TALKING ABOUT YESTERDAY BRIEFLY ON HEALTH AND SEXUAL AND GENDER MINORITIES THAT IS NOT STRICTLY LIMITED TO HIV. AND THIS SUBSTANCE USE -- THIS POPULATION YOU CAN SEE IN TERMS OF PREVALENCE OF TOBACCO USE DISORDER HAS BEEN CONSISTENTLY HIGHER AMONG SEXUAL AND GENDER MINORITIES. AMONG BISEXUALS IS WHERE WE SEE THE HIGHEST RATES. ALSO CANNABIS USE AMONG HISPANICS, AFRICAN-AMERICANS AND WHITES BEING THE HIGHEST. HISPANICS AND OVER BLACKS AND THEN WHITES. AND FINALLY I'LL SHARE THIS PAPER THAT MY LAB PUBLISHED LAST MONTH. ON THE -- WITH THE APPROACH OF MANAGING OR LEVERAGING THE ACCESS TO THE POPULATION OF ASSESSMENT AND TOBACCO HEALTH STUDY. FDA AND NIH FUNDED STUDY. IT IS FUNDED BY FDA THROUGH CONGRESSIONACONGRESS AUTHORIZATION. AND IN COLLABORATION. WE LOOKED AT WHAT HAPPENED TO YOUTH WHO AT BASELINE SAID THEY WERE NEVER SMOKERS. 88 OF THESE YOUTH WHO COMPLETED WAY 4 OF THIS STUDY. YOU CAN SEE THE DEMOGRAPHICS. IT'S FAIRLY DIVERSE GROUP. ABOUT 50% ARE MEN -- OR MALES. AND ASKING THREE SIMPLE QUESTIONS ABOUT ARE YOU LIKELY TO SMOKE A CIGARETTE IN THE NEXT YEAR. WOULD YOU SMOKE A CIGARETTE IF A FRIEND OFFERED IT TO YOU. ARE YOU CURIOUS ABOUT SMOKING? FOUND THAT SAYING YES TO ANY OF THOSE THREE OR FOUR QUESTIONS -- INCREASED YOUR ODDS OF HAVING EXPERIMENTED WITH CIGARETTES THREE YEARS LATER BY A FACTOR OF SEVEN. SO NOT A SUBTLE EXPECT. --EFFECT. * IN THIS DATABASE WE WERE ABLE TO ADJUST FOR EXPOSURE TO MARKETING. THE NOTION THAT TOBACCO INDUSTRY MARKETING MUCH OF IT THROUGH THE INTERNET NOWADAYS BUT ALSO THROUGH PRINT MEDIA WOULD REALLY HAVE OVERWHELMING EFFECTS BUT WE AFTER ADJUSTING FOR MARKETING SAW A DECREASE THAT WAS A DEYEAST CREASE A TIN WEIGHTED THE EFFECT * BUT DID NOT MAKE IT GO AWAY AND AFTER ADJUSTING FOR E-CIGARETTES -- STILL FINDING THAT THESE SIMPLE QUESTIONS HELPED IN PREDICTING. WHICH IS DIRECTLY RELATED TO ONGOING DAILY SMOKING LATER IN LIFE. OUR OFFICE OF PLANNING AND EVALUATION -- COLLABORATED ON A MULTI MORBIDITY FRAMEWORK. S IN WERE PUBLISHED IN MEDICAL CARE -- * LET ME FINISH THIS PRESENTATION WITH JUST A HIGHLIGHT OF COVID. DIDN'T PAY MUCH ATTENTION TO IT SO I THOUGHT I WOULD FINISH WITH THIS. THESE ARE DATA FROM THE CDC THROUGH MARCH. SO THERE MAY BE SOME MODIFICATIONS. NOT ONLY TO GIVE YOU THE SENSE OF THE PANDEMIC OF WHERE WE'VE BEEN. WE'RE ALL IN A MUCH BETTER PLACE TODAY THAN WE WERE EVEN LAST COUNCIL MEETING IN FEBRUARY WHEN THINGS WERE BEGINNING TO LOOK BETTER BUT STILL NOT SURE. BUT HIGHLIGHT THIS BURDEN IN THIS CASE SHOWN BY LATINO IN THE U.S. NOT OFTEN NOTICED. I THINK ON THE NATIONAL MEDIA. AMERICAN IDIOM AND ALASKAN NATIVES AND THEN AFRICAN-AMERICANS. *. THIS IS ADJUSTED FOR POPULATION SIZE SO PER 100,000. AND THE GROUPING OF ASIAN PACIFIC ISLANDERS HAD NOT HAD VISITS IN THAT REPORT. THE LATINO EXCESS DEATHS RELATIVE TO THEIR DEMOGRAPHIC REPRESENTATION AND IN THIS COMPLICATED SLIDE EACH BAR REPRESENTS AN AGE GROUP. AMONG CHILDREN AND YOUNG ADULTS OR PEOPLE OVER 85 THERE IS EXCESS DEATHS FOR LATINOS. IT IS THE TALLEST BARS IN MOST OF THE AGE RANGE. SAME IS TRUE FOR AFRICAN-AMERICANS. AMERICAN INDIANS AND PACIFIC ISLANDERS I -- IS HARDER. AND VACCINE UP TAKE HAS BEEN LINGERED BEHIND -- MUCH WAS MADE OFS TAN SEE BUT -- OF HESITANCY. I'M SURE THESE DATA ARE BETTER NOW BECAUSE OF ALL OF THE EFFORTS THAT HAVE BEEN MADE TO REACH THE POPULATION AND WE STILL SEE THAT AMONG THE REMAINING UNVACCINATED HISPANIC LATINOS, AFRICAN-AMERICANS THERE ARE MORE THAT ARE WILLING TO DO IT. IT'S A MATTER OF GETTING ORGANIZED TO REACH THEM. SO THERE IS NOT -- THEY ARE NOT ABSOLUTELY OPPOSED TO GETTING VACCINATED AS PERHAPS SOME WOULD THINK IN THIS CONTEXT. AND THEN THESE UPDATED DATA THAT I USE FOR RECENT TALK FROM THE WAMC. THE CALL TO ACTION NOT TO LET OUR GUARD DOWN. IT'S ONLY BEEN 40 YEARS SINCE WE'VE BEEN TALKING ABOUT THIS. OR SINCE I'VE BEEN TALKING ABOUT THIS SO WHAT WAS 40 MORE? TWO POINTS HERE. OUR IMPROVEMENT IN AFRICAN-AMERICANS, LATINO AND HISPANIC IS VERY GRADUAL. 15% OF MEDICAL SCHOOL ENROLLMENT IN 2020 WERE FROM THESE TWO UNDER REPRESENTED GROUPS. UP ABOUT 5% TOTAL. THERE ARE CONCERNS ABOUT BLACK MALES NOT GOING TO MEDICAL SCHOOL BUT I DO THINK THERE IS A SLIGHT HOPE FOR OPTIMISM. AND THE REAL DISTRAUGHT OF THE NUMBER OF AMERICAN INDIAN ALASKAN NATIVE HAVE GONE DOWN BY ALMOST 1,000 COMPARED TO 2013 AND THIS IS OF GREAT CONCERN. STEM PhDs U.S. GRAND PhDs VERY SIMILAR NUMBERS. 14%. 15% UNDER REPRESENTED GROUPS. RECEIVED THEIR PhD IN 2019. SO WE -- THE PIPELINE IS NOT EMPTY. IT'S NOT FULL. PEOPLE NEED TO GET HIRED. WE ARE LOOKING TO HIRE PEOPLE SO SEND US ANY GOOD SMART AND WILLING TO DO PUBLIC SERVICE TO OUR WEBSITE AND WE WILL LOOK TO HIRE -- WE'RE LOOKING TO EXPAND OUR HEALTH SCIENCE ADMINISTRATORS OR PROGRAM OFFICERS AND WITH THAT I WILL END -- AND STOP SHARING SO THAT WE CAN HAVE A COUPLE OF MINUTES FOR CONVERSATION. THANK YOU VERY MUCH. I TOOK LIBERTY TODAY TO EXPAND A LITTLE BIT MORE THAN OTHERS BECAUSE OF THE AFTERNOON SCHEDULE NOT BEING SO PACKED BUT MARSHALL I MAY HAVE TAKEN A LITTLE BIT OF YOUR TIME. >> IF YOU WANT TO SPEAK UP OR ANYONE ELSE -- PUT YOUR NAME IN THE CHAT AND I'LL CALL ON YOU. >> THANK YOU. GOOD MORNING. ELISEO. THANK YOU SO MUCH FOR SUCH COMPREHENSIVE NOT ONLY REPORT ON WHAT IS HAPPENING AT NIH AT ALL LEVELS BUT ALSO THE REVIEW OF THE INITIATIVES. I THINK IT'S VERY COMPREHENSIVE. VERY CLEAR. AND IF WE HAD MORE TIME I WOULD HAVE KEPT ASKING ABOUT ALL OF THESE DIFFERENT RESEARCH THAT ARE NOT IN MY TARGET AREA BUT THEY ARE SO FASCINATING SO THANK YOU AGAIN. >> ALWAYS WILLING TO TALK SCIENCE CARMEN SO DON'T HESITATE. >> I DON'T YET SEE ANY OTHER NAMES IN THE CHAT. IS THERE SOMEBODY WHO WOULD LIKE TO SAY SOMETHING. >> I SEE THAT BILL HAS JOINED US. >> DR. RILEY DO YOU WANT TO SAY HELLO AND INTRODUCE YOURSELF TO THE GROUP. >> SURE. HELLO. I'M SORRY I'M LATE BUT THE NIH NEVER SLEEPS. I'M BILL RILEY. I'M A NONVOTING MEMBER. >> AND THANK YOU. DR. READE I DON'T BELIEVE WE HAD A CHANCE TO HEAR FROM YOU. >> GOOD MORNING. JOAN READE AT HARVARD MEDICAL SCHOOL. >> ELISEO, DO YOU WANT TO INTRODUCE OUR SPEAKER. >> WE'RE GOING RIGHT TO MARSHALL, RIGHT? >> WE'LL HAVE A BREAK AFTER THE TALK. >> AFTER MARSHALL. OKAY. SO I THINK MOST OF YOU ARE FAMILIAR WITH DR. MARSHALL CHIN. HE IS A PROFESSOR OF HEALTH CARE ETHICS IN THE DEPARTMENT OF MEDICINE AT THE UNIVERSITY OF CHICAGO. A GENERAL INTERNIST. EXTENSIVE RESEARCH IN CLINICAL EXPERIENCE IN CARING FOR VULNERABLE PATIENTS WITH CHRONIC DISEASE. HAD A NUMBER OF IMPORTANT LEADERSHIP ROLES IN OUR DISCIPLINE -- CO-DIRECTOR OF THE FOUNDATION ADVANCING HEALTH EQUITY. AND HE ALSO IS SOCIAL CHIEF AND DIRECTOR IN RESEARCH AND GENERAL INTERNAL MEDICINE. MARSHALL AND I GO BACK TO MANY YEARS AGO. HE WAS A MEDICAL STUDENT AT UCSF AFTER GRADUATING FROM HARVARD. HE CAME WEST AND WORKED WITH STEVE SCHROEDER. THAT IS WHERE I MET HIM IN STEVE'S OFFICE. HE WENT ON TO GO DO A RESIDENCY AT THE BRIGHAM WOMEN'S HOSPITAL WHERE HE WAS ALSO A FELLOW. AND SO WE INTERES -- WE INTERACTED A NUMBE R OF TIMES. AND HAVE WATCHED HIM ACCOMPLISH MANY THINGS OVER HIS CAREER. AND WAS DELIGHTED TO SEE THAT HE WAS ELECTED TO THE NATIONAL ACADEMY OF MEDICINE IN 2017. AND SEND TO BE A MEMBER OF OUR ADVISORY BOARD WHEN I CALLED HIM TO TRY AND NOMINATE HIM. SO I'M VERY PLEASED OF HIS MANY CONTRIBUTIONS OVER THESE LAST FOUR YEARS. MARSHALL. >> THANKS SO MUCH ELISEO FOR THE KIND INTRODUCTION. THERE IS A TREMENDOUS DIVISION OF GENERAL INTERNAL MEDICINE. TREMENDOUS ROLE MODELS. AND JUST KNEW THAT YOU WOULD HAVE SUCH A HUMID IMPACT ON EQUITY ISSUES. SO THANK YOU SO MUCH. SO MUCH. SO, I'VE GOT THE SLIDE UP. AND SO I HAVE THREE GOALS FOR THE NEXT HALF HOUR. AND LEAVE ABOUT 15 MINUTES FOR QUESTIONS AND ANSWERS AND DISCUSSION. FIRST TO SUMMARIZE WHAT WE PRACTICALLY KNOW ABOUT ADVANCING HEALTH EQUITY AND SHARE A MODEL FOR ADVANCING HEALTH EQUITY. SECOND TO IDENTIFY KEY RESEARCH QUESTIONS AND PROPOSE HOW WE MIGHT IMPROVE OUR NATIONAL HEALTH EQUITY RESEARCH PORTFOLIO AND THIRD AS IS THE TRADITION OF THE TALKS WHERE THE COUNCIL MEMBERS WHO ARE ROTATING OFF I'LL DISCUSS MY RESEARCH AND MY STORY. AND THE SPECIFIC AGENDA IS I'LL START BY ASKING THE QUESTION. DOES THE HEALTH EQUITY RESEARCH FIELD HAVE THE MOST USEFUL PARADIGM? I'LL DESCRIBE THE ROAD MAP AND THEN TELL THE STORY OF MY RESEARCH AND PROJECTS THAT LED TO THE ROAD MAP AND THEN OUTLINE KEY CURRENT RESEARCH QUESTIONS IN WAYS TO IMPROVE THE HEALTH EQUITY RESEARCH ENTERPRISE. MY TALK IS BASED UPON MULTIPLE HATS. SO FIRST I'M A GENERAL INTERNIST. BOTH INPATIENT AND OUTPATIENT SETTING. AND I'VE DONE MY OWN RESEARCH. A LOT OF MULTI-LEVEL INTERVENTIONS TO REDUCE DISPARITIES. TALK ABOUT THE RWJF PROGRAM. ONE OF THE WONDERFUL THINGS IS HAVING A CHANCE TO MEET A LOT OF WONDERFUL GRANTEES DOING EXCITING THINGS ACROSS THE COUNTRY SO, I'VE BEEN ABLE TO SEE A FAIR AMOUNT OF COUNTRY AND PEOPLE DOING REALLY COOL THINGS. 7 AND WE'VE DONE ABOUT A DOES SYSTEMIC REVIEWS. WE'RE NEAR 8 AT UNIVERSITY OF CHICAGO AND SO I'VE LEARNED A LOT AND BEEN INVOLVED IN NATIONAL COMMITTEES AND MEETINGS SO I HAVE A PULSE FOR WHAT IS HAPPENING NATIONALLY. BUT FIRST WE'RE GOING TO USE A DEFINITION. SO MANY OF YOU HAVE SEEN THIS PICTURE. THE DIFFERENCE TOEAINA QUALITY EVERYONE GETS THE SAME SIZE BICYCLE. EQUITY REGARDLESS OF IF THEY ARE BIG OR SMALL OR A PERSON WITH DISABILITIES. I'LL HIGHLIGHT - -- AN ELEMENT OF SOCIAL JUSTICE LENS. HEALTH INEQUITIES INCLUDE A FAILURE TO OVERCOME INEQUALITIES INEQUALITIES. THE OLD ARE DYING AND THE NEW CANNOT BE BORN FROM ANTONIO GRANS CONTRADICTION. -- -- THEREOF WAS WORLD WAR I AND THE PERIOD BETWEEN WAS THE FAILURE OF SOME OF THE WESTERN EUROPEAN DEMOCRACIES TO PREVENT THE RISE OF FASCISM AND NAZIISM. SO THE OLD ARE DYING SO THE OLD WORLD ORDER. THE OLD POLITICAL IDEOLOGIES WERE NOT WELL EQUIPPED TO DEAL WITH THE TIME. THE NEW CANNOT TRANSFORM QUICK ENOUGH. AND SO ONE CAN ALSO THINK ABOUT THE CURRENT SITUATION WHERE THERE ARE THOSE WHO FAIR THE PASSING OF AN ELDER OR TRADITIONAL ERA AT THE SAME TIME STRIVING FOR NEW WAYS OF THINKING AND NEW WAYS OF ADDRESSING INEQUITIES -- IS NOT QUITE YET BEEN BORN AND WHEREAS A PERIOD OF STRIFE AND POTENTIAL MONITORS. THERE ARE OLD PARADIGMS WHICH MAY NOT BE THE BEST PARADIGMS FOR THE CURRENT CHALLENGES AND YET THE NEW IS BEING STIFLED. CAN WE GET BEYOND THIS TIME OF MONSTERS. THEY HAVE THIS PARADIGM PROJECT WHERE THEY ARE SAYING THE CURRENT HEALTH SERVICES PARADIGM IS NOT CUT FOR THE CURRENT CHALLENGES AND NEEDS TO BE REVISED AND UPDATED AND A NEW PARADIGM BORN. THEY COMMISSIONED THE WOMAN ON THE RIGHT WHO'S AN ORGANIZATIONAL SOCIOLOGISTS -- TO WRITE THIS PAPER WHICH WAS DESIGNED TO LOOK AT OTHER DISCIPLINES SO IN PARTICULAR SHE PICKED THE FIELD OF LAW AND -- AND MUSIC. AND THEN APPLY IT TO HEALTH SERVICES RESEARCH. SO SIVAN IS BRILLIANT. IN THE MIDDLE YOU HAVE RESEARCH DISCIPLINES. IT HAS BECOME INSTITUTIONALIZED AS IT BECOMES MORE MATURE. SO WE HAVE INSTITUTES LIKE NIMHD. WE HAVE DIFFERENT RESEARCH PROGRAMS. WE HAVE JOURNALS THAT HAVE SPECIFIC POLICIES. AND WITHIN ANY GIVEN FIELD THERE IS A CLASH IN TERMS OF OPPOSING VIEWS. THAT IS THE INTERNAL ISSUE. THERE ARE POLITICAL FORCES, TECHNOLOGIC FORCES THAT ALSO IMPACT. AS AN EXAMPLE WE ALL KNOW THAT WITH THE COVID-19 INEQUITIES AND POLICE BRUTALITY AND INCREASED AWARENESS OF SYSTEMIC RACISM -- ISSUES OF RACISM THERE IS AN A WILT TO HAVE A DISCUSSION THAT WAS NOT PRESENT EVEN A YEAR AGO SO IT EFFECTS THE HEALTH EQUITY RESEARCH FIELD. YOU CAN SEE SOME FIELDS THAT HAVE BOUNDED KNOWLEDGE. THEY SUSTAIN INNOVATIONS AND MODERATE CHANGES. YOU HAVE SOME FIELDS THAT ARE ABLE TO DO DISRUPTIVE INNOVATION. CHANGING THE DNA OF THE DISCIPLINE. SO THERE IS TRUE TRANSFORMATION. THIS HAD TO DO WITH NIH FUNDING AND THE DISPARITY IN FUNDING BETWEEN UNDER REPRESENTED MINORITY CANDIDATES OR SCHOLARS AND THE MAJORITY OF ETHNIC GROUP SCHOLARS. WHERE YOU SEE PEOPLE TRYING TO APPLY AND THEN THE GRANT REVIEWERS -- LIKE THE GATE KEEPERS -- THROWING SOME FOLKS OFF THE CLIFF AND THOSE WHO ARE FUNDED REFLECTING GROUP THINK OF WHAT IS ORDAINED BY THE CURRENT CULT. THE FAR RIGHT YOU SEE AN ALTERNATIVE WHERE THERE MIGHT BE EQUITY POLICIES THAT SORT OF A LEVEL PLAYING FIELD IN TERMS OF THE SERIOUS SCHOLARS AND A BROADER GROUP THAT ARE TRULY FUNDING THE CREATIVE PROPOSALS. THIS WILL BE THE FOURTH COUNCIL MEETING WHERE I SPECIFICALLY PRAISED THE NIMHD RESEARCH MODEL. WHICH IS A BROAD MODEL. RANKING FROM THE MICRO AND BIOLOGICAL TO THE HEALTH CARE SYSTEM AND THERE IS A LOT TO BE SAID FOR THIS MODEL AND I LIKE IT A LOT. THERE IS A MAJOR LIMITATION WHICH IS THAT THE MODEL DOES NOT SHOW HOW THE PIECES FIT TOGETHER. WHAT THE ASSOCIATIONS AND THE CAUSES OF PATHWAY ARE. A SIGNIFICANT LIMITATION. SO BOTTOM LINE IS -- ADVANCING HEALTH EQUITY MODEL. I WAS INVITED TO DO AN EDITORIAL FOR THE JOURNAL OF BMJ QUALITY SAFETY. THIS TRIES TO SUMMARIZE IT. YOU SEE THAT ULTIMATELY WE'RE NOT GOING TO GET ANYWHERE UNLESS ORGANIZATIONS IN SOCIETY TRULY COMMIT TO THE MISSION OF MAXIMIZING THE HEALTH OF DIVERSE INDIVIDUALS IN DIVERSE POPULATIONS AND THEN WE NEED TO INTENTIONALLY ADVANCE HEALTH EQUITY. WE NEED TO INTENTIONALLY DESIGN SYSTEMS TO HELP ADVANCE HEALTH EQUITY. IT GOES TO A ROAD MAP. IMPLEMENTING THE ROAD MAP AGAINST DISPARITIES. DOING AWE ROOT CAUSE ANALYSIS. AND THEN DESIGNING AND IMPLEMENTING PREVENTIONS THAT ARREST THE SPECIFIC CAUSES IN CONJUNCTION WITH THE COMMUNITY. EVEN AS RECENTLY AS TWO OR THREE YEARS AGO I WOULD HAVE UNDER PLAYED THIS PART AND IT'S EQUALLY IMPORTANT. IT IS ABSOLUTELY CRITICAL TO CREATE THIS CULTURE OF EQUITY AND -- ALSO IMPORTANTLY WHAT I THINK INCREASINGLY DIFFERENT ORGANIZATIONS ARE TRYING TO STRUGGLE WITH IS WHAT ARE THE SYSTEM STRUCTURES WITHIN AN ORGANIZATION OR DISCIPLINE OR FIELD THAT BIAS AGAINST AND OPPRESS MARGINALIZED POPULATIONS. THE ARROW IS WHERE THE RUBBER HITS THE ROAD. THAT EVERY WORKER IN AN ORGANIZATION SHOULD KNOW HOW TO OPERATIONALIZE AND ADVANCE EQUITY IN THEIR JOBS. ANYONE IF THEY ARE IN CUSTODIAL SERVICES OR FRONT OFFICE STAFF HOW DO THEY HAVE AN EQUITY LENS IN ADVANCING OF EQUITY IN THEIR DAILY JOBS. IMPROVING HEALTH EQUITY. ON THE RIGHT YOU HAVE REALLY IMPORTANT LEVERS. TO SUPPORT AND INCENTIVIZES AND THEN -- [ INDISCERNIBLE ] TO ADDRESS MEDICAL AND SOCIAL DRIVERS OF HEALTH. SO WHEN I TALK TO A VARIETY OF -- OF AWED ARE AUDIENCES THEY LIKE THE MODELS. IT RESONATES WITH THE WAY THE WORLD WORKS. SO HERE IS ANOTHER WAY. IN THE MIDDLE YOU HAVE THE DIFFERENT -- DESIGNING YOUR INTERVENTIONS AND THE PAYMENT AND THE TRANSFORMATION HAS TO ALIGN. THE LEFTER POINTS TO STAKEHOLDER BUY IN. AND THE BOTTOM RIGHT IS IMPLEMENTATION SCIENCE ISSUES. TO ANALYZE THE SITUATION. THE STRENGTHS AND WEAKNESSES AND OPPORTUNITIES AND THREATS AND THE WHOLE POINT WITH HOW DO WE GET THINGS TO WORK IN THE REAL WORLD. IMPLEMENTATION SCIENCE. HERES MY JOURNEY FROM NEAR VICTORIA IN NEW ZEALAND. AN INCREDIBLY BEAUTIFUL AREA. SO THIS IS THE SANITIZED VERSION. THERE WERE MORE CHALLENGES THAN BARRIERS ALONG THE WAY. BUT I'LL MAKE IT CLEAN IN TERMS OF THE STORY. I'M A BIG FAN OF QUALIFIED HEALTH CENTERS. AND WHEN I STARTED ON FACULTY MY THIRD YEAR -- A LOT OF WHAT HAPPENS IN YOUR CAREERS IS LUCK IF YOU'RE IN THE RIGHT PLACE AT THE RIGHT TIME. SO I WAS PUT IN CHARGE OF OUR DIABETES CENTERS POPULATION HEALTH COMPONENT. A GROUP OF CONSORTIUM -- THEN COB CONTACTED THE CENTERS LOOKING FOR A PARTNER TO DO COMMUNITY-BASED RESEARCH. AND WE WERE FORTUNATE TO BE CHOSEN TO BE THE PARTNER AND THAT LED TO A SERIES OF RESEARCH. IT WAS LIKE CRAWLING INITIALLY. THE FIRST PAPER WAS A TWO PAGE BRIEF REPORT. WE LOOKED AT THE BARRIERS TO IMPROVING DIABETES CARE. THAT WAS THE INITIAL PART AND THIS IS BILL TERRIFIC KNEE. -- TIERNEY. -- HIS ADVICE TO ME IS WHERE IS THE INTERVENTION STUDY. HE THOUGHT THERE WAS TOO MUCH IN TERMS OF DESCRIPTIVE WORK. SURVEYS AND BARRIERS AND TRYING TO UNDERSTAND THE PHENOMENA AND WHY THE DISPARITIES. THAT IS GREAT WORK, BUT TO HIS LOOKING IF THE GOAL IS TO IMPROVE CARE AND OUTCOMES YOU'VE GOT TO DO INTERVENTIONS. SO I THOUGHT HE IS RIGHT. SO HERE IS AGAIN WHERE SERENDIPITY FALLS INTO PLAY. MY SECOND RO1 WAS ONE WHERE WORKING WITH ABOUT 20 CENTERS WHERE THE 20 WOULD LEARN TOGETHER AND SHARE BEST PRACTICES AND WAYS TO IMPROVE DIABETES CARE AND THEN A YEAR OR SO AFTER HERS A -- THE PART OF GOVERNMENT THAT OVERSEES THE CENTERS DECIDED TO DO A 10 YEAR INITIATIVE WHICH WAS SIMILAR TO THE IDEAS WE HAD IN OUR RO1. WE WERE CHOSEN TO BE ONE OF THE TWO GROUPS DOING THE COLLABORATIVES AND IT BECAME A VERY EXCITING RICH AREA TO DO A VARIETY OF IMPLEMENTATION AND EVALUATIONS OF THESE APPROACHES. WE DID SORT OF ONE OF THE THEMES OF MY RESEARCH WAS LOOKING AT A VARIETY OF DIFFERENT ANGLES. CLINICAL AND ECONOMIC AND ORGANIZATIONAL. I'M NOT GOING TO GO INTO GREAT DETAIL. THE BOTTOM LINE RESULTS -- THE A1C IMPROVED. THE PARTICIPANTS THOUGHT THAT THE COLLABORATIVES -- DREW TIME AND ENERGY AND RESEARCH AWAY FROM OTHERS. BUT THERE WERE SPILL OVER EFFECTS -- WHERE COLLABORATIVE -- INCREASED. AND THEN DON BURKE WROTE IN THE EDITORIAL -- THAT SEEKS TO BUILD A BRIDGE 2002 IMPORTANT WORLDS. THE WORLD OF STUDY AND ASSESSMENT AND EFFECTIVENESS OF THE WORLD OF ACTION. I TRY TO MAINTAIN THAT PERSPECTIVE THROUGHOUT MY CAREER THAT MELDING THE IMPORTANCE OF RIGOROUS RESEARCH AND TRYING TO MAKE SURE THAT IT WOULD HAVE REAL WORLD IMPACT IN THAT WHAT WE'RE DOING WOULD BE RELEVANT. SO FIND THE RIGHT PARTNERS AND WE HAD WONDERFUL PARTNERS. ASK WHAT THE PRACTICAL IMPLICATIONS OF YOUR WORK AND USE MULTIPLE RESEARCH METHODS TO STUDY IT FROM ALL ANGLES AND NOT TO BE SILOED INTO A SINGLE WAY OF THINKING. SO WHAT IS HAPPENING AT THE NATIONAL LEVEL? WE ALSO ARE DOING LOCAL PROJECT. THE SOUTH SIDE DIABETES PROJECT. IN PARTICULAR MY COLLEAGUE ON THE FAR LEFT MONICA PEEK WHO CAME AS A TRAINEE. SO INITIALLY I WAS HER MENTOR BUT NOW SHE IS MY COLLEAGUE AND SHE IS MORE MY MENTOR IN A LOT OF THESE HEALTH EQUITIES. SO IT WAS ONE OF THE EARLY NATIONAL PROJECTS -- THE QUALITY OF CARE AND OUTCOMES OF A GEOGRAPHIC AREA. LOOKING AT INTEGRATING COMMUNITY AND HEALTH CARE SYSTEMS. QUALITY IMPROVEMENT AND DISPARITIES. AND TAKING APPROACHES THAT RELIED OFF HUMANS AND HUMAN CAPITAL. THE TRADITIONAL HEALTH GOALS. THE LONG-TERM GOALS ARE WHAT YOU HEAR ABOUT NOW. EMPOWERING COMMUNITIES AND BEING SUSTAINABLE. SO EVERYONE IS FAMILIAR WITH THE CHALLENGES OF URBAN ENVIRONMENTS. MANY PEOPLE OVERLOOK THE GREAT STRENGTHS IN TERMS OF COMMUNITY INSTITUTIONS. OUR MODEL HAD FOUR DIFFERENT ASPECTS. AND SO IT EVOLVED. YOU DON'T WORRY ABOUT THE DETAILS. HOW WE FILLED IN THE INDIVIDUAL COMPONENTS. BUT I WANT TO CONCENTRATE ON THE MEASURED TARGETS. YOU HAVE A PERSON LIVING IN A COMMUNITY. IF THEY HAVE ACCESS TO CARE. ABOVE THAT YOU HAVE THE POLICY SUPER STRUCTURE. PAYMENT. AT THE BOTTOM IMPROVING OUTCOMES. OUR PROJECTS INVOLVED OVER TIME TO BASICALLY ADDRESS AS FAR AS WE CAN TELL ALL OF THE MAJOR DIFFERENT' ELEMENTS OF DRIVERS OF THE MODEL SO IF THE COMMUNITY FACTORS. THE HEALTH SYSTEM FACTORS AND SOME OF THE POLICY FACTORS. AND SO I THINK IT'S REALITY THAT THAT IS WHAT PEOPLE DO IN THE REAL WORLD. TRYING TO ATTACK ALL OF THE DIFFERENT DRIVERS AS MANY AS THEY CAN THAT AFFECT THE OUTCOMES. WHERE THEY ARE GOING TO SAY WE'RE JUST GOING TO LOOK AT EDUCATION FOR EXAMPLE. 79 IT DOESN'T WORK THAT WAY. *. SO MONICA HAS THIS GREAT PROGRAM. EMPOWERMENT EDUCATION. WE DID A LOT OF COMMUNITY WORK. SSO FARMER MARKET'S PROGRAMS. COLLABORATIVE FOOD PANTRY -- TO MAKE A FOOD PANTRY MORE OF A HEALTH EDUCATION EVENT. DO THE TOURS FOR COMMUNITY EDUCATION IN THE LOW COST GROCERY STORES WHERE THE PATIENTS SHOP SO THEY KNOW HOW TO READ FOOD LABELS. WE DID A LOT OF MEDIA AND EVENTS. ANNUAL LIKE HEALTHY DIABETES RECIPE COMPETITION AND WE DO A LOT OF MEDIA. THIS IS WBON SOUTH SIDE OF CHICAGO. PAPERS -- AND WE HAVE A PRACTICE THAT TIE TOGETHER OUR RESEARCH AND OTHER PAPERS. THE BOTTOM LINE THE PROGRAM IMPROVED -- OUTCOMES. AND THEN AGAIN PEOPLE UNIFORMLY THOUGHT AN INTEGRATED HEALTH CARE PARTNERSHIP WAS THE RIGHT THING TO ADVANCE HEALTH EQUITY. PEOPLE WERE GENEROUS AND EAGER TO COLLABORATE. HOWEVER, THE DOWNSIDE WAS THAT THE CURRENT SYSTEM WAS NOT ALIGNED TO SUPPORT SUCH PARTNERSHIPS. MAJOR LESSONS TO WORK WITH PEOPLE YOU LIKE AND RESPECT. I THINK -- TO LEARN COMMUNITY ENGAGEMENT RESEARCH WOULD BE BENEFICIAL OVER TIME. BUILD YOUR SKILL SET. LIKE COMMUNICATION AND WORKING WITH THE MEDIA AND A DIVERSIFIED PORTFOLIO BECAUSE CBPR IS SLOW. WE ALSO DID POLICY RESEARCH. PROBABLY OUR MOST IMPORTANT PAPER IS THE ONE BY ROBERT NOCON. ONE OF THE MOST WIDELY CITED PAPERS. DEMONSTRATES THAT COMPARED TO OTHER TYPES OF OUTPATIENT CLINICS HEALTH CENTERS HAVE DECREASED BUSINESS AND HOSPITALIZATIONS AND SPENDING. LET'S SHARE ONE MORE RESEARCH PROJECT. LOOKING AT IMPROVING SHARED DECISION MAKING AMON A -- AMONG CLINICIANS AND LGBTQ+ COMMUNITY. WE BASICALLY INTERVIEWED OVER 200 LGBTQ+ PEOPLE OF COLOR. SO ONE QUOTE -- GETS TO THIS COMPLICATED ISSUE OF HOW THEY INTERACT WITH PROVIDERS OF COLOR. SO A LATIN MASCULINE GENDER MIGHT SAY THERE IS A LOT OF INTERNALLIZED FEELING ABOUT WHAT OUR BROWN COMMUNITIES DO AND DO NOT ACCEPT. THEY ARE RECOGNIZED BUT IT DOES TEND TO MAKE ME LESS LIKELY TO DISCLOSE MY TRANSGENDER IDENTITY. IT IS EASIER TO PASS AND WAIT TO SEE HOW SAFE IT IS BEFORE DISCLOSING THE OTHER IDENTITY. HOW COMPLEX THESE ISSUES ARE. ELISEO HAD A SLIDE ABOUT THE IMPORTANCE OF INCREASING THE NUMBER OF PHYSICIANS OF COLOR AND HOW THAT ALONE -- IS NOT ENOUGH. SO HERE IS A RELATED STORY THAT FOR ME ONE OF THE TRANSFORMATIVE EVENTS -- A LIFE CHANGING EVENT FOR ME WAS SPENDING THREE MONTHS IN NEW ZEALAND. I WAS WORKING ON A PAPER COMPARING WHAT THE TWO COUNTRIES ARE DOING WITH THEIR NATIONAL HEALTH CARE EQUITY POLICIES AND ONE OF THE TRUE PRIVILEGES WAS WORKING WITH THESE SIX WONDERFUL COLLEAGUES. THE THREE ON THE LEFT ARE INDIGENOUS PEOPLE OF NEW ZEALAND SO WE HAD DOZENS OF CHALLENGING CONVERSATIONS, DIFFICULT CONVERSATIONS AND IN OUR ULTIMATE PAPER THEY WERE GREAT ABOUT COINING THIS RECOMMENDATION OF HAVING FREE, FRANK FEARLESS DISCUSSIONS ABOUT STRUCTURAL RACISM, COLONIALISM AND THEN SOCIAL PRIVILEGE. 7 SO NOW WE'RE STARTING TO SEE THE DISCUSSION HERE IN THE U.S. THE IMPORTANCE OF HAVING THESE DISCUSSIONS. AND ONE THING THEY TAUGHT ME IS POWER IS THE ISSUE AND THAT IS WHY THESE DISCUSSIONS ARE HARD BECAUSE IT'S ABOUT CONTROL OVER RESOURCES. CONTROL OVER THE HISTORICAL NARRATIVE. A LOCALITY ABOUT ALTERNATIVE REALITIES. THE BATTLE IS OVER THE CONTROL AND POWER OF THE HISTORICAL NARRATIVE AND THE CONTROL OVER THE FRAMING OF HEALTH EQUITY. WHO HAS A VOICE AT THE TABLE AND WHAT ARE THE RULES OF THE GAME? WHAT IS DEEMED TO BE VALID RESEARCH? SO THESE ARE THE TWO PEOPLE THAT HAVE TAUGHT ME THE MOST ABOUT HEALTH EQUITIES OVER THE YEARS. WE HAD A PAPER LAST YEAR -- ABOUT RACE. YOU SEE ON THE DIAGRAM LIKE THESE FOUR DIFFERENT AREAS TO COVER. BUT THE TAKE HOME HERE ALSO THAT THERE ARE ALL OF THESE KEY CRITICAL CHALLENGING THINGS TO UNDERSTAND ABOUT CREATING A SAFE SPACE DEFINING LANGUAGE AND USING STORIES AND NUMBERS, TALKING ABOUT DIFFICULT ISSUES -- -- THAT ARE ALL IMPORTANT IN TERMS OF THE PROCESS OF IMPLEMENT MEPRO-PROCESS OFIMPLEMENTATION A ND CHANGE. IT REFLECTS REAL WORLDCOM PLEX TEE. I'LL START SPEEDING UP HERE. PERHAPS LIKE THE KEY THING WHICH MAYBE CHANGED MY CAREER TRAJECTORY WAS A MEETING I HAD MAYBE 18 YEARS AGO AND SO I GOT THIS E-MAIL OUT OF THE BLUE FROM DEBORAH JOY PEREZ. AND SHE SAID WE'RE GOING IS TO START A NEW EQUITY PROGRAM AT THE FOUNDATION -- WE'RE LOOKING FOR SOMEONE TO LEAD THE NATIONAL PROGRAM OFFICE. DO YOU WANT TO APPLY? I SAID SURE. HAPPY TO APPLY. NEXT WEEK HAPPENS TO HAVE JIM KNICKMAN. DO YOU MIND IF I BRING HIM BY TO TALK TO YOU. SURE. THEY WORKED ME FOR THREE HOURS STRAIGHT GRILLING ME AND THE END OF THE RESULT WAS WE WERE CHOSEN TO BE THE HEAD OF THE PROGRAM AND SO NOW -- WE'RE IN YEAR 17. AND HERE WAS THE STORY OF HOW WE GOT HERE. WE INITIALLY WORKED WITH ABOUT THREE DIFFERENT GRANTEES. A FEW HEALTH PLANS WHO DID THE FIRST PART IN IDENTIFYING DISPARITIES AND DIAGNOSING AND DESIGNED AN INTERVENTION AND MANY WERE SUCCESSFUL. ONE LESSON WAS -- WE CANNOT SUSTAIN IT. WGENTLEMANY OF THE INTERVENTIONS WORKED BUT THE LESSON WAS THAT THERE IS ONLY SO MUCH WE CAN DO AND PAYMENT HAS ALIGN ACROSS THE FEDERAL AND STATE PAYERS. WE'RE TRYING TO ALIGN THE STAKEHOLDERS. AND I MENTIONED THIS MERCK FOUNDATION. A LOT OF FRONT LINE LESSONS. HERE IS LIKE THE BOTTOM LINE. I DO A LOT OF WORK NOW WITH FRONT LINE ORGANIZATIONS AND HERE IS WHAT THEY SAY. IT'S GREAT TO HAVE MODEL PROGRAMS AND TO BE EXPOSED. HOWEVER IN OUR WORLD ULTIMATELY WE HAVE TO TAYLOR TO OUR PARTICULAR CONTEXT. WE NEED TO MAKE DECISIONS NOW BASED ON INCOMPLETE DATA AND LIVING THE MULTI-LEVEL MULTI-FRAMEWORK. THAT IS OUR REALITY. SO OVER SIMPLIFICATION IS NOT THE REAL WORLD. IT DOES NOT TRANSLATE WELL TO MUCH REAL WORLD EQUITY RESEARCH. SO IMPLEMENTATION IS CRITICAL. AND PATIENT CENTERED COMMUNITY CENTERED PROVIDER STAFF TORNADO APPROACHES. -- CENTERED. SO WHEN I GIVE MY STOCK TALK ABOUT HOW TO ADVANCE EQUITY I TALK ABOUT FIVE LESSONS. THERE IS NO MAGIC BULLET SOLUTION. WE PLEAD TO ADDRESS SOCIAL DETERMINANTS OF HEALTH INCLUDING STRUCTURE ALL RACISM. ON THAT LAST PART A COUPLE OF POINTS I WANT TO MAKE. FIRST -- -- THAT CAN BE VERY HELPFUL BUT THE MOST IMPORTANT DRIVER IS INTRINSIC MOTIVATION. DOING THE RIGHT THING. AT THE END OF THE DAY THAT IS WHAT PROVIDERS AND STAFF ULTIMATELY DRIVERS THEM AS WELL AS MOST LEADERS. IT REQUIRES DISCUSSION ABOUT DISTRIBUTE I HAVE JUSTICE. THE FEAR ALLOCATION OF RESOURCES AND THEN COMPETING ETHICAL FRAMEWORKS. SO HOW DOES THIS GET BACK TO THE OVER-ALL MODEL? AND THEN THIS THE OVER-ALL FIGURE OF USE AND PARADIGMS. SO LISA SIMPSON -- JUST FOUR DAYS AGO SENT OUT A SERIES OF 24 TWEETS AND HERE ARE THE FIRST TWO. AT ACADEMY HEALTH WE JUST HOSTED A DISCUSSION ON CURRENT INSENSITIVE AND WHAT NEEDS TO CHANGE TO INCREASE IMPACT OF OUR WORK AND ADDRESS INEQUITIES IN WHO AND WHAT WE REWARD. -- -- [ READING FROM SCREEN ] >> HEALTH CARE IS NOT DESIGNED TO MAXIMIZE HEALTH AND SIMILARLY I WOULD ASK WHAT IF THE ROLE OF RESEARCH WAS TO IMPROVE HEALTH BECAUSE A FAIR AMOUNT OF HEALTH RESEARCH IS NOT DESIGNED TO IMPROVE HEALTH. FIRST EMPHASIZE TRANSPORTATION DISCIPLINARY -- NOT SILOS. ] -- [ READING FROM SCREEN ] WE NEED TO MOVE BEYOND SAFE APPLICATIONS FOR STUDY SECTION REVIEW THAT ONLY I IN -- ONLY INCREMENTALLY ADVANCES THE FIELD. WE NEED TO INCORPORATE -- EXPERIENCE. WE HAVE TO ASK HOW CAN RESEARCH BE USEFUL. WE NEED TO DO A BETTER JOB INTEGRATING AND ONE EXAMPLE IS HOW DO WE DO THE RESTRUCTURE. AND WE SHOULD FUND AN ETHICAL RESEARCH AGENDA FOR EQUITY RESEARCH. WHAT QUESTIONS ARE CORE AND HOW DO WE START BALANCING THESE COMPETING DEMANDS AND PRIORITIES? A COUPLE OF MORE SLIDES HERE. KEEPING IT FRESH. I DO AN IMPROVE IN STAND UP COMEDY AND ONE OF THE MEMBERS OF OUR TEAM HE SAID YOU'RE PROBABLY NOT RESEARCHING THE BEST QUESTIONS IF YOU FEEL YOU'RE NOT LEARNING MUCH IN YOUR WORK. SO I ASK THIS QUESTION HERE. AND THERE ARE ALL OF THESE GOOD TO UNDERSTAND THE HUMAN EXPERIENCE. I HAVE TWO OF QUOTES. ONE FROM A PAPER THAT JUST CAME OUT. TO CARE FOR DIVERSE POPULATION IN 2021 CLINICIANS MUST HAVE SELF-INSIGHT AND TRUE ENERGY. FINANCIAL OF EVIDENCE BASED INTERVENTIONS. AND THIS QUOTE -- FROM SEVEN YEARS AGO NOW. THANK YOU VERY MUCH. >> I'LL TRY TO GET OUT OF SHARE SCREEN HERE AND HOPE THIS WILL WORK HERE. >> THAT WAS GREAT MARSHALL. THANK YOU VERY MUCH. WE CAN OPEN UP FOR A FEW QUESTIONS. WE HAVE A BREAK FOLLOWING THIS UNTIL 1:30 SO PEOPLE CAN DECIDE HOW MUCH THEY WANT TO TALK TO MARSHALL AND HOW MUCH -- >> MARSHALL I HAVE ONE QUESTION FOR YOU. SOMEWHERE IN YOUR PRESENTATION YOU IMPLIED THAT PEOPLE SHOULD LOOK AT STRUCTURAL RACISM IN THE CONTEXT OF ASSOCIATE CONTENTS OF HEALTH. ALL MINORITIES CAN BE SUBJECT TO STRUCTURAL RACISM. >> I MAY HAVE MISSPOKE. THAT IS A GREAT POINT. I WOULD HAVE -- SO STRUCTURAL RACISM -- MANY DIFFERENT PATHWAYS. BUT IT GOES WAY BEYOND THAT AS YOU SAID. BUT MY POINT TO CULTURAL OF EQUITIES IS ALSO IMPORTANT. THERE ARE WAYS -- STRUCTURAL RACISM WILL EMBED ITSELF IN GROUP THINK. AND IF WE'RE HONEST WITH OURSELVES THE BEST PART OF THE HARDEN WARD LOOK WE SHOULD DO AS PRIVATE FOUNDATIONS AND PUBLIC FUNDERS OF -- WHAT ABOUT THE STRUCTURAL ASPECTS THAT WE SET UP OUR RESEARCH CRITERIA. THERE WAS A SOCIOLOGISTS JANICE JOHNSON DS. I WAS GIVING A TALK AND MADE THE POINT -- HEALTH FIELD WE'RE NOW GRAPPLING WITH HOW TO DEAL WITH STRUCTURAL RACISM AND SHE SAID MAYBE YOU'RE RIGHT FOR HEALTH CARE BUT FOR PEOPLE WHO HAVE BEEN WORKING ON THIS FOR THEIR WHOLE CAREERS -- IT'S OLD HAT. THE PROBLEMS WITH THE HEALTH CARE HAS NOT CAUGHT UP. IT'S BECAUSE LIKE A LOT OF FOLKS WHO ARE EXPERTS HAVE NOT BEEN AT THE TABLE SO THEIR PARADIGMS HAVE NOT GOTTEN VOICED SO, THAT IS ONE EXAMPLE. >> I'M EVEN MORE IMPRESSESSED NOW THAT I KNOW YOU'RE A STAND UP COMIC. >> I HAVE A FEW THOUGHTS AND A QUESTION. FIRST OF ALL FOR YOUR TALK IT WAS EXCELLENT AND IT ALIGNS WITH THE THINGS THAT WE'RE DOING HERE IN HAWAII. I CALL IT IN DIG AYESING OUR * OUR HEALTH CARE SYSTEM AND I'M GLAD TO SEE YOU'VE WORKED IN NEW ZEALAND. WE DRAW MUCH FROM THEIR WORK. WE CONSIDER COLONIALISM AS A DETERMINANT OF HEALTH. I HAVE A FEW THOUGHTS FOR YOU. MAYBE QUESTIONS FOR TO YOU GET YOUR THOUGHTS ON. I'VE BEEN TALKING ABOUT CULTURAL SAFETY AND IN DIG AYESING THE HEALTH CARE SYSTEM. * YOU DO ELUDE TO THE FACT THAT THERE IS A PROBLEM OR CULTURAL ISSUE IN MEDICINE AND SCIENCE. AND THAT PERHAPS HEALTH CARE MAY BE CONTRIBUTING TO HEALTH DISPARITIES. WHAT ARE YOUR THOUGHTS AROUND THAT? IS THAT AN ACCURATE STATEMENT? THERE IS A CULTURAL ISSUE THAT PERPETUATES INEQUITIES? >> GREAT POINT AND WE LIKE TO -- THOSE OF US IN HEALTH EQUITY RESEARCH WE LIKE TO THINK WE'RE DOING WELL IN TERMS OF -- CULTURAL APPROACHES AND TRYING TO MEET PATIENTS WHERE THEY ARE AT. MY TIME WITH REES-JONES AND THE COLLEAGUES THERE THEY WERE WONDERFUL IN HELPING ME TO SHOW -- ONE THING -- LIKE A NARROW INTERVENTIONS VERSUS WHAT WOULD IT LOOK LIKE IF THE WHOLE SYSTEM WAS SET UP IN A WAY THAT IS CULTURALLY APPROPRIATE AND MATCHED. SO THE WHOLE APPROACH OF WHAT DOES IT MEAN TO HAVE A HEALTH CARE SYSTEM? -- AN AMERICAN HEALTH CARE SYSTEM AND THAT IS ANOTHER LEVEL OF MAGNITUDE BEYOND THE WAY THAT WE TEND TO THINK ABOUT CULTURAL TAILORING. A POINT WELL TAKEN AND IT'S CULTURE. IT'S STRUCTURE. IT'S PERSONNEL. IT'S EMBEDDING THE CULTURE THROUGHOUT ALL ASPECTS OF THE SYSTEM. SO, ITS A GREAT MODEL. >> MARSHALL, WE HAVE ANOTHER PERSON IN THE CHAT WHO HAS -- LISA BARNES. SORRY SPIRO. WE'LL COME BACK TO YOU. >> THAT WAS MASTERFUL. I REALLY ENJOYED IT. I LIKE YOUR MESSAGE ABOUT EVERYONE HAVING A ROLE TO PLAY. AND THIS WHOLE THING ABOUT CREATING A CULTURE OF HEALTH EQUITY. SO MY QUESTION IS ABOUT IF YOU ARE COMING FROM A HEALTH CARE SYSTEM OR A FIELD THAT IS REALLY DOMINATED BY ONE WAY OF THINKING -- HOW -- AND YOU WANT TO WORK WITH THE COMMUNITY. RIGHT. HOW DO YOU TRANSFORM THE POWER DIFFERENTIAL THAT EXIST THAT IS INHERENT BETWEEN ACADEMICS AND HEALTH CARE AND THE COMMUNITY SO THAT YOU CAN REALLY START TO CREATE THIS CULTURE OF EQUITY. DO YOU HAVE ANY CONCRETE EXAMPLES FROM YOUR OWN WORK WHERE YOU'VE BEEN ABLE TO MAKE THAT REAL SHIFT IN THE POWER DIFFERENTIAL? >> JUST TWO PARTS TO YOUR QUESTIONS. ONE IS FOR AN ISOLATED PROJECT YOU CAN DO IT. THIS IS A TYPICAL NIH PROJECT. YOU HAVE A GROUP THAT HAS AN ISOLATED PROJECTOR THEY'VE BEEN ABLE TO CREATE A PARTNERSHIP WITH THE COMMUNITY AND DOING THINGS THE RIGHT WAY. AND THAT CAN WORK IN THE SHORT-TERM. THE PROBLEM IS FOR A MORE WIDER IMPACT SO BECOMING PART OF THE WAY THE ORGANIZATION DOES BUSINESS OR DELIVERS CARE. OR GOES BEYOND THAT NARROW PROJECT TO THE WAY THEY CARE FOR MULTIPLE CONDITIONS THAT. IS NOT GOING TO HAPPEN UNLESS THERE IS A WIDER CHANGE. WELL HOW DO YOU GET TO THAT POINT? ALL OF THE DIFFERENT ORGANIZATIONS DOING THE HARDEN WARD LOOK. SO -- WE WORK WITH A NUMBER OF HEALTH PLANS. WE'VE BEEN STARTING TO HAVE THE DISCUSSIONS WHERE -- TO THE POINT WHERE SOME ORGANIZATIONS THEY WANT TO GIVE A PRIORITY. SO ONE WE HAD A COUPLE SESSIONS WHERE THEY STARTED TO HAVE THE DISCUSSION OF WHAT DOES IT MEAN TO BE STRUCTURALLY RACIST. HOW DO WE THEN HAVE SMALL GROUP DISCUSSIONS OF IN MICRO LEVELS IN TERMS OF PERFORMANCE MEASUREMENT IN THE TOMORROWS OF SETTING UP PAYMENT. WHAT ARE THE PROBLEMS? THAT LEVEL OF SMALL GROUP DISCUSSION. HAVING THE FREE, FRANK LESS FEARLESS DISCUSSION. THAT LEVEL OF INPUT AND CHALLENGE AND DISCUSSIONS WILL HAVE TO OCCUR. NO SIMPLE SOLUTION BUT THOSE ARE THE DISCUSSIONS THAT HAVE TO OCCUR. >> SO I'VE GOT THREE MORE PEOPLE LINED UP FOR QUESTIONS. I'VE BEEN IN CONTACT WITH THE NEXT SPEAKER. HE HAS AGREED TO START LATER SO WE CAN ENTERTAIN THESE THREE QUESTIONERS. DR. MANSON FIRST. >> MARSHALL, THANK YOU. THE ACCOLADES OF OUR FELLOW COUNCIL MEMBERS. IT WAS A LOVELY PRESENTATION BLENDING PERSONAL NARRATIVES AND STORYTELLING WITH I THINK SOME CRITICAL EXAMPLES. MY CHALLENGE FOR YOU IS THE FOLLOWING, MARSHALL. I BELIEVE THIS MESSAGE IS IN THERE. I FREQUENTLY ENCOUNTER FROM A LARGE MAJORITY OF MY COLLEAGUES THE ARGUMENT THAT FOCUS ON SOCIAL JUSTICE AND HEALTH EQUITY IS IMPORTANT BUT IT DISTRACTS US FROM THE PRIMARY AGENDA OF SCIENCE. IT IS IMPORTANT CONTEXTUALIZING FORCE THAT MAY CONTRIBUTE IN SOME WAYS BUT THAT IT IS IN THE MOST CALLOUS TERMS OF SOME WINDOW DRESSING. I BELIEVE YOUR PRESENTATION HAS A NUMBER OF EXAMPLES TO A RIGOROUS COMPARATIVE ANALYSIS OF THE VALUE ADDED IS THE THE APPROACH THAT YOU'RE ADVOCATING TO THE IMPROVEMENT OF THE SCIENCE. NOT ONLY DO THE NATURE OF THE QUESTIONS THAT WE ASK THE METHODS THAT WE IMPLORE TO ANSWER THOSE QUESTIONS AND THE -- FIND THINGS MAY RESULT AND ULTIMATELY THE APPLICATION -- I THINK YOU HAVE AVAILABLE TO YOU THE EVIDENCE TO DO A VERY CAREFUL RIGOROUS COMPARATIVE ANALYSIS TO ILLUSTRATE CONCRETELY WHAT THE VALUE ADDED IS FOR THIS PARTICULAR PERSPECTIVE AND I THINK WE NEED MORE OF IT. >> THANK YOU, SPIRO FOR THAT GREAT POINT. YOU THINK ABOUT THE VARIOUS COVID INEQUITY QUESTIONS THAT COME UP. VACCINE -- DISTRIBUTION AND PRIORITIZATION. ETHICAL ISSUES ARE EMBEDDED. FUNDAMENTAL TO THE ISSUE YOU CANNOT DISASSOCIATE IT FROM -- IT'S PART OF THE SCIENCE. AND THE QUESTIONS OF IMPROVING HEALTH. SO AND IN SOME WAYS -- IT'S A BIG MISTAKE PRETENDING IT'S NOT THERE. AND THAT IS WHY WE NEED TO DO MORE RESEARCH IN TERMS OF HAVING THE DISCUSSIONS. I WOULD HOPE THAT WITH ALL OF THE MONEY AND THE COVID INITIATIVES THAT THERE IS PARALLEL FUNDING IN TERMS OF THE ETHICAL RESEARCH AGENDA FOR THOSE TYPE OF THINGS. IT'S SUCH AN IMPORTANT PART OF THAT. AS WELL AS A LOT OF PEOPLE ARE INTERESTED IN IMPLEMENTATION. CHANGE IN BEHAVIOR. AGAIN THE ISSUE OF INTENTIO -- IN -- INTRINSIC MOTIVATION. >> DR. JOHNSON, DO YOU STILL HAVE A QUESTION? >> I DO. THANK YOU. THANK YOU SO MUCH, MARSHALL. THAT WAS OUTSTANDING. I'VE BEEN A FAN FOR A LONG TIME. I WANTED TO FOLLOW-UP ON ONE POINT THAT WE STARTED YESTERDAY IN OUR 3:00 SESSIONS WITH DIFFERENT -- GROUPS AT THE NIMHD AND YOU MENTIONED IT HERE ABOUT THAT IN THE NIMHD FRAMEWORK WHERE IT'S AN AWESOME FRAMEWORK FOR THINKING ABOUT DISPARITIES BUT WHAT IS MISSING IS THE CONNECTION BETWEEN THE DIFFERENT PIECES OF THAT AND I'VE BEEN THINKING ABOUT THAT A LOT SINCE THE FOAs REGARDING STRUCTURAL RACISM HAS COME OUT AND THE WORK THAT WE DEAL WITH DEALS WITH DISPARITIES RELATED TO IMPLICIT BIAS OR ASSESSING PATIENT NEEDS SO AS PEOPLE HAVE TRIED TO PITCH ISSUES AROUND STRUCTURAL RACISM WHAT I FIND IS THEY ARE STILL LOOKING AT INTERPERSONAL AND BIAS AND DECISION MAKING. AS YOU THINK ABOUT THE LINKAGES WHAT IS THE CONCRETE PATHWAY OR THE INTERVENTION THAT MIGHT BE AT THE LEVEL OF STRUCTURAL RACISM THAT TRICKLES DOWN AND IMPACTS THE INTERACTIONS WITHIN THE CLINICAL ENCOUNTER OR VICE VERSA. HOW DO WE THINK ABOUT THAT CONNECTION THAT IS NOT THERE? >> THAT IS A GREAT QUESTION KIMBERLY. AND THERE IS SO MANY PEOPLE HERE -- -- I'M NOT GOING TO CLAIM TO HAVE THE MODEL HERE. THE POINT THAT I WANT TO MAKE IS THE GOAL OF NIMHD IS TO SUPPORT RESEARCH THAT HELPS ADVANCE HEALTH EQUITY AND REDUCE DISPARITIES AND IMPROVE THE HEALTH OF DIVERSE COMMUNITIES ACROSS THE -- COUNTRY. THEY ARE MORE LIKELY TO MAXIMIZE THE IMPACT IF THEY THINK ABOUT SOME OF THE CONNECTIONS. THE LOGIC MODEL OF HOW STRUCTURAL RACISM ADDRESSING THIS WOULD IMPROVE HEALTH? AND SOME OF THIS IS NONAND SOME NOT KNOWN SO WE CANNOT BE TOO RIGID IN TERMS OF INITIAL MODEL BUT HAVING NO MODEL OR NOT -- THE OUTSIDE WORLD OF WHAT CLUES -- IT MEANS IT HAS NOT BEEN THOUGHT THROUGH OR PERHAPS A MISSED OPPORTUNITY OF NOT HELPING TO GUIDE THE FIELD TO WHAT BUILD BE HIGH PRIORITY CREATIVE INNOVATIVE RESEARCH. TOO MUCH RESEARCH IS INCREMENTAL AND NOT PARTICULARLY HELPFUL. SO BILL STARTED THE PROCESS AND THERE IS A VARIETY OF STRUCTURAL SOCIAL FACTORS. A VARIETY OF WAYS AND YOU GET INTO THE MIND IN TERMS OF THE WAY INDIVIDUALORSES WORK AND WE CAN COME UP WITH A NICE LISTEN FOR ALL. * WITHOUT A LITTLE MORE THE CONNECTIONS THERE -- IT'S A MISSED OPPORTUNITY IN TERMS OF HAVING A HIGHER PERCENTAGE OF APPLICATION BEING LIKELY INNOVATIVE AND CREATIVE AS OPPOSED TO INCREMENTAL CHANGE AND TRULY DYNAMIC CHANGE THAT MY COLLEAGUE TALKS ABOUT. >> DR. SHELL. I GIVE YOU THE LAST WORD. I HAD THOUGHT MAYBE WE WOULD WRAP UP AROUND 1:15. SO LET'S BE AS CLOSE TO THE POINT AND THEN AFTER THAT WE CAN DECIDE HOW LONG OF A BREAK WE MIGHT TAKE. OUR NEXT SPEAKER HAS BEEN GRACIOUS ENOUGH TO SAY 5-10 MINUTES WOULD NOT INTERRUPT WITH HIS SCHEDULE. >> I'M TOTALLY FLEXIBLE SO TAKE WHATEVER TIME YOU NEED. IT'S NOT OFTEN I'M TOTALLY FLEXIBLE BUT AT LEAST FOR THE NEXT 10-15 MINUTES I AM. >> MARSHALL I APPRECIATED THE PRESENTATION. THE ONE THING THAT STUCK IN MY BRAIN IS YOUR WORK IN NEW ZEALAND AND I AGREE WITH THE SLIDE ABOUT THE SLIDE WITH THE POWER IS THE ISSUE. WHAT ARE YOUR THOUGHTS ABOUT WHAT CHANGES THE INDIVIDUALS WHO HAVE THE POWER TO THEN RELINQUISH THEIR POWER TO THE OTHER GROUPS SO I AGREE WITH THE CONTROL OVER RESOURCES THE NARRATIVE. BUT WHAT ARE YOUR THOUGHTS ON THE GROUPS THAT ARE IN POWER AND THEN ALLOWING OR RELINQUISHING THE POWER TO THE GROUPS THAT HAVE BEEN SUPPRESSED. >> POWER IS TRICKY AND THE PARALLEL PART IS THE INTERESTING MOTIVATION PART IS THAT PEOPLE WOULD LOVE TO DO THINGS FOR THE RIGHT REASON. SO PART OF MAYBE THE WAY OUT OF THE CONUNDRUM IS WE NEED TO DO A BETTER JOB OF -- THAT PEOPLE ARE REWARDED FOR DOING THE RIGHT THING. IN MY OTHER WORLD THE FOUNDATION WORK OF PAYMENT, THE HEALTH CARE SYSTEM IS NOT SET UP TO REWARD IMPROVED CARE FOR DIVERSE POPULATIONS. WHAT IF IT WAS SET UP THAT WAY? THIS GREAT INCENTIVE TO DO THINGS THAT WOULD LEAD TO IMPROVING CARING FOR MARGINALIZED POPULATIONS. MORE SUCCESSFUL AND BE REWARDED BECAUSE IT'S GOING TO LEAD TO BETTER REIMBURSEMENT. SO YOU'RE RIGHT. IT'S TRICKY. POWER IS ALWAYS A STRUGGLE BUT AT THE SAME TIME WE CAN DO MUCH MORE OF CALLING UP WHAT THESE ISSUES ARE AND DOING BETTER WITH SETTING UP THE RULES OF THE GAME. STRUCTURES AND FLOW OF MONEY SO THAT PEOPLE HAVE AN INCENTIVE TO DO THE RIGHT THING AND ADVANCE HEALTH EQUITY. >> I'M GOING TO LEAVE IT TO YOU. IT SEEMS LIKE ANY THOUGHT PROVOKING TALK PEN COURAGING MORE QUESTIONS. THERE ARE MORE PEOPLE WHO WOULD LIKE TO ASK QUESTIONS BUT SHOULD WE CONTINUE AT THIS POINT WITH MORE QUESTIONS? >> I THINK WE SHOULD ALL TAKE A BREAK. 20 MINUTES -- GET SOME OF FOOD. AND WE'LL COME BACK TO LISTEN TO RICK. I'M SURE IT WILL BE EQUALLY THOUGHT PROVOKING SO THANK YOU VERY MUCH MARSHALL. WE'LL HEAR FROM YOU A LITTLE BIT LATER. >>WELCOME BACK FROM THE BREAK. WE LOOK FORWARD TO THIS SECOND PRESENTATION. RICK WOYCHIK -- STARTED IN HIS ROLE JUST NOT QUITE A YEAR AGO AFTER SERVING AS DEPUTY DIRECTOR FOR SINCE 2011 AND ACTING DIRECTOR BEFORE THAT. I'VE BEEN WORKING CLOSELY WITH RICK OVER THE PAST YEAR ON SEVERAL OF THE COVID INITIATIVES. AND I CAN CERTAINLY ATTEST TO HIS COLLEGIATE, INTELLIGENCE AND SCIENTIFIC ASK MUM. *. HE SPENT TIME IN THE BAY AREA. NO WONDER I LIKE HIM SO MUCH WHERE HE SPENT SEVERAL YEARS IN THE PHARMACEUTICAL SECTOR. MOVED TO SAN FRANCISCO IN 1998 AS THE HEAD OF THE PARK DAVIS LABORATORY AND CHIEF SCIENTIFIC OFFICER AT LYNX THERAPEUTICS BEFORE COMING BACK AT THE JACKSON LABORATORY WHERE HE MADE A HUGE MARK AND IMPACT. SO RICK IS GOING TO TELL US ABOUT THE OVERVIEW OF THE ENVIRONMENTAL HEALTH SCIENCES RESEARCH AND HOW IT HAS A LOT OF POTENTIAL INTERACTIONS WITH MINORITY HEALTH AND HEALTH DISPARITIES. RICK, WELCOME. >> EXCELLENT. ELISEO, THANK YOU FOR THE INVITE AND THANK YOU TO ALL OF YOU. CAN YOU HEAR ME? >> YEAH. >> GOOD. I'VE BEEN HAVING INTERNET PROBLEMS. >> AGAIN THANK YOU FOR THE OPPORTUNITY TO DESCRIBE SOME OF THE WORK THAT WE'RE DOING HERE. AS MANY OF YOU KNOW NIMHD HAS BEEN A GREAT PARTNER WITH US FOR MANY YEARS AND I SUSPECT THAT YOU KNOW THAT WE HAVE A STRONG COMMITMENT TO HEALTH DISPARITIES AND ENVIRONMENTAL JUSTICE. BUT I THOUGHT -- WHAT I WOULD DO TODAY IS GIVE YOU A BROADER PERSPECTIVE AS IT RELATES TO AIR POLLUTION AND CHEMICAL AND ENVIRONMENTAL EXPOSURES IN A WHAT THAT WOULD PREDISPOSE TO HEALTH DISPARITIES. I'LL DESCRIBE SOME OF THE WORK THAT WE'RE DOING TO DOCUMENT THE TYPE OF EXPOSURES THAT AFFECT COMMUNITIES OF COLOR AND SUBJECT THEM TO HEALTH DISPARITIES. I'LL START OFF WITH A BRIEF SUMMARY OF OUR MISSION AND VISION. THE MISSION IS TO DISCOVER HOW THE ENVIRONMENT AFFECTS PEOPLE. OUR VISION STATEMENT IS TO PROVIDE GLOBAL LEADERSHIP. SO THE KEY PART IS THE WORD PREVENTION. PREVENTING DISEASE AND DISABILITY AND WE BELIEVE DIFFERENTIATES OUR WORK FROM OTHER ICs ACROSS THE NIH WHICH MANY ARE FOCUSED ON DEVELOPING CURES. WE STRIVE TO PREVENT THE EXPOSURES TO THOSE POTENTIALLY DELATORIUS AGENTS IN ORDER TO PROMOTE PUBLIC HEALTH. SO ONE OF MY FIRST JOBS WE'VE BEEN THROUGH A COUPLE OF ROUNDS NOW AND WE'VE BEEN WORKING ON A STRATEGIC PLAN THAT WILL TAKE US THROUGH 2023. THE FIRST THEME IS ADVANCING ENVIRONMENTAL HEALTH SCIENCES AND THIS INVOLVES STUDYING HOW THE ENVIRONMENTAL EXPOSURES IMPACT ALL LEVELS OF BIOLOGICAL ORGANIZATIONS RANGING FROM THE MOLECULAR, ORGAN SYSTEMS AS WELL AS ALL STAGES ACROSS THE LIFE-SPAN. SO IT'S A LARGE THEME AND IT INVOLVES LOTS OF DIFFERENT PROJECTS AND EXPERIMENTAL APPROACHES. THE SECOND THEME IS PROMOTING TRANSLATION. DATA TO KNOWLEDGE TO ACTION. IF WE HAVE WANT TO HAVE AN IMPACT IT'S NOT JUST ABOUT EXPERIMENTS BUT TRANSLATING THIS FOR THE BENEFIT OF PUBLIC HEALTH SO THAT HEALTH PROVIDERS AND POLICY MAKERS CAN BE MAKING THE TYPES OF DE-- DECISIONS THAT ARE IMPORTANT. AND THE THIRD IS ABOUT ENHANCING THROUGH STEWARDSHIP AND SUPPORT. WE RECOGNIZE THAT OUR SUCCESS IN OUR MISSION REQUIRES THAT WE NEED TO PAY ATTENTION TO THE STEWARDSHIP OF OUR HUMAN, FINANCIAL AND INFRASTRUCTURE RESOURCES. SO STUDYING THE ENVIRONMENT IS AN ENORMOUS AND COMPLICATED TASK AND INVOLVES MANY TYPES OF EXPOSURE. TO STUDY THE CHEMICALS IN THE PRODUCTS THAT WE USE. INDUSTRIAL POLLUTANTS. PESTICIDES AND OTHER AGRICULTURE CHEMICALS THAT MAY FIND THEIR WAY INTO OUR FOOD AND WATER. COMPANIE-- COSMETICS AND SUN SCREENINGS AND CHEMICALS IN OUR WORKPLACES AND THE INFLUENCE OF LIFESTYLE FACTORS, SUCH AS NUTRITION, SMOKING AND VAPING AND STRESS. THE BOTTOM LINE IS THAT WE STUDY A VARIETY OF ENVIRONMENTAL EXPOSURES THAT CAN ULTIMATELY CONTRIBUTE TO ADVERSE HEALTH EFFECTS AND WE HAVE A BETTER UNDERSTANDING. TO MAKE THIS MORE COMPLICATED THERE IS A CONCEPTUAL SHIFT RECENTLY AND IT'S ABOUT MOVING AWAY FROM THE OLD PARADIGM OF THE DOSE MAKES THE POISON. SO WE USED TO THINK THAT WE NEEDED TO FOCUS ON THOSE ACUTE HIGH LEVEL EXPOSURES BECAUSE WE CAUSE MUTATIONS AND IN SOME CASES EVEN KILL PEOPLE SO WE FOCUSED ON THESE THINGS BUT NOW WE HAVE A MUCH BETTER UNDERSTANDING AND WE REALIZE THAT THOSE CHRONIC LOW DOSE EXPOSURES CAN ALSO IMPACT HUMAN BIOLOGY. MANY CHEMICAL AGENTS THAT WE STUDY THEY FUNCTION LIKE DRUGS AND HORMONES. A VARIETY OF CONDITIONS THAT COULD COMPROMISE HEALTH. WE DISCOVER THOSE BASIC BIOLOGICAL NETWORKS THAT DRIVE HUMAN BIOLOGY. AND THEN WE STUDY HOW THESE ENVIRONMENTAL AGENTS CAN INTERFERE TO CAUSE DISEASE, DISABILITY AND OTHER THINGS. SO NEXT SLIDE PLEASE. 7 ONE OF THE MOST IMPORTANT THINGS ABOUT STUDYING ENVIRONMENTAL EXPOSURES IS TRYING TO CORRELATE THE TIME THE EXPOS YOU ARE WITH THE HEALTH EFFECTS AND SO WE'VE DEVELOPED SOMETHING CALLED THE WINDOWS THE CONCEPT OF WINDOWS OF EXPOSURE. WE CANNOT CORRELATE THE MOST RECENT EXPOSURE TO ENVIRONMENTAL COX CAN'T THE DEVELOPMENT OF CANCER. OR ANY OTHER ADVERSE HEALTH EFFECTS. *. IN IN CASES THEY OCCUR VERY EARLY IN LIFE. DURING PREGNANCY SO WE'VE GOT TO PAY ATTENTION TO THE WINDOWS OF EXPOSURE MAKES THE STUDY MORE COMPLICATED. ANOTHER PRINCIPLES THAT IS OF GREAT INTEREST IS THE CONCEPT OF MIXTURES. WE'RE NOW RECOGNIZING THAT THE VAST MAJORITY OF THE THE WORK THAT WE DO WE NEED TO BECOME MUCH MORE SOPHISTICATED. GET AWAY FROM STUDYING JUST BENZENE OR OTHER TYPE OF CHEMICALS AND REALIZING THAT WE LIVE IN A WORLD WITH COMPLICATED EXPOSURES. ON WE'RE TRYING TO DEVELOP A MORE SOPHISTICATED FRAMEWORK WHERE WE CAN ACTUALLY FACTOR IN DIFFERENT CHEMICALS. SO DEALING WITH THE MIXTURES IT'S NOT SOMETHING THAT WE'VE SOLVED YET BUT SOMETHING THAT WE HAVE A GREAT INTEREST IN ADVANCING OUR KNOWLEDGE ABOUT. SO ANOTHER CONCEPT THAT WE STUDY AS PART OF THE STUDYING THE ENVIRONMENT IS RECOGNITION THAT THE MICROBIOME PLAYS AN IMPORTANT ROLE. LIKE IN MOST THINGS THESE DAYS. AS WE RECOGNIZE THIS IS ABOUT STUDYING THE COMPLEX POPULATIONS OF MICROORGANISMS. WE HAVE A MICROBIOME WITHIN OUR GUT AND IN OUR MOUTH AND SKIN AND OTHER PLACES AROUND OUR BODY AND THE COMPILATION IS DIFFERENT IN DIFFERENT PARTS OF THE BODY. THEY ARE IN SPECIFIC TYPES OF DISEASE OR FOR EXAMPLE OBESITY. AND WE KNOW THAT THERE ARE SPECIFIC ENVIRONMENTAL EXPOSURES THAT CAN LEAD TO CHANGES IN THE MICROBIOME. THE ENVIRONMENTAL EXPOSURE MAY BE AFFECTING THE MICROBIOME AND MAY BE TRIGGERING THE ADVERSE EFFECTS. SO OVER-ALL THE EXPOSURE FROM -- SCIENCE POINT OF VIEW -- THE INSTITUTE AND THE ENVIRONMENTAL SCIENCE INSTITUTE IS USING A MORE SOPHISTICATED FRAMEWORK. CALLED THE EXPOSOME. IT INVOLVES THE TOTALITY OF EXPOSURE. IT INCORPORATES ELEMENTS OF WINDOWS. THE TIME IN WHICH IT OCCURRED. MIXTURE. DIET. SOCIOECONOMIC STRESS AND ALL OF THE TYPES OF ENVIRONMENTAL EXPOSURES THAT CAN ULTIMATELY GIVE RISE TO ADVERSE HEALTH EFFECTS. SO NEEDLESS TO SAY YOU CAN IMAGINE THAT THE -- TOOLS FOR MEASURING INDIVIDUAL EXPOSURES AND THIS IS GOING TO BE A HUGE DATA SCIENCE MANAGEMENT PROJECT. THAT WE'RE WORKING ON NOW. SO WE'VE DONE A LOT OF WORK OVER THE LAST SEVERAL YEARS BUILDING UP OUR I.T. OF THE STRUCTURE AND MAKING SURE THAT WE HAVE THESE ROBUST I.T. TOOLS TO MANAGE THE VARIOUS DATA SOURCES COMING IN FROM ALL DIFFERENT CORNERS OF THE WORLD. SO I ALSO WANT TO GO INTO AN AREA THAT MORE DIRECTLY RELATES TO MY OWN EXPERIENCE AS A GENETICIST. ALSO INVOLVES DIFFERENTIALS SUSCEPTIBILITY TO ENVIRONMENTAL AGENTS. SO WHAT MAY BE DELL TEAR YOUR TO ONE * INDIVIDUAL MAY NOT BE BAD FOR SOMEONE ELSE. WE WORKED TOGETHER WITH MANY SISTER ITs AND THE IDEA WAS TO EXAMINE IF THERE ARE GENE VARIANTS ASSOCIATED WITH DIFFERENT EXPOSURES. TO DETERMINE IF THERE ARE VARIATIONS IN GENES. TO OTHER CHEMICALS AS WELL AS PSYCHOSOCIAL STRESS. SO OF COURSE WE'RE VERY INTERESTED IN FACTORING INTO THE EQUATION HOW HEALTH DISPARITIES FACTOR IN TO AN INDIVIDUAL'S BIOLOGY. SO A NICE ILLUSTRATION IS SHOWN HERE. ON THE LEFT YOU HAVE SOME MOUSE EXPERIMENTS AND ON THE RIGHT HUMAN EXPERIMENTS. SEVERAL OF THE INVESTIGATORS WITHIN THE COMMUNITY HAVE JOINED TOGETHER AND THEY'VE DECIDED TO EVALUATE THE TOXICITY OF COMMONLY USED OVER THE COUNTER MEDICATION. TYLENOL, ACETAMINOPHEN. THE X AXIS THOSE ARE JUST DESIGNATIONS FOR DIFFERENT STRAINS AND THE ADVANTAGE OF DOING THIS WITH MICE IS WITHIN A STRAIN EACH STRAIN IS GENETICALLY IDENTICAL SO ALL OF THEM -- WITH THE EXCEPTION OF X AND Y CHROMOSOMES ALL OF THE ANIMALS ARE TWINS. SO WHAT YOU CAN SEE IS THAT THE TOXICITY RESPONSE IS HIGHLY VARIABLE DEPENDING UPON THE GENETIC STRAIN OF THE MOUSE AND THIS IS ALL THE SAME DOSE OF ACETAMINOPHEN. IF AN ANIMAL RESPONDS TO ACETAMINOPHEN SAME DOSE AND HAS AN AD VERSE HEALTH EFFECT IT'S A FUNCTION OF THEIR GENETIC BACKGROUND. ON THE RIDE SIDE IS INDIVIDUAL HUMANS AND THEY RESPOND TO THE SAME DOSE IN DIFFERENT WAYS. THE BOTTOM LINE IS IF YOU WANTED TO UNDERSTAND THE IMPACT OF THE ENVIRONMENT IT'S NOT JUST ABOUT ESTABLISHING WHAT ARE THE THINGS THAT ARE IN THE ENVIRONMENT THAT HAVE POTENTIALLY BAD ADVERSE HEALTH EFFECTS BUT YOU NEED TO ALSO UNDERSTAND SOMETHING ABOUT THE INDIVIDUAL BIOLOGY AND IN THIS CASE STUDYING THEIR GENETICS. IT'S NOT JUST STUDYING DRUGS. MOST ARE STUDYING ENVIRONMENTAL AGENTS. THIS IS AN EXAMPLE OF DIFFERENTIAL RESPONSE TO BENZENE. A CARCINOGEN. AND ON THE Y AXIS WOULD BE THE DIFFERENT MICE AND THE CLEARANCE RATE OF BENZENE FROM THE SYSTEM IS HIGHLY VARIABLE DEPENDING UPON GENETIC BACKGROUND SO IF YOU WANT TO TRULY UNDERSTAND YOU HAVE TO FACTOR THE GENETIC BACKGROUND OF THE INDIVIDUAL INTO THE EQUATION. THE FURTHER EXPLORE THE CONCEPT -- USING HUMAN POPULATIONS NOT MICE -- NIHS IS WORKING TO INTEGRATE ENVIRONMENTAL EXPOSURES INTO THIS EMERGING GLOBAL PROGRAM CALLED THE INTERNATIONAL COMMON DISEASE ALLIANCE. SO SOME OF YOU MAY HAVE BEEN PART OF THE MEETING. IT WAS A MEETING HELD BACK IN DECEMBER OF 2019. FRANCIS COLLINS ALONG WITH ERIC LANDER. AS WELL AS KEY SCIENTISTS FROM ACROSS THE GLOBAL COMMUNITY AND THEY KICKED OFF THIS ALLIANCE. FUNDAMENTALLY THE ICDA IS ABOUT COALESCING INTERNATIONAL SUPPORT AND COLLABORATION FOR DEVELOPING THE TOOLS TO MAP GENE VARIANTS THAT ARE ASSOCIATED WITH COMPLEX TRAITS. AND THEY ARE INTERESTED IN THE TYPES OF COMPLEX TRAITS THAT UNDERLIE COMMON DISEASES LIKE DIABETES AND OBESITY. AND OF COURSE WE'RE INTERESTED IN THIS BECAUSE WE DISCOVERED THAT THERE IS NO SINGLE GENE OR GENE VARIANT. IT'S A COMPLEX STRAIGHT. IT INVOLVES MULTIPLE DIFFERENT GENES THAT ULTIMATELY CONTRIBUTE TO THE GENETIC SUSCEPTIBILITY. SEEKING TO GATHER GLOBAL COOPERATION IN VARIOUS COHORTS AROUND THE GLOBE. WE'RE WORKING TO MAKE SURE THAT THE TYPES OF EXPOSURES THAT ARE ASSOCIATED WELL HEALTH DISPARITIES ARE INCLUDED IN THE ICDA AND TO THIS END THIS APPROACH WE HOPE WILL PROVIDE THE STATISTICAL POWER TO FIND THE NETWORKS OF GENES THAT ARE ASSOCIATED WITH COMMON DISEASES ENVIRONMENTAL EXPOSURES AND HEALTH DISPARITIES. IT'S A GREAT PROMISE FOR THE FUTURE. THIS IS A SLIDE THAT JUST REMIND US ALL OF THE TYPES OF ENVIRONMENTAL EXPOSURES THAT ARE KNOWN TO GIVE RISE TO SPECIFIC DISEASE PHENOTYPES. MANY ARE ASSOCIATED WITH HEALTH DISPARITIES. SO WE KNOW THAT EXPOSURES TO AIR POLLUTION -- EXPOSURE TO HEAVY METALS LIKE LEAD AND ARRESTS ANYONE. EXPOSURE TO PESTICIDES. AND ALL OF THESE CONTRIBUTE TO DISEASE PHENOTYPES RANGING FROM DECREASED IQ, BEHAVIORAL PROBLEMS, CANCER, CARDIOVASCULAR DISEASE AND RESPIRATORY DISORDERS ALL ASSOCIATED WITH HEALTH DISPARITIES SO BY INTEGRATING ENVIRONMENTAL EXPOSURES INTO THE FRAMEWORK WE'LL HAVE AN OPPORTUNITY TO BETTER DEFINE THE INFLUENCE OF GENETICS AND ENVIRONMENT IN PREDISPOSING TO HEALTH EFFECTS. HOPEFULLY I'VE CONVINCED YOU THAT GENETICS PLAYS AN IMPORTANT ROLE. AND WE USED TO THINK THAT WE COULD TEASE OUT ALL OF THE BIOLOGICAL NETWORKS THAT DRIVE DIFFERENTIAL RESPONSES BY JUST LOOKING AT THE SEQUENCE. BY SEQUENCING THE GENOME. BUT WE'VE COME TO UNDERSTAND THAT IT'S POSSIBLE TO CHANGE THE EXPRESSION OF GENES THROUGH WHAT WE CALL EPIGENETIC MECHANISMS. THESE THAT INVOLVE SPECIFIC NUKE OHIO TIDES. -- * AND THAT THESE COULD HAVE POWERFUL IMPACTSES ON THE WAYS THAT GENES ARE EXPRESSED. I DON'T WANT TO GO INTO THE DETAILS BUT THE BOTTOM LINE IS THERE ARE CHANGES IN THE SHAPE OF DNA OR THE WAY THAT DNA IS EXPRESSED WITHIN A CELL THAT ARE INFLUENCED BY CHEMICAL EXPOSURE PSYCHOSOCIAL STRESS AND OTHER THINGS. THERE IS A GENETIC COMPONENT OF COURSE BUT ALSO A MAJOR ENVIRONMENTAL COMPONENT IN CONNECTED WITH IT IS EPIGENETICS. THIS IS ONE OF MY FAVORITE SLIDES TO ILLUSTRATE THE INFLUENCE OF EPIGENETICS. THIS IS WORK FROM MY OWN LABORATORY. SOMETHING THAT WE STARTED OVER 20 YEARS AGO AND WE'RE STILL WORK ORGANIZE IT. -- WORKING ON IT. *. IF A MOUSE LOOKS DIFFERENT AND HAS A DIFFERENT COAT COLOR IT'S PROBABLY GENETICALLY DIFFERENT. WE DISCOVERED THAT THOSE MICE THAT HAVE A TOTALLY YELLOW COAT COLOR AT ABOUT 3 MONTHS OF AGE THEY LOSE CONTROL OF THEIR APPETITE. SO THEY ARE LUNCH BUT THEIR BRAIN IS TELLING THEM I'M STARVING AND THEY BACK MASSIVELY OBESE AND TYPE II DIABETICS. SO -- THE REMARKABLE THING IS THAT THESE MICE ARE ALL GENETICALLY IDENTICAL. THEY HAVE THE SAME SET OF CHROMOSOMES. THE SAME SEQUENCE OF DNA AND WHAT WE FOUND IS THAT THERE IS A MUTATION THAT EACH ONE OF THESE MICE CARRY THAT PREDISPOSES TO THE MICE TO BECOME TOTALLY YELLOW. AND MASSIVELY OBESE AND TYPE II DIABETICS. BUT THE MICE ALL THE WAY TO THE RIGHT CARRIES THAT MUTATION BUT WE WENT ON AND DEMONSTRATED THAT THE MUTATION IS SUPPRESSED. YOU'RE NOT CHANGING THE SEQUENCE BUT IT'S EPPIE GENETIC SUPPRESSION OF THE STRAIGHT. * IS SO A LITTLE BIT COMPLICATED. WHAT MAKES THIS MODEL THAT WE'RE STUDYING THAT WE ORIGINALLY CHARACTERIZED IN THE EARLY 1990s IT WAS NOT MY LAB BUT RANDY GERALD'S LAB AT DUKE THAT DEMONSTRATED THAT WHAT WE CALL THE DOMINANCE HIERARCHY WHICH IS SHOWN ON THE TOP. ON THE LEFT ALL THE WAY TO TOTALLY YELLOW MICE TO THE RIGHT-HAND SIDE IS TOTALLY NORMAL COAT COLORED MICE AND YOU COULD INFLUENCE THE PHENOTYPE THAT ARISES IN MICE THAT CARRY THIS MUTATION BY WHAT YOU FEED MOTHERS DURING PREGNANCY. SO SPECIFICALLY IF YOU FEED MICE MOTHERS THINGS THAT HAVE WHAT WE CALL METHAL DONORS YOU CAN SHIFT THE HIERARCHY TO THE RIGHT SO YOU GET MORE MICE THAT ARE FENO TYPICALLY NORMAL SO THEY ARE NOT DEVELOPING THE YELLOW COAT COLOR AND THE OBESITY AND TYPE II DIABETES. THERE ARE OTHER TYPES OF CHEMICALS THAT IF YOU TREAT MOTHERS WITH VERY LOW DOSE YOU CAN SHIFT THE HIERARCHY TO THE LEFT. WE DID AN EXPERIMENT CALLED WITH A PESTICIDE A NATURALLY OCCURRING PESTICIDE CALLED ROTONONE. I CAN GIVE YOU MORE OF THE RATIONAL OF WHY WE DID THAT EXPERIMENT. WE DEMONSTRATED THERE ARE A GREATER NUMBER OF FULLY YELLOW MICE THAT ARE BORN FROM MOTHERS THAT ARE TREATED WITH A VERY LOW CONCENTRATION. THE PESTICIDE TREATMENT CAN INFLUENCE THE EPIGENETIC STATUS OF THIS GENE THIS MUTATION ON THE GENOME OF THESE ANIMALS. SO THIS IS A VERY BUSY SLIDE. I'M GOING TO TALK YOU THROUGH THIS AND I KNOW THAT YOU'RE NOT MO-- MOLECULAR GENETICIST. WE WENT ON TO ANALYZE THE GENOMES. WE CAN LOOK AT EVERY SINGLE NUCLEI AND WE'RE LOOKING FOR EPIGENETIC MARKS AND HOW THESE CHANGE OVER THE COURSE OF DEVELOPMENT. OVER HERE ON THIS DOSE WE ANALYZED THE ANIMALS AT WEANING WHICH HAPPENS AT DAY 22 AT 6 MONTHS AND 18 MONTHS AND YOU CAN SEE HERE THERE ARE CLUSTERS. EACH ONE OF THESE SLOTS THIS IS SOMETHING THAT WE CALL A HEAT MAP. BUT EACH SLOT REPRESENTS A REGION OF THE GENOME. A SPECIFIC NUCLEI. IF IT'S YELLOW IT'S EPPIE GWINNETT CALLIC FREE. IF IT'S BLUE IT'S MODIFIED. * SO YOU CAN SEE THAT ARE CHANGES OVER THE COURSE OF TIME FROM 6-12-18 MONTHS. CERTAIN REGIONS THAT CHANGE BETWEEN 12-18 MONTHS AND IF YOU'RE NOT AWARE OF THIS AN 18-MONTH-OLD MOUSE IS A VERY OLD MOUSE. SO, ITS APPROACHING THE ENTIRE LIFE-SPAN SO THERE ARE LOTS OF DIFFERENT THINGS SO THE EPPIE GENOME IS VERY * DYNAMIC. HERE WE ARE. 10 PARTS PER MILLION TREATMENT WITH THIS PESTICIDE DURING DEVELOPMENT AFFECTS A WHOLE CLUSTER OF THESE GENE REGIONS BETWEEN 6-12 MONTHS. THIS WAS AN EXPOSURE THAT HAPPENED DURING PREGNANCY SO THE OFFSPRING THAT ARISE HAVE THESE CHANGES IN THEIR EPPIE GENOMES. * I'M GOING TO MOVE ALONG. THE BOTTOM LINE IS AND YOU CAN SEE COMPARING THE ZERO PARTS PER MILLION THERE ARE ALL OF THESE REGIONS THAT ARE EPPIE GENETICALLY CHANGED AT THE DIFFERENT AGES EVEN THOUGH THE EXPOSURE OCCURRED DURING PREGNANCY. SO THIS GETS BACK TO THE WINDOWS OF EXPOSURE CONCEPT. SO IF YOU'RE LOOKING AT THE EXPOSURE TO DIFFERENT ENVIRONMENTAL FO FOX CANS YOU'VE GOT TO PAY ATTENTION TO THE TIMING. -- A WONDERFUL PAPER ON THE EPPIE GENOME AS A BIOSENSOR OF THE SOCIAL, PHYSICAL AND CHEMICAL CONTRIBUTORS TO ENVIRONMENTAL JUSTICE. PSYCHOSOCIAL STRESS CAN INFLUENCE THE EPPIE GENOME. * SO, ITS CLEAR EVIDENCE THAT THE SOCIAL AND PHYSICAL AND CHEMICAL IMPACTS CAN IMPACT THE EPPIE GENOME. SO THIS IS A WONDERFUL ARTICLE. IF YOU'RE INTERESTED IN CONNECTING TO EPIGENETIC CHANGES IT'S A WONDERFUL STARTING POINT. I WANT TO MOVE ON NOW TO THINGS THAT ARE LESS MOLECULAR BUT MORE DIRECTLY RELATED TO THE ISSUES OF HEALTH DISPARITIES. NIHS HAS BEEN GRAPPLING WITH THE ISSUES THAT WE CALL ENVIRONMENTAL JUSTICE FOR MANY YEARS. WE'VE COME TO RECOGNIZE THAT THERE ARE DIFFERENTIAL IMPACTS FROM EXPOSURES TO PESTICIDES AND INDUSTRIAL CHEMICALS AND AIR POLLUTIONS AND THESE ARE BASED ON THE SOCIAL, POLITICAL AND ECONOMIC FACTORS THAT PLAY A ROLE IN CREATING HEALTH DISPARITIES. THIS IS A FIGURE FROM THE COVER OF THE 1987 UNITED CHURCH OF CHRIST COMMISSION FOR RACIAL JUSTICE. A REPORT STATED THAT RACE IS A MAJOR FACTOR OF THE PRECEDENCE OF HAZARDOUS WASTE. RACE PROVED TO BE A MORE SIGNIFICANT COMPONENT. IN MUCH THE SAME WAY AND HOPEFULLY I'VE CONVINCED YOU THAT THERE ARE CHEMICAL EXPOSURES THAT CAN INFLUENCE THESE THINGS. THE ENVIRONMENTAL HEALTH SCIENCE COMMUNITY IS NOW BEGINNING TO APPRECIATE THAT RACISM CAN BE CONSIDERED A TOXIN AS WELL. THIS IS A TOPIC THAT CAME UP IN FEBRUARY. SO WE RECOGNIZED THAT THE SOCIAL STRUCTURES THAT ARE BASED ON RACE DETERMINE DIFFERENTIAL ACCESS TO OPPORTUNITIES. RISKS AND RESOURCES THAT DRIVE HEALTH. DISCRIMINATION HAS BEEN LINKED TO ADVERSE MENTAL AND -- HEALTH OUTCOMES. I DON'T THINK I NEED TO CONVINCE THIS GROUP OF THAT. SEGREGATED AREAS WHICH LACK QUALITY SCHOOLS, GOOD JOBS AND HEALTH CARE AND TRANSPORTATION, AND CLEAN ENVIRONMENT. THESE ARE ALL DRIVERS FOR RACIAL HEALTH DISPARITIES AND THE PHYSICAL AND SOCIAL CONDITIONS THAT CHARACTERIZE THIS LEAD TO ELEVATED EXPOSURE TO CHEMICALS AND PSYCHOSOCIAL STRESSORS. NIHS HAS BEEN WORKING WITH NIMHD TO STUDY THE IMPACT OF THE ENVIRONMENT AM -- ENVIRONMENTAL EXPOSURES TO UNDERSTAND THEM. JUST ONE EXAMPLE OF WHAT WE'RE UP AGAINST AND I APOLOGIZE THE LETTERS ARE SMALL. THIS IS A PLOT SHOWING THE DIFFERENCE. INDEPENDENT OF INCOME. SO WHAT YOU CAN SEE THE EXPOS USUAL TO FALL IT'S -- * THE CONTAMINANTS IN PLASTICS. IT'S 122% HIGHER IN NONHISPANIC BLACK CHILDREN. THE DIAGRAM ALSO SHOWS THAT NONWHITE AND RACIAL WOMEN HAVE THE HIGHEST LEVELS OF TOXIC METALS AND NONHISPANIC AND THESE WERE CONSISTENT ACROSS ALL AGE GROUPS SO. HOUSTON WE'VE GOT A PROBLEM. ANOTHER EXAMPLE THAT * SHOWS HEALTH DISPARITIES THAT AFFECTS ESPECIALLY PEOPLE OF COLOR IN THE UNITED STATES AND THE DISPROPORTIONATE EXPOSURE TO AIR POLLUTION THAT IS WHAT THIS SLIDE IS ALL ABOUT. YOU MIGHT HAVE READ ABOUT THIS IN THE "NEW YORK TIMES." IT WAS SUPPORTED AND INDICATED THAT ALL MAJOR PARTICULATE MATTER DISPROPORTIONATELY AFFECT PEOPLE OF COLOR AND SPECIFICALLY INVOLVED OVER 5,000 EMISSION SOURCES INVOLVING 14 SOURCE SECTORS FROM INDUSTRIAL SOURCES LIKE POWER PLANTS. SO ACCORDING TO THE INVESTIGATORS THIS EFFECT IS SYSTEMIC AND APPLIES TO ALL MAJOR EXPOSURE SECTORS AND ACROSS STATES, AND INCOME LEVELS AND DEGREES OF EXPOSURE. BECAUSE OF THE LEGACY OF THE POLICY THESE ETHNIC AND RACIAL DISPARITIES HAVE PERSISTED EVEN AS OVER-ALL EXPOSURE HAS DECREASED SO WE HOPE THAT BY FUNDING STUDIES LIKE THIS OR THESE STUDIES WILL HELP TO GUIDE NATIONAL AND LOCAL STAKEHOLDERS FOR POLICIES. ANOTHER EXAMPLE OF AIR POLLUTIONS AND HOW IT AFFECTS PEOPLE OF COLOR IS BASED ON AND YOU'RE SHOWING THE DATA HERE IS BASED ON WORK JOINTLY FUNDED AS PART OF OUR CENTER OF CONVENIENCE ON ENVIRONMENTAL HEALTH DISPARITIES. SO SPECIFICALLY THE STUDY INVOLVES TOOLS THAT WERE DEVELOPED TO ANALYZE THE SPATIAL AND TEMPORAL SHIFTS IN AIR POLLUTION ACROSS THE STATE OF MASSACHUSETTS. WHILE THEY DECREASED OVER AN 8 YEAR PERIOD THIS EXPOSURE DISPARITIES BY RACE AND ETHNICITY ACTUALLY INCREASED. DISPARITIES WERE MORE PRONOUNCED IN URBAN VERSUS RURAL AREAS AND THEY WERE MAGNIFIED WHEN THE RATES WERE FACTORED IN. LET ME GO ON NOW AND LET ME SKIP TIME I'M SAME LOOKING AT THE TIME SO LET ME SKIP OVER TO THE NEXT SLIDE. THIS IS A QUICK COMMENT I'M GOING TO MAKE. AND SO WE STUDIED NOT ONLY THE THINGS IN THE ENVIRONMENT, THE GENETICS AND LOOKING AT THE IMPACT OF DIFFERENT ENVIRONMENTAL EXPOSURES AND VARIOUS COMMUNITIES BUT WE ALSO WANT TO ADDRESS THE FACTORS THAT ARE -- NADA DRESSING THE FACTORS THAT DRIVE HEALTH DISPARITIES WE ALSO WANT TO BE PARTNERING WITH COMMUNITIES TO BETTER ADDRESS WHAT TO DO ABOUT THESE SELF-DISPARITIES. THERE WAS A TALK ABOUT ONE OF OUR GRANTEES DR. KOBE WILSON. THE OUTCRY FOR SOCIAL RACIAL AND ENVIRONMENTAL JUSTICE. CAN SCIENCE AND COMMUNITY ENGAGED RESEARCH ANSWER THE CALL? HE HIGHLIGHTED A NUMBER OF IMPORTANT THINGS. COMMUNITY MEMBERS ARE THE SUBJECT MATTER EXPRESSE EX-- EXPERTS AND WE PLEAD TO LISTEN TO WHAT THEY SAY. ALSO PRESSING FOR THE CASE THAT WE NEED TO NOVEMBER BEYOND DOCUMENTING OUR FINDINGS TO TAKING OUR SCIENCE AND PUTTING IT TO ACTION. HE IS SAYING THAT SCIENTIFIC DISCOVERY IS GREAT BUT IT NEEDS TO BE COUPLED WITH ACTION. EMPOWERMENT. HOPING THAT BY BRINGING OUR SCIENCE FORWARD WE CAN ENCOURAGE PEOPLE WITHIN COMMUNITIES TO GET ACTION RESOURCES AND TAKE ACTION. SO LET'S GO TO THE NEXT SLIDE. JUST AS AN EXAMPLE WE TRY TO WORK WITH TRIBAL COMMUNITIES AND WE ALSO TRY TO EMBRACE THEIR CULTURAL NORMS AND THEIR SOCIAL SUPPORT SYSTEMS IN A WAY THAT IS CONSISTENT WITH TRIBAL ECOLOGICAL KNOWLEDGE. TEK INVOLVES TRADITIONAL KNOWLEDGE TRANSMITTED THROUGH THE GENERATION. ALSO BELIEFS ABOUT HOW TRIBAL COMMUNITIES FIT INTO THEIR ECOSYSTEMS. I'M SHOWING THE WORK THAT WE SUPPORTED AT THE MEDICAL COLLEGE OF WISCONSIN TO DEVELOP AND TEST A MOBILE APP DESIGNED TO COMMUNICATE FISH CONSUMPTION ADVICE. THIS APP IS BASED ON DATA FROM THE AUTHORITY AND IT'S ABOUT THE CONTAMINANTS THAT OCCUR WITHIN THE FISHERIES USED BY NATIVE AMERICAN TRIBES SO THE APP COMBINES DATA TO PROVIDE PERSONALIZED FISH CONSUMPTION -- ADVICE. TO MAKE HEALTHY DECISIONS ABOUT WHAT TYPE OF FISH THEY CAN BE EATING TO MINE MYSELF THE CONSUMPTION OF SOME OF THE ENVIRONMENTAL TO BE CANTS. TOXICANTS. WE'RE TALKING ABOUT COMMUNITY-BASED INTERVENTION SO WE ON THE PREVIOUS SLIDE LOOKING AT NUTRITIONAL IMPACTS. AND VARIOUS FRUITS AND VEGETABLES CAN BE IMPACTING THE QUALITY OF HEALTH. THIS IS A GREAT EXAMPLE SO OUR COMMUNITY-BASED INTERVENTION IS SUPPORTING WHAT WE CALL THE GREEN HEART STUDY AT THE UNIVERSITY OF LOUISVILLE. THIS WORK WILL ASSESS WHETHER INCREASING RESIDENTIAL VEGETATION IMPROVES HEALTH OUTCOMES IN THE LOUISVILLE AREA. THE WORK PROPOSES TO TAKE BASELINE MEASUREMENTS, MEASURES STRESS LEVELS AS WELL AS THE STRENGTH OF SOCIAL TIES IN ABOUT 800 PARTICIPANTS. AND THEY WILL TAKE -- EVALUATE POLLUTION LEVELS AT THE SAME TIME. THEN THEY PLAN TO GET IN THERE AND PLANT THOUSANDS OF TREES AND PLANTS AND SHRUBS THROUGHOUT THE NEIGHBORHOODS AND THE PARTICIPANTS WILL RECEIVE ANNUAL CHECK UPS TO EVALUATE HOW GREENERY HAS AFFECTED THEIR HEALTH AS WELL AS SOCIAL TIES. THE STUDY SAYS IT ALL. IT'S SHOWN HERE ON THE LO -- I THINK I'M OUT OF TIME HERE AND I WANT TO MAKE SURE THERE IS PLENTY OF TIME TO ASK QUESTIONS. SO I'M GOING TO GO OVER AND I'M NOT GOING TO COVER SOME OF THE WORK THAT WE DO ON CLIMATE CHANGE AND HEALTH AND A FEW OTHER THINGS. BUT LET ME STOP AT THIS POINT. AND WE CAN OPEN IT UP FOR ANY AND ALL QUESTIONS. OUR DEPUTY DIRECTOR GWEN COLEMAN IS WAITING IN THE WINGS SO IF THERE ARE QUESTIONS WE WOULD BE HAPPY TO ADDRESS ANYTHING ANY QUESTIONS YOU MIGHT HAVE. >> THANK YOU VERY MUCH, RICK. THAT WAS GREAT. JUST ONE COMMENT. I THINK EARLY YOU ON SAID SOMETHING ABOUT THE PARADIGM OF CHRONIC LOW DOSE EXPOSURES MATTER. I THINK THERE IS A LOT OF PARALLEL TO CHRONIC STRESS AND THE EXPOSURE TO DISCRIMINATION AND RACISM AS CHRONIC LOW DOSE MATTERS OVER TIME AND THAT YOU DON'T SEE THE EFFECTS FOR DECADES SOMETIMES. SO THANK YOU VERY MUCH FOR THAT. >> AND THAT IS REALLY AN IMPORTANT POINT. THERE HAS BEEN THIS PARADIGM OR SHIFT IN OUR THINKING THAT BEFORE IT USED TO BE SO SIMPLE. PAY ATTENTION TO THOSE RECENT HIGH LEVEL EXPOSURE THINGS BUT NOW WE REALIZE THAT THOSE LOW LEVEL CHRONIC EXPOSURES IT AFFECTS OUR BIOLOGY PROBABLY THROUGH SOME EPIGENETIC MECHANISMS. OTHER COMMENTS OR QUESTIONS? >> DR. -- I WAS FASCINATED AND EXCITED BECAUSE OF THE INFORMATION THAT YOU PRESENTED REGARDING EPIGENETICS AND WE PARTICULARLY HAVE BEEN INTERESTED IN THE ROLE OF MOTHER PRENATAL STRESS AND OUTCOMES. MAYBE I MISSED SOME OF THE OPPORTUNITIES BUT I THINK WE NEED MORE OPPORTUNITIES OF -- INVOLVING THE STUDY OF PRENATAL PARTICIPANTS AND MAYBE HAVING INTERVENTIONS AND LOOKING AT IF AN OUTCOME -- CERTAINLY SOME OF THE OUTCOMES ARE LATER IN LIFE-LIKE CARDIOVASCULAR DISEASE BUT CERTAINLY BECAUSE WE HAVE SO MANY ENVIRONMENT AM EVENTS NOT TO SAY DISASTERS LIKE EARTHQUAKES, FLOODS THAT REMIND ME OF THE PROJECT THE ICE STORM. AND MAYBE WE SHOULD FOCUS ON THAT AREA AS PART OF IT. >> WE HAVE ABSOLUTELY NEED TO BE FOCUSING ON THESE EARLY DEVELOPMENTAL EXPOSERS. WE ARE. 7 *. IT'S A BROAD PART OF OUR PORTFOLIO. AND I SEE -- -- GWEN IS RIGHT IN THE MIDDLE. YOU WANT TO MAKE A FEW COMMENTS. AND I ALSO WANT TO MAKE ANOTHER COMMENT. >> HI, EVERYONE AND THANKS FOR ALLOWING ME TO BE HERE TODAY. WE'VE HAD 20 YEAR PARTNERSHIPS WITH THE USPA. DEVELOPING RESOURCES AND SCIENCE AND WITH THAT WE HAVE FOLLOWED PROBABLY 25 PLUS BIRTH COHORTS WHERE THERE IS VERY WELL CHARACTERIZED THE THREE TRIMESTERS OF PREGNANCY AND WE'VE LEARNED ABOUT BODY BURDEN AND FOLLOWING THE CHILDREN UP TO AGE 21 AND THE NIH HAS PIVOTS INTO THE PROGRAM ECHO WHICH IS ALSO ABOUT 84 STUDIES OF YOUNG CHILDREN BIRTH COHORTS AND NOW WE'RE DOCUMENT CAN THE EARLY LIFE EXPOSURES AS THE BACKBONE OF THAT PARTICULAR PROGRAM. WE'VE ALSO RECENTLY STARTED TO STUDY THE ENVIRONMENTAL EFFECTS ON PLACENTA AND WE'RE EXCITED THAT THE AMERICAN COLLEGE OF OBSTETRICS AND AGAIN OH COME GEE HAS A PAPER SHOWING THAT IT'S QUITE IMPORTANT TO STUDY *. >> PSYCHOSOCIAL STRESS AND STARVATION WAS -- THERE WERE STUDIES THAT DEMONSTRATED THAT STARVATION DURING PREGNANCY CAN INFLUENCE HOW GENES ARE FUNCTIONING LATER IN LIFE. SOME ARE TRANS GENERATIONAL. IT'S THE OFFSPRING FROM THE MOTHERS THAT ARE AFFECTED BUT THEIR OFFSPRING IS AFFECTED AS WELL. REMEMBER IT'S SOME OF THOSE LITTLE BOXES IN THE DIAGRAMS. THERE ARE THINGS THAT ARE HAPPENING AT 12-18 MONTHS OF AGE IN A VERY OLD MOUSE THAT ARE CHANGED AS A CONSEQUENCE THE EXPOS US THAT HAPPENED DURING PREGNANCY SO THAT WAS A REALLY OPENER TO LOOK AT SOME OF THE MOLECULAR MECHANISMS AND THE GENES THAT ARE MISFIRING AS A CONSEQUENCE OF THE ENVIRONMENTAL EXPOSURES SO WE'VE GOT A LOT TO LEARN AND IT'S NOT JUST CHEMICALS. THERE IS STRONG EVIDENCE THAT PSYCHOSOCIAL STRESS UNTIL HEALTH DISPARITIES CAN BE INFLUENCING THOSE EPIGENETIC MARKS THAT CAN CHANGE HOW GENES ARE BEING EXPRESSED. DOES THAT ANSWER YOUR QUESTION? >> YES AND I WOULD ALSO LIKE TO ADD TO THAT NOT ONLY -- IF WE STOP -- EXPLAINING WHY THINGS HAPPENING BECAUSE OF PRENATAL EXPOSURE. A THAT DOESN'T GIVE MUCH HOPE TO PEOPLE BUT WHEN YOU MENTION THINGS THAT YOU CAN MODIFY IN DIET AND MODIFY IN LIFESTYLE THAT MIGHT ACTUALLY IMPACT ON THE EPIGENETICS THEN THERE IS HOPE. YOU'RE NOT JUST WHO YOU ARE BECAUSE OF WHO YOU WERE BORN OUT OF BUT YOU CAN MAKE CHANGES. >> THE GOOD NEWS IS THAT IT'S NOT LIKE YOU ARE MUTATING THE DNA. YOU'RE NOT CHANGING THE BASIC SEQUENCE. THESE EPIGENETIC MARKS ARE POTENTIALLY REVERSIBLE. SO EAT YOUR POLLY PHONE ALSO AND ENJOY THE FRUITS AND VEGETABLES AT DINNER TONIGHT. *. >> GOOD AFTERNOON. I ENJOYED THE TALK. IT WAS VERY GOOD. AND I CERTAINLY APPRECIATE YOUR COMMENT -- ABOUT STRUCTURAL RACISM BEING CONSIDERED AS AN ENVIRONMENTAL TOXIN WHICH I FIND THAT INTERESTING. I WAS NOT THAT SURPRISED BY THAT. BUT LET ME ASK YOU THIS. CAN YOU COMMENT ON HOW THAT CAN BE ISOLATED AND QUANTITATED TO MEASURE THE DIRECT IMPACT OF STRUCTURAL RACISM CONTRIBUTION TO ENVIRONMENTAL DISPARITIES? >> IT'S A VERY INTERESTING QUESTION. THE LAST MINUTE I INSERTED THANKS, TOM FOR INCERTIFICATING THAT EXTRA SLIDE FROM KEN AND IF YOU WANT THE REFERENCE JUST SEND ME AN E-MAIL AND I'LL GET IT TO YOU. TAKE A LOOK. KEN WAS THE DIRECTOR OF NIHS. ABOUT 20 YEARS AGO. >> 1991. >> A TERRIFIC DIRECTOR. HE PUBLISHED THIS ARTICLE TO TRY TO BETTER UNDERSTAND THE EPIGENETIC CONSEQUENCES OF STRUCTURAL RACISM AND HEALTH DISPARITIES. SO IF THERE ARE GOING TO BE CHANGES IN YOUR HEALTH AND YOUR DISEASE SUSCEPTIBILITY IT MEANS THAT YOUR GENES HAVE BEEN EXPRESSING DIFFERENTLY. NASA WHERE WHEN THE RUBBER MEETS THE ROAD THAT MEANS THERE ARE CHANGES IN THE NUCLEUS OF CELLS THAT ARE EXPRESSING GENES IN DIFFERENT WAYS. HIS PROPOSAL WAS WE CAN MEASURE THE EPIGENETIC CONSEQUENCES OF EXPOSURE TO AIR POLLUTION AND VARIOUS PESTICIDES OR FLAME RETARDANTS OR VARIOUS THINGS BUT YOU CAN GO IN NOW AND DO AN EPIGENOME ANALYSIS SIMILAR TO THE HEAT DIAGRAM THAT I SHOWED YOU. NOW YOU CAN BEGIN TO UNDERSTAND WHICH REGIONS OF THE CHROMOSOMES IN THE GENOME ARE IMPACTED BY PSYCHOSOCIAL STRESS AND YOU CAN USE OTHER POWERFUL TOOLS TO BETTER UNDERSTAND WHICH GENES ARE MISS EXPRESSED AS A CONSEQUENCE OF THAT AND THAT CAN NOW START GETTING TO THE FUNDAMENTAL MOLECULAR IDEOLOGY. THERE ARE CERTAIN GENES THAT ARE UP REGULATED OR DOWN REGULATED IT MAY GIVE US A BETTER UNDERSTANDING OF POTENTIAL DRUG TARGETS OR WAYS TO GO IN AND INTERVENE MEDICALLY AND DOES THAT ANSWER YOUR QUESTION. >> YES. THANK YOU VERY MUCH. IF YOU NEED THE REFERENCE JUST DROP ME AN E-MAIL. 7. >> KEN WAS AT HARVARD SO I KNOW HIM PRETTY WELL ACTUALLY. >> KEN IS TERRIFIC. WE HAVE A SPECIAL HONORARY LECTURE EVERY YEAR IN KEN'S HONOR SO THAT WOULD BE COMING UP IN SEPTEMBER SO KEEP POSTED. HE GAVE THE INAUGURAL LECTURE. >> OTHER QUESTIONS? >> DR. EMILY RAMIREZ. >> THANK YOU VERY MUCH FOR A WONDERFUL PRESENTATION. WE FIND THAT WE HAVE HIRE LIVER CANCER RATES IN SOUTH TEXAS COMPARED TO THE REST OF TEXAS IN OUR HISPANIC POPULATIONS. SO IN TERMS OF THIS PREPLATE ALEX POSER IS THAT SOMETHING THAT WILL SHOW UP LATER IN TIME OR HOW QUICKLY WILL YOU BE ABLE TO PICK THAT UP? >> IT'S DIFFERENT REGIONS OF THE GENOME ARE GOING TO BE -- DIFFERENTIAL EFFECTS WITH DIFFERENT CHEMICALS. SO WE'RE HOPING THAT FOR ANY GIVEN THEM E CHEMICAL OR COMBINATION WE CAN GET A SENSE OF THE GENOMIC SIGNATURE OF WHAT THAT EXPOSURE MEANS AND THEN ONCE WE HAVE THAT LIKE WHAT I WAS REFERRING TO WITH DR. SUTHERLAND -- * WE CAN GO IN AND PROBE AROUND. THERE MIGHT BE A GENE THAT BECOMES UP REGULATED IN THESE CELLS AS A CONSEQUENCE OF THE ENVIRONMENTAL EXPOSURES. SO IT ALLOWS US TO START GETTING AT THE MOLECULAR MECHANISMS. WHAT ARE THE GENES THAT ARE NOW MISBEHAVING WITHIN DIFFERENT CELLS THAT ARE PREDE DID I POSING TO LIVER CANCER. >> NORMALLY LIVER CANCER IS DIAGNOSED AT A FAIRLY LATE OF STAGE SO I DIDN'T KNOW HOW LONG THAT EXPOSURE THAT OCCURRED IN PREPRESENT NATE TALL STAGE HOW FAR OUT IT COULD BE DETECTED. >> KEEP IN MIND AGAIN -- THAT HEAT DIAGRAM. THERE ARE CHANGES IN THE WAY THE GENOME WORKS AND THE GENES THAT ARE BEING EXPRESSED AT 18 MONTHS OF AGE WHICH FOR A MOUSE IS THE EQUIVALENT HUMAN IS GETTING WAY UP THERE IN AGE SO THERE ARE CHANGES IN THE WAY JEANS WORK AT THAT AGE -- GENES WORK -- AT THAT AGE. IT'S ALL OVER THE PLACE. * IF YOU'RE INTERESTED IN THIS GIVE ME A CALL. DIFFERENT REGIONS OF THE GENOME WITH DIFFERENT CHEMICAL AGENTS AND PSYCHOSOCIAL STRESS. MANY ARE STRESS RESPONSE GENES -- GENES THAT ARE DIFFERENTIALLY ESPECIALLY GET NEAT CALLLY MODIFIED. * ELEGANT EXPERIMENTS. EVERY NOW AND AGAIN YOU HAVE A RAT MOTHER THAT DOESN'T TAKE CARE OF HER PUPS VERY WELL. NORMALLY RATS LICK THEIR PUPS AND THEY WILL BE SUCKING ON THE MA'AM MAURY GRAND AND EVER EVERYONE WILL BE NICE AND HAPPY. BUT * OCCASIONALLY YOU HAVE MOTHERS WHERE THE PUPS ARE SCATTERED AROUND THE CAGE AND THEY DISCOVERED THEIR STRESS RESPONSE GENES ARE NOT WORKING PROPERLY SO THESE ANIMALS HAVE LOST THEIR CAPACITY TO RESPOND TO STRESS. AS YOU CAN TELL I STUDY A LOT OF EPIGENETICS SO YOU'RE ASKING ALL OF THE RIGHT QUESTIONS. >> THANK YOU VERY MUCH. APPRECIATE IT. >> OTHER QUESTIONS? >> THIS IS JUDITH LONG. I HAD A QUESTION. I'M SORRY I'M NOT ON CAMERA BUT I'M HAVING BAND WIDTH ISSUE. I THINK WE HAVE TO UNDERSTAND IT -- BUT I AM A LITTLE WORRIED ABOUT MEDICAL LIESING RACISM * STRUCTURAL RACISM AND EVEN YOU SAID WE COULD FIND A PILL FOR IT. I DON'T THINK THE ANSWER IS THAT WE TREAT -- THE PERSON IS SICK FROM RACISM AND NOW THE TREATMENT IS A PILL. AND I JUST THINK THERE HAS BEEN A REAL HISTORY A DANGEROUS HISTORY OF MEDICAL LIESING DIFFERENCES BETWEEN RACES AND ETHNICITIES. IT IS FASCINATING AND IMPORTANT TO UNDERSTAND HOW RACISM AND STRUCTURAL RACISM GETS UNDER PEOPLE'S SKIN BUT I'M WORRIED BUT THE POTENTIAL SLIPPERY SLOPE FOR THE MEDICAL SITUATION OF IT. * WE HAVE TO ADDRESS THE UPSTREAM OF IT. NOT THE DOWNSTREAM CONSEQUENCE. SO I WANTED TO RAISE THAT BECAUSE I KNOW IT'S FASCINATING AND EVERYBODY IS TALKING ABOUT HOW DO THESE THINGS GET UNDER PEOPLE'S SKIN BUT WE HAVE TO BE CAREFUL ABOUT HOW WE THINK OF THESE THINGS. >> I'M SO PLEASED YOU ASKED THIS QUESTION WHICH GIVE ME AN OPPORTUNITY TO CLARIFY MY POSITION. IF I CAME ACROSS THAT WAY LET ME CORRECT THAT. I'M NOT SAYING THERE IS A DRUG FOR EVERY -- PHYSIOLOGICAL RESPONSE. DRUGS ARE NOT THE ANSWER. BY ANALYZING THE GENOMES WE CAN GET A BETTER SENSE OF WHAT ARE THE MAKE NEWSIC THINGS THAT ARE MISBEHAVING * OR OTHER ENVIRONMENT AM PERSON PET SITUATIONS. * WE SPONSORED WORK TO GO AHEAD AND PLANT TREES AND SHRUBS AND ENRICH THE GREEN ENVIRONMENT IN WHICH PEOPLE LIVE. WE SPONSOR OTHER EXPERIMENTS TO LOOK AT NUTRITIONAL INTERVENTIONS. SO IT MAY NOT BE A DRUG. IT MAY BE YOGA. IT MAY BE MEDITATION. IT MAY BE OTHER INTERVENTIONS THAT CAN ULTIMATELY IMPROVE THE QUALITY OF HEALTH. I'M GLAD YOU ASKED THAT QUESTION AND I DON'T WANT ANYONE TO THINK I'M THE TYPE OF PERSON THAT IS GOING TO ADVOCATE PEDALING A PHARMACEUTICAL. JUDITH, DOES THAT CLARIFY THINGS FOR YOU? >> YEAH. I THINK WE NEED TO KEEP THIS FOREFRONT IN THE CONVERSATION ABOUT EPIGENETICS. 7 I WORRY THAT YOGA IS LIKE A DRUG. IT'S MORE ABOUT ADDRESSING THE UPSTREAMS. IT'S ABOUT ADDRESSING THE STRESSORS THAT WE HAVE IN OUR SOCIETY THAT ARE CAUSING THESE -- OR WHATEVER IT IS. MORE THAN CHANGING THE ENVIRONMENT. CHANGING THE SOCIETY SO I THINK GIVEN OUR HISTORY AND OUR COUNTRY WE NEED TO BE CAREFUL ABOUT THESE DISCUSSIONS AND THINKING ABOUT IT. LIKE -- BUT I APPRECIATE THE CLARIFICATION. THANK YOU. >> AND AGAIN JUST CLARIFYING. IT'S A MULTI-FACETED IDEOLOGY AND WE HAVE TO PAY ATTENTION TO ALL OF THE DIFFERENT VARIABLES. OUR MISSION VISION STATEMENT IS ABOUT PREVENTION PENNSYLVANIA IF WE CAN GET IN THERE WE CAN * IDENTIFY SOME OF THE TRIGGERS THAT ARE CAUSING ADVERSE HEALTH EFFECTS. LET'S TREAT IT AT THE BEGINNING. AND UNDERSTANDING THIS THROUGHOUT THE ENTIRE LIFE COURSE. >> I WANT TO THANK RICK. THERE IS ONE MORE QUESTION FROM DR. BARNES AND THEN WE SHOULD MOVE ON. >> DR. BARNES. >> THANK YOU FOR YOUR PRESENTATION. A FOLLOW-UP ON JUDITH'S QUESTION. I STUDY ALZHEIMER'S AND VERY INTERESTED IN THE EXPOSOME. AS YOU KNOW PEOPLE OF COLOR ARE NOT REPRESENTED IN STUDIES OF GETICS AND EPIGENETICS. SO THE DANGER IN THIS FIELD IS THAT WE WILL REDUCE HEALTH DISPARITIES TO GENETIC DIFFERENCES. HOW IS YOUR INSTITUTE GOING ABOUT DIVERSIFYING EITHER GRANTEES OR THE WORKFORCE SO THAT WE CAN MITIGATE THAT POTENTIAL? >> WELL THAT IS A GREAT QUESTION. WHERE CAN I START ON THAT ONE? THE SHORT ANSWER IS THAT IS WE ARE SENSITIVE TO THE GENETIC VARIABILITY. AND WHETHER IT'S IN MOUSE STUDIES. REMEMBER THE MOUSE STUDIES I SHOWED YOU USING ANY ONE STRAIN OF MOUSE GIVES YOU A ONE DATA POINT BUT YOU HAVE TO LOOK ACROSS THE ENTIRE GENETIC SPECTRUM TO GET A BETTER SENSE OF WHETHER A GIVEN DRUG OR ENVIRONMENT AMEX POSTER IS DELATORIUS. THIS IS A BIG FOCUS. WE'VE GOT TO GET OUR HEAD OUT OF THE SAND AND LOOK AT THE RACIAL DISTRIBUTION WITHIN THE COHORTS THAT WE'RE COLLECTING. THERE'S A LOT OF INTEREST IN MOVING INTO AFRICA AND JUST ABSOLUTELY MAKING SURE THAT WE HAVE A BROAD BASED GENETIC DIVERSITY IN OUR STUDIES BUT IT GOES BEYOND. IT GOES INTO RACIAL DISPARITIES. AND SO JUST LOOKING AT DIVERSE POPULATIONS OF INDIVIDUALS. BECAUSE WE'RE GOING FOR GET ANSWERS THAT ARE NOT GOING TO ADDRESS REAL WORLD SITUATIONS IF WE CONCENTRATE JUST TO LOOKING AT EUROPEAN CAUCASIANS WHICH UNFORTUNATELY THERE IS A LOT OF HISTORY OF FOCUSING ON THAT BUT LET ME ASSURE YOU ESPECIALLY AS I REFER TO THIS ALLIANCE THERE ARE MAJOR DISCUSSIONS NOW ABOUT INCREASING THE DIVERSITY WITHIN THOSE POPULATIONS AND THEN WHAT WE'RE BRINGING TO THIS IS WE'VE GOT TO GET THEM OFF CENTER AND PAY ATTENTION TO SOME OF THE ENVIRONMENTAL EXPOSURES AND OTHER THINGS THAT ARE ULTIMATELY AFFECTING THE PREDISPOSITION OF PHENOTYPES. DOES THAT ACTUALLY REASSURE YOU THAT WE'RE EXQUISITELY SENSITIVE TO THOSE ISSUES AND WORKING TO ADDRESS THEM. AS YOU MAY OR MAY NOT KNOW I'VE LAID OUT AS PART OF MY VISION A NUMBER OF LEADERSHIP VALUES AND DIVERSITY, EQUITY AND INCLUSION IS CENTRAL TO ONE OF THE VALUES AND THAT APPLIES TO ALL OF THE SCIENCE AS WELL AS THE HIRING PRACTICE AT THE INSTITUTE. WE'VE GOT TO DO THAT. >> THANK YOU. >> I WANT TO THANK YOU AGAIN RICK FOR A NICE TOUR OF THE NIHS PORTFOLIO AND ALSO YOUR OWN BACKGROUND AND WORK IN GENETICS USING MOUSE MODELS. THAT HAS GOT A LOT OF INTERESTING RESPONSES AND NIMHD DOES DOES HAVE THE ENVIRONMENTAL DISPARITY IS CENTERS THAT WE RENEWED THIS PAST YEAR AMIDST THE PANDEMIC AND HAVE THREE GOING FORWARD. THAT I THINK HAVE BLENDED OUR PRIORITIES IN A NICE WAY IN THOSE THREE CENTERS. TO ADVANCE THAT SCIENCE. YOU ALSO HAVE HAD A SOCIAL EPIGENOMEICS PROGRAMS WITH RO1S THAT IS HAVE BEEN SUCCESSFUL IN FUNDING LOTS OF SCIENTISTS. WE NEED TO HAVE SOME SORT OF A WORKSHOP TO SEE WHERE WE ARE WITH WHAT WE'VE LEARNED FROM THOSE FIELDS HAVING HEARD A COUPLE OF TIMES THE PRESENTATIONS. AND I CAN SAY WITHOUT ANY HESITATION AT ALL RICK IS A CHAMPION OF ALL OF THE ISSUES THAT WE SUPPORT IN TERMS OF WORKFORCE DIVERSITY ADDRESSING HEALTH DISPARITIES. WHEN HE SAID AT THE BEGINNING NIHS IS ABOUT PREVENTING DISEASE HE SEND A MESSAGE THAT RESONATES WITH ME IS ALSO POPULATION BASED INSTITUTE MUCH LIKE OURS AND SO I THINK THAT WE HAVE A LOT IN COMMON AND IN SOME WAYS THE DISTANCE TO NORTH CAROLINA DOESN'T MATTER AS MUCH NOW THAT WE'RE ALL ON ZOOM. SO THANK YOU RICK FOR A WONDERFUL PRESENTATION. >> ELISEO, THANK YOU FOR YOUR ATTENTION AND IT WAS GREAT BEING HERE. I LOOK FORWARD TO CONTINUE TO WORK WITH YOU. IN THE INTEREST OF TIME I SKIPPED OVER THAT SLIDE THAT I PREPARED REGARDING OUR CO-FOUNDED CENTER TOGETHER. IT'S BEEN GREAT WORKING TOGETHER AVENU-- SO LET'S CONTINUE WORKING TOGETHER. >> LIKE CLIMATE CHANGE. IT'S COMING. >> YOU'LL HAVE TO HAVE ME BACK AND TOGETHER WE CAN TALK ABOUT SOME OF THE EXCITING THINGS THAT ARE HAPPENING IN CLIMATE CHANGE AND HEALTH RESEARCH. >> RIGHT. OKAY. >> THANKS, EVERYONE. BYE. >> BEFORE WE GIVE YOU A SHORT BREAK I WANT TO TAKE A FEW MINUTES TO RECOGNIZE RETURNING MEMBERS FROM OUR COUNCIL. 7 I THINK THIS IS TRADITIONALLY WE GIVE THEM A FEW MINUTES TO SAY A FEW WORDS. AND I WILL SAY A FEW WORDS ABOUT EACH ONE. I'M GOING TO START WITH -- RAMIREZ. SHE IS RECOVERING FROM LARYNGITIS. SHE IS A FRIEND, COLLEAGUE AND JUST A TOP-NOTCH SCIENTIST AND ADVOCATE AND IT'S BEEN DELIGHTFUL TO HAVE YOU ON COUNCIL. IT'S YOUR SECOND TOUR. AND WHEN I FIRST MET HER WE WERE BOTH WORKING ON TOBACCO CONTROL RETENTIONS IN LATINO COMMUNITIES. SHE WAS WORKING WITH ALFRED McCALISTER IN SOUTH TEXAS USING THE MEDIA AND I WAS IN SAN FRANCISCO WHERE WE INCORPORATED MEDIA BAUGH BUT WE WERE FOCUSED ON THE COMMUNITY-BASED USING AT THAT TIME BELIEVE IT OR NOT PRINT MATERIALS AS OUR MAIN FOCUS. WE BOTH DID SIMILAR THINGS AND LATER WE COLLABORATED CLOSELY FOR ABOUT WHAT 23 YEARS ON DIFFERENT PROJECTS RELATED TO CANCER CONTROL BEFORE I CAME TO NIMHD. THANK YOU FOR YOUR TIME ON COUNCIL AND IF WE WERE IN PERSON I WOULD GIVE YOU A LOVELY CERTIFICATE SIGNED THAT WE'LL GET TO YOU AT SOME POINT. >> FIRST OF ALL I WANT TO SAY -- IT'S REALLY BEEN A JOY OVER THE YEARS OF KNOWING EACH OTHER AND ALL OF THE WORK THAT WE'VE DONE AND WHERE WE ARE NOW AND WHERE YOU ARE NOW TO HAVE A POTENTIAL INFLUENCE IN THE HEALTH DISPARITY ISSUES THAT WE'VE BEEN WORKING ON. I'VE STOOD ON THREE COUNCILS AND THERE WAS A TIME PERIOD WHERE TWO OF THOSE OVERLAPPED WHICH THEY DON'T ALLOW NOW. I'VE LEARNED A LOT. YOU AND YOUR TEAM HAVE DONE WITH THE FRAMEWORK AND THE NEW BOOK THAT IS OUT AND PUTTING A SHINING EMPHASIS ON THE NEED TO FOCUS ON HEALTH DISPARITIES. YOU GREW UP IN A MAJOR ACADEMIC INSTITUTION AND UNLESS WE HOLD OUR LEADERS ACCOUNTABLE IT'S HARD TO GET THE CHANGE THAT WE NEED. SO THANK YOU. IT'S JUST BEEN A PLEASURE TO BE ABLE TO SERVE WITH YOU SIDE BY SIDE AND IF YOU NEED ME BACK I'M AVAILABLE. >> WE'LL CALL ON YOU. THANK YOU VERY MUCH. NEXT I WANT TO SAY A WORD ABOUT GISELLE CORBY SMITH. CONNECTED TO ME AND THE INTERNAL MEDICINE SOCIETY WHICH IS MY PROFESSIONAL HOME. A MAJOR INFLUENCE IN MY CAREER AND SHE WAS AN EMERGING LEADER AFTER I HAD ESTABLISHED. I REMEMBER THE FIRST TIME WE HELD A SCIENTIFIC SESSION THAT WAS FOCUSED ON HEALTH DISPARITIES AND THE ROOM WAS PACKED. IT WAS ONE OF THE SMALL ROOMS. AND HOW MUCH -- AND THAT WAS IN 1993 IF I'M REMEMBERING CORRECTLY AND HOW MUCH THE SOCIETY HAS CHANGED AS A FORMER PRESIDENT AND LEADER IN COMMUNITY ENGAGED RESEARCH AND HEALTH DISPARITY RESEARCH AND NOW YOU'RE NOT GOING TO GET RID OF ME BECAUSE NOW YOU'RE CO-PI OF THE CDCC SO WE'RE GOING TO BE SEEING YOU ON A REGULAR BASES. SO THANK YOU FOR YOUR SERVICE TO OUR COUNCIL. AND FOR ALL OF THE CONTRIBUTIONS YOU HAVE MADE TO THE FIELD. >> ELISEO, THANK YOU FORGIVING ME THE OPPORTUNITY TO SERVE ON THIS COUNCIL AND TO GET TO MEET THESE INCREDIBLE COLLEAGUES. IT'S EACH MEETING -- HAS BEEN JUST A TOUR DEFORCE IS WHAT I WAS THINKING DURING THE PRESENTATIONS TODAY. IT'S BEEN MY REAL PLEASURE TO GET TO KNOW AND MEET EACH OF YOU ALL. SOME OF WHO I HAVE KNOWN BEFORE. JOAN AND I HAVE CROSSED PATHS ALONG THE WAY BUT SEVERAL OF YOU ALL I MET FOR THE FIRST TIME ON COUNCIL. SPIRO ALSO DOESN'T GET OUT THAT EASY. HE SERVES ON OUR STEERING COMMITTEE AND HONESTLY THIS HAS BEEN THE HIGHLIGHTS OF MY CAREER. AND THANK YOU EACH FOR THE OPPORTUNITY TO SERVE WITH YOU. >> THANKS AND WHEN I RECRUIT -- RECRUITED SOME FOLKS SOMEONE LIKE GISELLE NEED A LITTLE CONVINCING AS TO WHY COUNCIL IS RELEVANT SO I'M GLAD TO HEAR THAT YOUR TIME HAS BEEN GOOD AND MARSHALL CHIN. >> YOU WERE RIGHT ELISEO. >> NEXT IS MARSHALL CHIN WHO I INTRODUCED AND SPOKE ABOUT EARLIER AND I THINK WATCHING AND INTERACTING WITH MARSHALL OVER THE YEARS HAS BEEN A REAL PLEASURE. I ACTUALLY HAD NOT FULLY REGISTERED THAT YOU WERE A STAND UP COMIC THAT. IS FANTASTIC. ALTHOUGH I HAD SEEN THAT PIECE THAT YOU SHOWED SO SOMEHOW MY BRAIN DIDN'T REMEMBER IT SO NOW I WILL. SO THANK YOU VERY MUCH MARSHALL FOR ALL OF THE THINGS YOU'VE DONE. ALSO THE COLLEAGUE FROM SGIM AND FORMER PRESIDENT OF THE SOCIETY WHO HAS BEEN A CONSTANT FORCE ON THE ISSUE OF HEALTH EQUITY PARTICULARLY AROUND COMMUNITY ENGAGEMENT AND ALSO AS A MENTOR OR LEADER IN THE FIELD. MARSHALL. >> THANKS SO MUCH ELISEO. I'M HAVING INTERNET PROBLEMS SO I'M ON THE PHONE RIGHT NOW. THANK YOU FOR INVITING ME TO COUNCIL. I REALLY ENJOYED IT AND APPRECIATE THE OPPORTUNITY. IT'S GREAT THAT YOU'RE THE DIRECTOR. SOMEONE WHO'S A GREAT DIVIDE ANYTHING AND TEACHER AND HUMAN BEING. EVERYTHING FROM THE FRONT LINE EXPERIENCE TO THE ORGANIZATIONAL POLICY EXPERIENCE THIS IS A GREAT MATCH YOU AND NIMHD AND SO GLAD TO SEE HOW YOU'VE THRIVED HERE IN YOUR TIME IN WASHINGTON. TO THE STAFF I HAVE REALLY ENJOYED WORKING WITH YOU ALL. AND I THINK LIKE PEOPLE IN EQUITY ARE MISSION DRIVEN PEOPLE. THIS IS ONE OF THE TIMES IN OUR COUNTRY WHERE THERE'S REAL OPPORTUNITY. A REAL WINDOW YEAR AND I'M LOOKING FORWARD TO CONTINUE TO FOLLOW NIMHD'. IT'S A GREAT OPPORTUNITY TO MAKE A DIFFERENCE AND TO MY COLLEAGUES ON THE COUNCIL THAT IS GREAT. WHAT A WONDERFUL GROUP. THE FOLKS THAT TEND TO BE EQUITY ADVISORY GROUPS THERE TENDS TO BE IT'S DIFFERENT THAN OTHER GROUPS. THERE IS A SENSE OF MISSION AND CO-LEAGUE ALL THE AND BONDING IN * WONDERFUL WAY. I'M ENJOYED THE MEETINGS AND CONVERSATIONS AND I LOOK FORWARD TO KEEPING IN TOUCH WITH PEOPLE. THANK YOU FOR A GREAT EXPERIENCE. >> THANK YOU SO MUCH, MARSHALL FOR THOSE KIND WORDS. I USED TO BE A CLINICIAN. IT'S MORE IN THE DISTANT PASTAS TIME GOES BY AND LAST BUT NOT LEAST IS SPIRO MANSON. I MET SPIRO WHEN WE HAD OUR FIRST MEETING IN BETHESDA WITH OURS SCHEMED PROGRAM OFFICER SAID STALL WHO WE ALL CAME TO REALLY LOVE IN THOSE FIRST COUPLE OF CYCLES OF THE GRANTS. EVEN THE SPIRO IS ALREADY WELL-KNOWN IF THE FIELD OUR CIRCLES HAD NOT OVERLAPPED DIRECTLY ALTHOUGH WE BOTH KNEW PEOPLE IN COMMON AND WORKED WITH PEOPLE IN COMMON BUT WE HAD NOT INTERESTED ACTED. WE HAD A * NATURAL GRAVITATION TO EACH OTHER SO THE WORK THAT WE DID AND HOW WE SAW THINGS AND AS TIME WENT BY WITH THE RICK MORE * CENTERS WE GREW CLOSER. I HAVE TO THANK YOU SPIRO FOR MUCH, MUCH ADVICE OVER THE YEARS. I HAVE DEPENDED ON YOU FOR IN INSIGHTS AND JUST TO BOUNCE PROBLEMS OFF REGARDING PARTICULARLY AROUND WHAT I'VE LEARNED ABOUT NATIVE PEOPLE IN NORTH AMERICA. AND I HOPE TO CONTINUE TO BE ABLE TO TAP ON YOU FOR OCCASIONAL CONVERSATIONS ON THESE ISSUES SO THANK YOU FOR YOUR TIME ON COUNCIL AND I'M SURE I WILL BE CROSSING PATHS WITH YOU. >> THANK YOU ELISEO FOR YOUR KIND WORDS. YOUR PRAYS IS QUITE WELCOMED AND ALWAYS IMPORTANT THOSE OF US WORKING IN THE FIELD TO ENCOURAGE US ALONG THESE PATHS. I'M NOT GOING TO ECHO ALL OF THE SENTIMENTS THAT MY COLLEAGUES BEFORE ME HAVE EXPRESSED REGARDING YOUR LEADERSHIP AND YOUR STAFF AND COLLEAGUES EXCEPT TO SAY THAT IT'S A REMARKABLE EXPERIENCE. THE LAST FOUR YEARS HAS BEEN PARTICULARLY IMPORTANT FOR ME. AND THE REASON WHY IS BECAUSE THE MIDDLE OF 2004 I WAS A MEMBER OF THE NATIONAL ACADEMY OF MEDICINE STUDY COMMITTEE THAT DID THE INITIAL REVIEW OF THE NIH'S HEALTH DISPARITY RESEARCH PLAN. AND WHILE THAT REVIEW WAS PROMISING AND SUPPORTIVE OF THE STAGES OF THE INSTITUTE IT EMPHASIZED A PROGRAM OF RESEARCH THAT WAS INTERTWINED WITH HEAVY EMPHASIS ON COMMUNITY ENGAGED WORK AND A COMMITMENT TO SOCIAL JUSTICE AND HEALTH EQUITY AND I COULD NOT BE MORE PLEASED TO HAVE THE OPPORTUNITY TO REVIEW THE NEW STRATEGIC PLAN THAT HAS BEEN APPROVED AND AUTHORIZED AND TO SEE THAT THAT PLAN BRINGS TO FRUITION THAT THAT STUDY HAD HOPED TO PASS. CONGRATULATIONS TO ALL OF YOU AND YOUR COLLEAGUES THAT HAVE MADE THAT OCCUR. I WILL ALSO SAY ELISEO YOU DIDN'T BELIEVE ME AT THE TIME BUT WHEN WE WERE TOGETHER IN SOUTH DAKOTA AND IT WAS ONE OF THE FIRST -- SITE VISIT BY AN IC DIRECTOR INTO INDIAN COUNTRY AND I STILL HAVE VIDEO OF YOU JOINING US IN WHICH YOU DID FAIRLY WELL AND I WANTED TO UNDERSCORE WE ALWAYS TALK ABOUT THE IMPORTANCE OF RELATIONSHIPS AND NOT JUST RELATIONSHIPS AMONG COLLEAGUES BUT RELATIONSHIPS WITH OUR CONSTITUENTS AND YOU ESTABLISHED AT THAT PARTICULAR MEETING BY YOUR ENGAGING AND FORTHRIGHT AND AUTHENTIC MANNER INCLUDING JOINING PEOPLE IN AN ACTIVITY THAT WAS VERY FOREIGN THAT CEMENTED YOUR PLACE IN INDIAN COUNTRY. I'M THRILLED TO HAVE BEEN A PART OF THIS AND ALONG WITH MY COUNCIL COLLEAGUES OVER THE PAST FOUR YEARS SO THANK YOU FOR THAT ARE OPPORTUNITY. >> I KNOW YOU'VE TALKED ABOUT THAT VIDEO BUT I DON'T KNOW THAT YOU'VE ACTUALLY POST EDIT. SO THANK YOU FOR KEEPING IT. >> I CAN IF YOU WANT. >> IT'S ALL RIGHT. SBUT GOING TO INDIAN COUNTRY IS SOMETHING THAT I HAVE MISSED DUE TO TRAVEL RELY STRIKESES. I LEARNED A LOT FROM * THESE VISITS AND CERTAINLY MY LAST ONE WAS OUT TO THE ZUNI PUEBLO IN NEW MEXICO. I CHERISH THE LAST TIME I WAS OUT THERE. TOM, DO WE TAKE A BREAK OR KEEP PLOWING FORWARD. WE'RE ABOUT 20 MINUTES BEHIND. WE COULD TAKE A QUICK FIVE MINUTES IF SOMEBODY NEEDS A BIOLOGICAL. >> WE HAVE LEFT THE CONSENTS. -- CONCEPTS. >> AND ONE OTHER ITEM ON THE AGENDA. >> I WOULD SUGGEST THAT WE PLOW ON PEOPLE CAN TAKE THEIR BREAK IF THEY NEED TO. >> I WOULD ASK PEOPLE TO STAY FOR THE QUORUM. PLEASE IF YOU HAVE COMMENTS OR THOUGHTS ABOUT THE CONCEPT MAKE THOSE VERBAL AND LOUD SO OUR NIH VIDEO CAST AUDIENCE CAN KNOW YOUR THOUGHTS. IF YOU PUT IT IN THE CHAT THAT IS NOT GOOD ENOUGH FOR THIS. OKAY. WITH THAT LET ME GET TO MY NOTES. WE'RE GOING TO MOVE TO THE CONCEPT. THERE IS ONLY ONE CONCEPT TO PRESENT TODAY. TWO COUNCIL MEMBERS ARE ASSIGNED. IN AN EFFORT TO MAKE THE BEST USE OF TIME THE OTHER MEMBERS OF THE COUNCIL WERE ASKED TO SHARE ANY COMMENTS THEY HAD WITH AN ASSIGNED REVIEWER AND THE ASSIGNED REVIEWERS WERE ASKED TO INCLUDE THOUGHTS WITHIN THEIR OWN CONTINUES SO THE ASSIGNED REVIEWERS WILL SPEAK FIRST BUT FOLLOWING THAT WE'LL OPEN DISCUSSION AND THERE CAN BE ADDITIONAL COMMENTS FROM ANY MEMBER OR CLARIFICATION OF ANYTHING THAT WAS SAID WHICH I THOUGHT WAS ATTRIBUTED TO THEM. THERE WILL BE TIME FOR OPEN DISCUSSION. FOLLOWING THAT WE'LL ENTERTAIN A MOTION WHETHER TO APPROVE OR DISAPPROVE THE CONCEPT AND WE'LL NEED A VOTE OF THE MEMBERS AT THAT TIME. -- OUR COUNCIL REVIEWERS -- OUR PROGRAM OFFICER IS DR. RICK BERZON. RICK, YOU WANT TO TAKE IT AFTER LONG. >> THANK YOU SO MUCH, TOM AND I'D LIKE TO THANK JUAN. ARE YOU THERE TO FORWARD THE SLIDES. AND I WOULD ALSO LIKE TO THANK DR. JENNIFER ALVIDREZ. TO PREVENT TEST AND TREAT HIV AMONG HEALTH DISPARITY POPULATION WITHIN PRIMARY CARE SETTINGS WITH A HIGH RATE OF NEW INFECTIONS. IN 2019 THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES LAUNCHED THE ENDING THE HIV INITIATIVE TO END IT BY TO 30. A CRITICAL COMPONENT INVOLVES EARLY DIGITALS ALONG WITH PREVENTION OF NEW TRANSMISSIONS, TREATMENT OF INFECTIONS AND RESPONSE TO HIV OUTBREAKS AND THIS SLIDE SHOWS THE GEOGRAPHIC OUTBREAKS. OF THE APPROXIMATELY 38,000 NEW INFECTIONS THAT OCCURRED IN 201869% IN GAY AND BISEXUAL MEN. BLACK AND HISPANIC MENNA COUNSELED FOR THE LARGEST SHARE. RACIAL AND ETHNIC DISPARITIES CONTINUE TO EXIST. 37% OF CASES WERE AMONG BLACKS AND 30% WERE AMONG HISPANICS WHILE 27% AMONG WHITES. PRIMARY CARE SETTINGS ARE IMPORTANT VENUES FOR HIV TESTING IN THE U.S. WHILE 700 MILLION ANNUAL VISITS WERE MADE -- BY PERSONS AGE 13-64 DURING THE YEARS 2009-2017 HIV TESTING OCCURRED AT LESS THAN 1% OF VISITS TO PHYSICIAN OFFICES, LESS THAN 3% TO COMMUNITY HEALTH CENTERS AND LESS THAN 1% OF VISITS TO EMERGENCY DEPARTMENTS. PATIENTS SEEN IN PRIMARY CARE SETTINGS COULD BENEFIT FROM HAVING ESTABLISHED CARE WITH RAPID TRANSMISSION TO TREATMENT. FOR THOSE AT RISK WHO DO TEST NEGATIVE PROVIDERS ARE WELL POSITIONED TO OFFER PREVENTIVE TREATMENT. THE CDC ESTIMATES THAT 1.2 MILLION ADULTS IN THE U.S. MIGHT BENEFIT FROM PREP BUT ONLY A MINORITY. 205,000 ARE USING IT. THEREFORE THERE IS A SIGNIFICANT UNMET NEED TO INCREASE ACCESS FOR THOSE AT RISK FOR THE VIRUS. GIVEN THE LARGE NUMBERS OF INDIVIDUALS WHO HAVE INDICATIONS FOR PRECIPITATION THERE ARE NOT ENOUGH SPECIALISTS TO MEET THE NEED AND SPECIALTY SETTINGS ARE LESS LIKELY TO BE AVAILABLE IN RURAL AREAS OR OTHER UNDERSERVED AREAS. PREP IS A PREVENTIVE INTERVENTION FOR OTHERWISE HEALTHY INDIVIDUALS AND PRIMARY CARE CLINICIANS CAN PROVIDE IT AT THE POINT OF FIRST CONTACT. EDUCATING PRIMARY CARE PROVIDERS AND REMOVING BARRIERS TO SCREENING WHILE INCREASING TESTING DURING PRIMARY CARE VISITS WILL ADVANCE TREATMENT STRATEGIES AND TESTING. THEY MAY BE RELUCTANT TO PRESCRIBE PREP. THERE MAY BE A PERCEPTION THAT WILL NOT ADHERE TO IT. PRIMARY CARE SETTINGS ARE UNDER UTILIZED VENUES TO POPULATIONS WHO WILL NOT SEEK SERVICES DUE TO LACK OF ACCEPTABILITY OR ACCESSIBILITY. MORE RESEARCH IS NEEDED TO UNDERSTAND HOW TO BEST DELIVER HIV RELATED SERVICES AND PRAI PRIMARY CARE SETTINGS TO HIGH RISK POPULATIONS THAT EXPERIENCE HEALTH DISPARITIES. THIS INITIATIVE WILL SUPPORT RO1 PROJECT THAT'S TEST APPROACHES AND STRATEGIES AMONG HEALTH DISPARITY POPULATIONS OR SUBGROUPS WITHIN PRIMARY CARE SETTINGS LOCATED IN GEOGRAPHIC AREAS WITH HIGH RATE OF INFECTIONS. OBSERVATIONAL STUDIES THAT ONLY IDENTIFY PREDICTORS OF TESTING WITHOUT EVALUATING THEIR INTERVENTION EFFECTS ARE NOT A PRIORITY FOR THIS INITIATIVE. AND MAY I HAVE THE FINAL SLIDE. AREAS OF SPECIAL INTEREST INCLUDE BUT ARE NOT LIMITED TO INCREASED IN ENGAGEMENT IN PRIMARY CARE OF HIGH RISK POPULATIONS WITHOUT A USUAL SOURCE OF HEALTH CARE. WILLINGNESS TO PRESCRIBE PREP. AND REDUCING IMPLICIT BIAS. PROMOTING PATIENT ENGAGEMENT AND TREATMENT ADHERENCE IN PRIMARY CARE SETTINGS THROUGH LINKAGES. PROMOTING PATIENT ENGAGEMENT THROUGH PEER AND COMMUNITY SUPPORT. AND ENDING AND EXTENDING THE PROVISION OF HIV PREVENTION AND CARE SERVICES WITHIN PRIMARY CARE SETTINGS ACROSS MULTIPLE DOMAINS. THIS INITIATIVE IS ALIGNED WITH HIGH PRIORITY TOPICS FOR USING HIV/AIDS DESIGNATED FUNDS. THANK YOU FOR YOUR ATTENTION AND I'M HAPPY TO ANSWER QUESTIONS. >> AT THIS TIME DR. CORBY SMITH HAD TO LEAVE. SO DR. -- CAN YOU FILL US IN ON THE OPINIONS ABOUT THIS CONCEPT. >> THANK YOU FOR THE OPPORTUNITY TO GIVE SOME OF FEEDBACK ON THIS CONCEPT. OVER-ALL I THINK I WANT TO COMMUNICATE THAT'S VERY STRONG IN TERMS OF ITS FOCUS ON RESEARCH ON HIV RESEARCH IN PRIMARY CARE SETTINGS. WE'VE MADE TREMENDOUS ADVANCES IN HIV TESTING IN COMMUNITY SETTINGS AS AN APPROACH. [ INDISCERNIBLE ] BUT YET LOWER RATES OF VIRAL SUPPRESSION -- BUT MAYBE MORE SO IN PRIMARY CARE SO THIS FOCUS ON PRIMARY CARE MAKES I'M LOT OF SENSE AND A VENUE FOR TURNING AROUND SOME OF THE CHALLENGES AROUND HIV TESTING. FOR EXAMPLE WE KNOW ONLY ABOUT ONE IN FIVE SEXUALLY ACTIVE TEENAGE BOYS HAVE HAD A TEST IN THEIR LIFETIME AND PRIMARY CARE MAY BE THE BEST PLACE TO REACH THEM BECAUSE THEY ARE TOO YOUNG TO BE IN THE OTHER AREAS. ENDING THE HIV EPIDEMIC IS FOCUSED ON THE 48 COUNTIES. WASHINGTON, D.C. AND SAN JUAN PUERTO RICO WHERE MORE THAN HALF OF THE DIAGNOSIS OCCURRED IN 2017 SO THERE THIS IS ALIGNED WITH THE HOTSPOTS AS WELL AS THE SEVEN STATES WITH MORE HIV -- [ INDISCERNIBLE ] TESTING AS A GATEWAY TO PREVENTION OR CARE. IT IS ALIGNED WITH MANY OF THE LOCAL JURISDICTIONAL PLANS THAT HAVE BEEN ROLLED OUT THROUGHOUT THE COUNTRY. SOME THOUGHTS ABOUT THE FACT THAT MEN WHO HAVE SEX WITH MEN AND TRANSGENDER WOMEN AND SPECIFICALLY USING THAT WORD PRIORITY POPULATION MAKES A LOT OF SENSE BECAUSE AS A FOCUS GROUP THE CONCEPT IS NOT LIMITED TO ONLY THOSE GROUPS BUT IDENTIFYING THEM AS A PRIORITY POPULATIONS APPROPRIATE AS DR. BERZON SHARED. PROBABLY EVEN MORE IMPORTANT THAN THAT WHEN WE THINK ABOUT ENDING THE EPIDEMIC IS THAT OVER 75% OF HIV TRANSMISSIONS EACH YEAR BY COMPARISON HETEROSEXUAL MEN ARE 6%. HETEROSEXUAL WOMEN UNDER 6%. LASTLY GIVEN THAT WE HAVE THESE HIGHLY EFFECTIVE INTERVENTIONS -- [ INDISCERNIBLE ] AND PREVENTION TREATMENT WE NEED TO BETTER UNDERSTAND HOW TO BETTER IMPLEMENT THEM SUCH AS IN PRIMARY CARE. IMPLEMENTATION IS OUR GREATEST CHALLENGE IN THAT FRONT AND SCIENCE AND HEALTH SERVICES RESEARCH ARE ABSOLUTELY CRITICAL FOR HOW WE CAN SCALE UP THESE EFFECTIVE INTERVENTIONS WITH FIDELITY -- HOW WE CAN SCALE THEM UP WITH ATTENTION TO EQUITY AS WELL. WITHIN THE IMPLEMENTATION SCIENCE THERE ARE A COUPLE OF AREAS THAT COULD BE IMPORTANT SUCH AS ATTENTION TO CARE THROUGHOUT LIFE TRANSITION. THE SEXUAL DEBUT OF YOUNG PEOPLE. LEAVING PILEAVE -- LEAVING INCARCERATION. [ INDISCERNIBLE ] THOSE ARE JUST A COUPLE OF THOUGHTS ON THE CONCEPT. IT'S VERY STRONG AND THE FOCUS ON PRIMARY CARE THE SPECIFIC POPULATIONS AND THESE PRIORITIES MAKE A LOT OF SENSE AND ARE WELL ALIGNED WITH THE INITIATIVE. >> IS THERE ANYONE ELSE ON THE COUNCIL WHO WOULD LIKE TO SAY ANYTHING ABOUT THIS CONCEPT? >> THANK YOU, BRIAN AND I FULLY AGREE WITH THE POPULATIONS THAT ARE AT HIGHER RISK FOR HIV INFECTION AND TRANSGENDER WOMEN BUT WITHIN THE MSM COMMUNITY THERE IS A GROUP OF BISEXUAL MEN THAT HAVE SEX WITH WOMEN. SO BY HAVING PRIORITY BUT NOT EXCLUSIVE -- AND PRIMARY CARE PEOPLE DON'T NECESSARILY IDENTIFY THEMSELVES UP FRONT. I THINK -- ALLOWS THE INVESTIGATORS TO HAVE A WIDER RANGE OF GROUPS TO BE INCLUDED IN FOR EXAMPLE TESTING AND THEN FOCUS ON WHATEVER POPULATIONS THEY HAVE IDENTIFIED. I JUST WANT TO MAKE SURE THAT WE SHOULD NOT EXCLUDE MINOR POPULATIONS WHO ARE ALSO AT RISK. >> JUST -- I WAS THINKING ABOUT THAT COMMENT AS WE WERE TALKING ABOUT IMPLEMENTATION, SCIENCE QUESTIONS. THIS QUESTION OF HOW DO YOU TARGET PRIORITY POPULATIONS WITHIN PRIMARY CARE IS AN IMPORTANT QUESTION AS WELL. SO I THINK YOUR COMMENT REALLY TRIGGERED THAT OBJECTION ADVANTAGES AS WELL. THANK YOU. >> ANY OTHER QUESTIONS OR COMMENTS? >> MOTION TO APPROVE THE CONCEPT? >> OKAY. WE HAVE A MOTION TO APPROVE THE CONCEPT. DO WE HAVE A SECOND. >> I SECOND. >> MEMBERS IF YOU COULD PLEASE ENTER YOUR VOTE IN THE CHAT. YES TO GO ALONG WITH THE MOTION. OR NO IF YOU DISAGREE. THE MOTION PASSES. ALL APPROVED AND NO VOTES AGAINST IT. WITH THAT -- WE CLOSE THE WORK ON THIS CONCEPT. >> THANK YOU. >> YOU'RE WELCOMED DR. BERZON. >> THIS IS A SPECIAL PRESENTATION FROM DR. COOPER. JUAN, IF YOU COULD SWITCH THE SLIDES. >> THANK YOU. SO I WOULD LIKE TO TAKE THIS OPPORTUNITY TO HIGHLIGHT A VERY SPECIAL ANNOUNCEMENT THAT OCCURRED ON MAY 2,2021. I IMAGINE THAT EVERYONE IS FAMILIAR WITH THE OSCARS, RIGHT? THOSE AWARDS AMONG THE HIGHEST HONORS FOR FILMS IN A GIVEN YEAR. WELL, DID YOU KNOW THAT THE UNITED STATES GOVERNMENT HAS ITS OWN OSCARS WHICH ARE THE PR PRESTILLING US SAMUEL J. HEYMAN SERVICE TO AMERICA MEDALS. THE SAMMY'S. THE PARTNERSHIP INCLUDED A COVID-19 RESPONSE CATEGORY TO RECOGNIZE THE EXTRAORDINARY FEDERAL OFFICIALS WHO MADE SIGNIFICANT CONTRIBUTIONS TO RESPONDING TO THE PANDEMIC AND SAVING LIVES AND SIMILAR TOGETHER ONS SCARS SELECTION TO THE FINALIST IS A HUGE FINANCIAL COMPLIMENT AND NIMHD IS EXCITED TO HAVE OUR OWN SAMMY FINALIST. WE SHOULD HAVE A DRUMROLL. HERE WE GROW. THE FINALIST INCLUDE NIMHD DIRECTOR DR. ELISEO PƒREZ-STABLE AND DIRECTOR DR. GARY GIBBONS WHO HAVE BEEN SELECTED TOGETHER AS JOINT FINALISTS. THIS AWARD CATEGORY RECOGNIZES THEM FOR THEIR TIRELESS WORK AND NATIONAL IMPACT IN ADDRESSING THE PERSISTENT DISPARITIES EXPERIENCED BY RACIAL ETHNIC MINORITY POPULATIONS. THEY ARE AMONG A GROUP OF 29 EXCEPTIONAL FEDERAL EMPLOYEES OR TEAMS BEING HONORED AS HEROES OF THE COVID-19 PANDEMIC RESPONSE AS WELL AS OUTSTANDING PUBLIC SERVANTS FOR THEIR EXTRAORDINARY PUBLIC SERVICE AND CONTRIBUTIONS TO MAKE THE NATION HEALTHIER, SAFER AND MORE PROSPEROUS. THE FINALIST SELECTION AS A TEAM STEMS FROM THEIR LEADERSHIP AN ACTIVE NATIONAL PRESENCE TO DEVELOP AND EXCEPT IMPLEMENT FEDERAL PROGRAMS TO INCREASE SARS COVID 2 TESTING TO DEFECT THE VIRUS AS EARLY AS POSSIBLE, INCREASED DIVERSITY AND INCLUSION IN CLINICAL RESEARCH IN VACCINE TRIALS IN UNDERSERVED COMMUNITIES ACROSS THE COUNTRY AND TO SERVE AS TRUSTED VOICES AND MESSENGERS AT A TIME WHEN WE NEED IT AND NOT JUST TALKING THE TALK -- BUT -- [ INDISCERNIBLE ] CALLS TO PROMOTE EQUITY. THESE INCLUDE TWO INITIATIVES BY REDUCING COVID-19 MORBIDITY EXPERIENCED BY UNDERSERVED AND VULNERABLE COMMUNITIES. INDEED DR. -- TEAMS HAVE BEEN HEAVILY INVOLVED IN SUPPORTING THESE EFFORTS AND WE ALSO GREATLY APPRECIATE YOUR CHALLENGING CONTRIBUTIONS AND THERE ARE OTHER HIGHLY IMPRESSIVE NOMINEES OR FINALISTS. IN THE CATEGORY THESE INCLUDE THE TEAM OF DR. GRAHAM AND CORBETT AS WELL AS DR. MARKS WHO HAVE MADE EXTRAORDINARY CAN'TSES. -- CONTRIBUTIONS. THIS YEAR'S FINALIST ARE CONTENDERS FOR OTHER MEDALS. AND EVEN BEING SELECTED AS A FINALIST IS A HUGE CAREER ACCOMPLISHMENT. CONGRATULATIONS AND THANK YOU. >> THANK YOU VERY MUCH FOR THOSE VERY KIND WORDS MONICA. NONE OF THIS WOULD HAVE BEEN POSSIBLE WITHOUT YOUR TIRELESS EFFORT FROM DAY ONE ARRIVING THE DAY WE SHUT DOWN COCHAIRING THE SOCIAL BEHAVIORAL AND ETHICAL IMPLICATIONS. COVID INITIALLY AND THE RADx PROGRAM AND CEAL ALWAYS ANSWERING THE CALL AND WITH US JUST ABOUT EVERY STAFF PERSON AT NIMHD ALL OF YOU HAVE BEEN DEDICATED TO THIS RESPONDING TO THE EMERGENCY IN A WAY THAT PERHAPS I COULD SAY WELL IT'S WHAT I EXPECT FROM NIH BUT WE REALLY NEVER KNOW UNTIL THE FIRE COMES. AND I THINK I'M REALLY PROUD OF OUR STAFF AND EVERYONE AT NIH BUT ESPECIALLY AT NIMHD AS WE ARE CONTINUING IN THIS EFFORT TO ADDRESS HEALTH DISPARITIES HEALTH INEQUITIES AND ADVANCE HEALTH EQUITY. IT IS, WE HAVE A TREMENDOUS WINDOW OF OPPORTUNITY. THERE HAVE BEEN REINFORCEMENTS OF MANY OF THE PRINCIPLES THAT WE'VE STOOD BY BOTH DURING MY TIME AS DIRECTOR AND FOR 15 YEARS SINCE PRIOR TO THAT THE DR. ROUGH IN WAS DIRECTOR * OF THE CENTER AND INSTITUTE WE STOOD FOR COMMUNITY ENGAGED RESEARCH FROM THE BEGINNING. WE'VE TALKED ABOUT RACISM AND STRUCTURAL RACISM FROM THE BEGINNING. WE HAVE NOT SHIED AWAY FROM CONTROVERSIAL TOPICS. WE'VE SEND -- ASK SEND AND BRAME BRACED *. AND TRYING TO INTEGRATE THIS WITH THE COMPLEXITIES OF HUMAN LIFE AND THE SO-CALLED REAL WORLD I THINK IS ALWAYS CHALLENGING ALWAYS FUN AND ALWAYS BRINGS SURPRISES SO I WANT TO THANK EVERYONE FOR ALLOWING ME TO BE ON THIS JOURNEY WITH YOU. IT'S AN HONOR SO THANK YOU, MONICA. >> THANK YOU TO ALL. I THINK TOM WE'RE AT THE END. >> SO WE'RE AT THE PART OF THE AGENDA THAT IS CLOSING REMARKS AND ADJOURNMENT SO THE FLOOR IS YOURS. >> I THINK I JUST SAID WHAT I WANT TO SAY. I WANT TO THANK ALL OF THE MEMBERS OF THE COUNCIL. I REALLY DO MISS SEEING YOU. THIS IS WHAT OUR FOURTH VIRTUAL COUNCIL, RIGHT? AND I THINK ALTHOUGH WE CAN GET USED TO IT AND IT'S NOT NOT TO TRAVEL SOMEWHERE WE'VE GOT TO FIND A BALANCE BETWEEN LIVING VIRTUALLY AND SEEING REAL PEOPLE AGAIN. MORE REAL PEOPLE THAN THE ONES THAT YOU NORMALLY SEE. -- SOME RETURNED TO THE PHYSICAL WORK SPACE WILL BE PART OF OUR REALITY OVER THE NEXT FEW MONTHS. WE'LL SEE WHAT POLICIES COME AND I DO LOOK FORWARD TO A TIME WHEN WE CAN MEET AGAIN. MAYBE NOT IN THE MIDDLE OF WINTER WHEN IT'S SNOWING AND COLD OUTSIDE BUT IT'S BETTER THAN ALWAYS STAYING ON THE VIRTUAL SIDE. SO WE HAVE NOT BEEN AS DEMANDING OF OUR COUNCIL MEMBERS IN THE LAST YEAR SORT OF GETTING INVOLVED IN WORK GROUPS IN PART -- PENDING SOME CHANGES AS WE FINALIZE OUR REORGANIZATION. WE WILL BE ASKING YOU FOR WORK GROUPS SO STAY TUNED. AND THOSE OF YOU WHO ARE RETIRING MEMBERS ARE NOT NECESSARILY EXCUSED. WE WILL CALL ON YOU FOR SERVICE COMPONENTS IN THE FUTURE AS WELL. SO THANKS AGAIN FOR A WONDERFUL MEETING AND HOPE THAT YOU HAVE A GOOD REST OF YOUR DAY.