>> GOOD AFTERNOON AND WELCOME
EVERYONE.
I'M ELLISEO PEREZ-STABLE THE
DIRECTOR OF THE INSTITUTE OF
MINORITY HEALTH AND THANK YOU
FOR JOINING US FOR THE
DIRECTOR'S SERIES.
WE'RE OBSERVING HISPANIC
HERITAGE MONTH.
THE 2024 HERITAGE MONTH THEME IS
[SPEAKING SPANISH]
TRANSLATES TO PIONEERS OF CHANGE
SHAPING THE FUTURE TOGETHER.
THIS YEAR'S NATIONAL THEME
HIGHLIGHTS A DIVERSITY OF
HISPANIC LATINO COMMUNITIES AND
THE STRENGTH THAT COMES FROM
UNIT.
Y
UNITY.
I'M PLEASED TO INTRODUCE
DR. RUDOLPH RODRIGUEZ EXPLORING
SEGREGATION AND THE OUTCOMES ON
THE HISPANIC LATINO POPULATION.
DR. RODRIGUEZ HOLDS SEVERAL
POSITIONS AT THE UNIVERSITY OF
WASHINGTON WHERE HE IS PROFESSOR
OF MEDICINE, VICE CHAIR OF THE
DEPARTMENT OF MEDICINE.
HE PREVIOUSLY SERVED AS THE
NEPHROLOGY DIRECTOR AND THE
DIRECTOR OF HOSPITAL AND
SPECIALTY MEDICINE AT THE V.A.
AND LEADS THE V.A. PROGRAMS AND
PATIENTS HE SERVES AS THE
NEPHROLOGY BOARD CHAIR OF
MEDICINE THE BODY THAT GOVERNS
THE CERTIFICATION OF THOSE WHO
RESIDENTS TO BE BOARD CERTIFIED
IN INTERNAL MEDICINE.
NOW, DR. RODRIGUEZ WAS
PREVIOUSLY A FACULTY MEMBER OF
UNIVERSITY SAN FRANCISCO AS A
NEPHROLOGIST AT SAN FRANCISCO
HOSPITAL AND WAS MUCH LOVED
THERE AND ONES RECEIVE THE
CONSULTANT OF THE YEAR AWARD.
RECOGNIZED BY UCSF DEPARTMENT OF
MEDICINE AS A MASTER CLINICIAN
AND WAS WIDELY RECOGNIZED AS A
SPECTACULAR CLINICAL TEACHER BY
RESIDENTS, FELLOWS AND STUDENTS.
HE'S A NATIVE SAN FRANCISCAN WHO
COMPLETED HIS MEDICAL DEGREE AT
UCLA AND MET HIM AS A FOURTH
YEAR STUDENT DOING A ROTATION AT
UCSF IN 1988.
LATER CONNECTED WITH HIM AFTER
HE COMPLETED A NEPHROLOGY
FELLOWSHIP AT UCSF AND JOINED
THE FACULTY BASED AT SAN
FRANCISCO GENERAL HOSPITAL.
OF NOTE, HIS MOTHER HAD BEEN A
PATIENT IN THE PRIMARY CARE
CLINIC AT UCSF LATER UNDER THE
DIVISION OF INTERNAL MEDICINE I
WAS THE DIRECTOR OF AT UCSF.
HE'S WELL PUBLISHED, OVER 70
PAPERS.
HIS RESEARCH INTERESTS INCLUDE
VIRAL INFECTIONS IN KIDNEY
DISEASE AND THE EMPLOY OF
GEOGRAPHY, RACE, POVERTY AND
KIDNEY DISEASE AND INTEREST IN
HEALTH DISPARITIES APPLIED OUT
WITH HIS COMMITMENT TO TEACHING
ABOUT HISPANIC LATINO
POPULATIONS AND HAS A COURSE
THAT COVERS THESE TOPICS AT THE
UNIVERSITY OF WASHINGTON.
JOIN ME IN GIVING A VIRTUAL
WELCOME TO OUR HISPANIC HERITAGE
MONTH SPEAKER, DR. RUDY
RODRIGUEZ WHO WILL ADDRESS
RESIDENTIAL SEGREGATION AND
HEALTH OUTCOMES.
RUDY.
>> THANK YOU VERY MUCH AND THANK
YOU TO THE NATIONAL INSTITUTE ON
MINORITY HEALTH AND HEALTH
DISPARITIES FOR INVITING ME.
I MUST ADMIT WHEN I GOT THE
E-MAIL FROM DR. PEREZ-STABLE IT
WAS ADDRESSED TO ME BUT SAID
BECAUSE YOU'RE AN
INTERNATIONALLY RENOWNED
RESEARCHER AND HAVE A GREAT
REPUTATION.
I ASKED HIM IF HE SENT IT TO THE
RIGHT PERSON.
DON'T NECESSARY CONSIDER MYSELF
THAT BUT I'M A LITTLE TOO OLD TO
HAVE IMPOSTER SYNDROME AND I
SAID YES THOUGH WE'RE
CELEBRATING HISPANIC HERITAGE
MONTH AND I WANT TO TALK ABOUT A
TOPIC IMPORTANT TO ME,
RESIDENTIAL SEGREGATION.
TELL ME WHEN YOU CAN SEE IT.
>> WE SEE IT, OKAY.
>> GREAT.
SO I'LL TALK A LITTLE BIT ABOUT
HISPANIC POPULATION AND
SEGREGATION HAS AFFECTED MAINLY
AFRICAN AMERICAN AND HISPANIC
POPULATIONS.
THIS MAP IS FROM THE UNIVERSITY
OF VIRGINIA.
THEY NO LONGER PUBLISH THESE
BECAUSE IT WAS BASED ON THE 2010
CENSUS BUT THESE MAPS HAVE WHERE
A WHITE DOT MEANS ONE DOT
CITIZEN AND GREEN, BLACK, ASIAN
AND HISPANIC AROUND THE COUNTRY.
DISCLOSURES, I GET A SMALL
HONORARIUM AND ABIM ASKED ME TO
SHOW THE SLIDE WHEN I GIVE A
TALK AND THEY'RE DOING A LOT OF
GOOD WORK IN DIVERSITY, EQUITY
AND INCLUSION INCLUDING
ADDRESSING INTERNATIONAL MEDICAL
PROBLEMS, GETTING BETTER DATA ON
RACE AND ETHNICITY YOU, LOOKING
FOR BIAS AND OTHER INITIATIVES.
THESE ARE MY OBJECTIVES.
UNDERSTANDING HOW TO MEASURE
SEGREGATION ADDRESSING THE
IMPACT OF OUTCOMES AND THE
DISCUSSION AT THE END I'LL TAKE
HOPEFULLY THE FULL HOUR AND
SORRY ABOUT THE NUMBER OF SLIDES
BUT I'VE CREATED A FEW MAPS.
THE ROLE OF THE MEDICAL
COMMUNITY IN DISMANTLING I THINK
RESIDENTIAL SEGREGATION.
I GREW UP IN SAN FRANCISCO AND I
THINK THIS IS ONE OF THE REASONS
WHY IT'S ALWAYS BEEN AN
IMPORTANT TOPIC TO ME.
I REMEMBER GOING TO CANDLE STICK
PARK WHICH NO LONGER EXISTS
WHERE AND YOU WOULD DRIVE
THROUGH HUNTER'S POINT THE
SEGREGATED AREA PRIMARILY
AFRICAN AMERICAN AND ONE THING
ABOUT LIVING IN THESE CITIES IS
THESE AREAS EXIST BUT WE
SOMETIMES FORGET ABOUT IT AND
EVENTUALLY MY PARENTS MOVED FROM
SAN FRANCISCO AND BOUGHT A HOUSE
IN MARIN BEFORE I WENT TO HIGH
SCHOOL.
EVEN THERE THEY HAVE HOUSING --
THIS IS GOLDEN GATE CITY IN
MARIN CITY.
MARIN CITY IS ONE OF THE RICHEST
IN THE NATION BUT HAVE GOLDEN
GATE VILLAGE WHICH WAS PRIMARILY
AFRICAN AMERICAN AND STILL
EXISTS.
THE FILLMORE IN SAN FRANCISCO I
DON'T KNOW IF YOU'VE SEEN THE
MOVIE ABOUT THE FILLMORE WHICH
WAS MOSTLY AFRICAN AMERICAN AND
NOW HAS BEEN GENTRIFIED.
AND STANFORD WHERE EAST PALO
ALTO WAS NEARBY AND MOSTLY WHITE
BUT WAS PREDOMINANTLY AFRICAN
AMERICAN AND WAS THE MURDER
CAPITAL OF THE U.S. IN 1993 AND
WHEN I WENT TO MEDICAL SCHOOL
WHERE THE WATTS RIOTS OCCURRED
AND IN THE '60s AND WITH RODNEY
KING IN THE '90s AND MOSTLY
AFRICAN AMERICAN AREAS.
IT'S ALWAYS BEEN A TOPIC THAT
HAS DISTURBED ME.
SO SEGREGATION IS A PROCESS BY
WHICH POPULATION GROUP IS FORCED
INVOLUNTARILY TO CLUSTER VERSUS
AN ENCLAVE.
WE KNOW AREAS WHERE HISPANICS OR
ASIANS PLAY LIVE BUT SOME ARE
ENCLAVES WHERE IMMIGRANTS COME
TO LIVE.
IT MAY ACTUALLY BE A POSITIVE
THING VERSUS SEGREGATION.
OUT EXISTS BECAUSE OF DE JURE
MEANING LEGAL REASONS THAT
EXISTED OR FOR OTHER NON LEGAL
REASONS OR POLICY I'LL GO OVER.
I WANTED TO JUST GO OVER HOW
WE'D AMATRIX AND THE
DISSIMILARITY INDEX IS THE MOST
WAY TO MEASURE SEGREGATION AND
HIGH SEGREGATION AREA WITH THIS
INDEX WOULD MEAN FOR EXAMPLE
THIS PICTORIAL YOU'D HAVE
COMPLETE SEPARATION OF MINORITY
VERSUS MAJORITY VERSUS LOW
SEGREGATION.
THIS IS THE FORMULA HERE.
A VALUE ABOVE 60 IS CONSIDERED
HIGH LEVELS OF SEGREGATION AND
40 TO 50 MODERATE.
OTHER MEASURES ARE THE GINI
INDEX WHICH IS A DISTRIBUTION OF
INCOME AND WEALTH.
ZERO IS PERFECT EQUALITY.
1 MAY BE ONE PERSON HAS ALL THE
WEALTH COMPARED TO EVERYONE
ELSE.
THE INDEX OF CONCENTRATION OF
EXTREMES USED IN SMALLER AREAS.
THE DISSIMILARITY INDEX IS NOT
GOOD TO STUDY FOR EXAMPLE SAY
COUPLE STATES.
THIS WAS CREATED BY DOUGLAS
MASSEY AFTER 2000.
THE OTHER WAY IT'S MEASURED IS
BY RED LINING MAPS.
THIS IS -- I ENCOURAGE PEOPLE TO
GO TO MAPPING AND EQUALITY
WEBSITE AND CLICK ON THE MAPS
BECAUSE BASICALLY THE RED LINE
MAPS OF THE 1930s WILL SHOW UP.
THIS IS ONE OF LOS ANGELES AND
AGAIN THESE MAPS WERE CREATED IN
THE '30s AND I'LL GO OVER MORE
ABOUT THE MEANING BUT THE RED
LINING REFERS TO THESE RED AREAS
THAT WERE LABELLED AS AREAS THAT
PEOPLE SHOULDN'T RECEIVE LOANS
AND INVESTMENT AND THESE AREAS
IN GENERAL OVER TIME BECAME
MOSTLY AFRICAN EVEN THOUGH THEY
MAY NOT HAVE BEEN AT THE TIME.
THIS IS ONE OF THESE RED LINING
MAPS IN DETROIT.
THIS IS THE RED LINING MAP.
THIS IS A MAP I CREATED FOR THIS
TALK USING MAP TITUDE AND THE
RED LINING REFERS TO THE MAPS
AFTER THE GREAT DEPRESSION.
MORTGAGES WERE CREATED WHERE FOR
THOSE WHO BOUGHT HOMES AMORTIZED
MEANING YOU COULD SLOWLY PAY OFF
INTEREST AND THE BASE OF THE
HOUSE.
PRIOR TO THAT YOU COULDN'T DO
THAT BUT AFTER THE GREAT
DEPRESSION IS WHEN THESE LOANS
WERE AVAILABLE.
THE MAPS WERE CREATED IN 1935 TO
1940 BY THE HOMEOWNERS LOAN
CORPORATION A FEDERAL AGENCY
THAT DOESN'T EXIST ANYMORE AND
THESE ARE A SIGN THE
NEIGHBORHOODS SHOULD BE INCLUDED
IN HOME OWNERSHIP OR LENDING
PROGRAMS.
MOST WERE BLACK NEIGHBORHOODS
BUT NOT ALL.
INTERESTINGLY THE PUBLIC DIDN'T
KNOW ABOUT THESE AND WERE NOT
DISCOVERED UNTIL 1976 BY
HISTORIANS.
GENERALLY THE AREAS WERE
DEPRIVED OF INVESTMENT AND
DETORE -- DETERIORATED ONE PET
PEEVE IS WHY RED LINING EXISTS
AND IT'S SYNONYMOUS WITH ALL THE
ISSUES AND POLICIES THAT
CONTRIBUTED TO RESIDENTIAL
SEGREGATION IN THE PAST AND
TODAY WHICH I'LL COVER.
SO I ENCOURAGE PEOPLE TO GO TO
THE MAPPING INEQUALITY SITE.
IT'S EASY TO GET TO AND
BASICA
BASICALLY SUBMIT YOUR CITY AND
YOU SHOULD BE ABLE TO SEE THE
MAPS.
THIS IS ONE OF SAN FRANCISCO
WHERE I GREW UP.
I WAS TELLING PEOPLE THAT I
HADN'T REALLY LOOKED AT THE MAP
CLOSELY BUT I NOTICED MY
ELEMENTARY SCHOOL -- MY POINTER
IS NOT WORKING RIGHT NOW BUT ONE
OF THE THESE AREAS IS WHERE MY
PARENTS ORIGINALLY BOUGHT HOMES
AND A WENT TO ELEMENTARY SCHOOL.
THE AREAS MARK IN RED IN THE SAN
FRANCISCO AREA.
THIS IS ONE OF THE RED LINING
MAPS OF EL PASO.
AND AGAIN THIS WAS CREATED IN
THE '30'S AND THERE WERE FEW
AFRICAN AMERICANS IN EL PASO AT
THE TIME AS MOST THERE ON THE
RIGHT YOU SEE EL PASO TODAY.
ALL THE DARK AREAS ARE GREATER
THAN 50% HISPANIC SO IT'S BEEN
TRANSFORMED.
THE MAP ON THE BOTTOM RIGHT IS A
MAP OF A WHITE POPULATION.
YOU COULD SEE A LITTLE BIT
INCREASE NEAR THE ARMY BASE
THERE IN THE UPPER RIGHT AND ON
THE LEFT ARE STILL NOT
PREDOMINANTLY WHITE BIT A HIGHER
PERCENTAGE OF WHITE RESIDENTS.
AGAIN, JUST TO POINT WE
INTERPRET THE MAPS IT'S NOT ALL
ABOUT AFRICAN AMERICANS THOUGH
MOST OF IT IS.
AND THIS SHOWS YOU THE SHARE OF
AFRICAN AMERICANS AND THE RED
LINED AREAS.
YOU CAN SEE WHEN THEY WERE
CREATED, AFRICAN AMERICANS WERE
ABOUT 15% TO 20% IN THE
NEIGHBORHOODS.
PEAKED IN THE '70s BUT STILL
FAIRLY HIGH TODAY.
MORE IMPORTANTLY HOME OWNERSHIP
AND HOUSE VALUES YOU CAN SEE
HERE IS OBVIOUSLY THE DROP AFTER
THE HOUSING CRASH BUT PRIOR TO
THAT THE LARGE DIFFERENCES
BETWEEN AREAS MARK AS BEING
DESIRABLE WITH THE RED LINED
AREAS.
THIS IS -- SO ANOTHER WAY
SEGREGATION IS BEING MEASURED
TODAY.
YOU CAN SEE THERE'S BEEN MORE
PUBLICATIONS ABOUT RED LINING
AND THEN LOOKING AT HEALTH
OUTCOMES.
THIS IS TODAY THE MOST RECENT
CENSUS IN 2020.
THIS IS DISSIMILARITY NATURAL
GREATER THAN 40 IS MODERATE AND
THESE ARE THE HIGHLY SEGREGATED
CITIES OF TODAY.
THERE'S BEEN PROGRESS BUT NOT
MUCH.
AND JUST A REMINDER THAT EVEN
SUBURBS CAN REMAIN MODERATELY
SEGREGATED.
AFRICAN AMERICANS IN 2010 IN
SUBURBAN AREAS LIVED IN
MODERATELY SEGREGATED AREAS.
SEGREGATED SUBURBS.
THIS SHOWS HOW HARD IT IS TO GET
RID OF SEGREGATION.
THIS IS 1980s THE DISSIMILARITY
INDEX INCREDIBLY HIGH, 2020
CENSUS.
YOU CAN SEE HIGH STILL IN THE
LARGE METROPOLITAN AREAS WHERE
THERE'S ABOUT OVER 5 MILLION
AFRICAN AMERICANS COMPARED TO
THE COUNTRY OF 40 MILLION.
SO IT'S STILL THERE.
SO WHAT'S THE HISTORY?
FOR THOSE OF YOU IN D.C., WHERE
SOMETIMES I'LL FOCUS THE TALKS
AND CREATE MAPS WHERE YOU LIVE
NOT IN BETHESDA BUT D.C.
THIS IS A JACOB LAWRENCE
MIGRATION SERIES AND FEATURES A
LOT OF THE STRUGGLES THAT LED TO
SEGREGATION.
SO A LITTLE TIME LINE AND WHY
WE'LL FOCUS ON AFRICAN AMERICAN
BECAUSE OBVIOUSLY SEGREGATION IN
AFRICAN AMERICANS IS TIED TO
SLAVERY AND THE JIM CROW LAWS.
AS A REMINDER, PLESSY V.
FERGUSON FOUND SEPARATE BUT
EQUAL WAS OKAY AND JIM CROW LAWS
WEREN'T IN EFFECT UNTIL 1876
UNTIL 1965.
THE GREAT MIGRATION IS A
MOVEMENT OF 6 MILLION AFRICAN
AMERICAN OUT OF RURAL SOUTHERN
U.S. TO URBAN AREAS TO 1970.
THEN THINGS DIDN'T START TURNING
AROUND UNTIL BROWN V. BOARD OF
EDUCATION AND THE CIVIL RIGHTS
ERA INCLUDING 1968.
IT TOOK THE ASSASSINATION OF
MARTIN LUTHER KING TO PASS THE
FAIR HOUSING ACT.
THIS IS HOPEFULLY MANY OF YOU
HAVE READ THE WARMTH OF OTHER
SONS DESCRIBE THE GREAT
MIGRATION OF AFRICAN AMERICANS
TO CALIFORNIA AND SOME OF THE
OTHER LARGE URBAN AREAS.
SO WHY DOES IT EXIST?
AGAIN, IT'S NOT JUST THE RED
MAPS, THE RED LINING, IT'S
RACISM.
SO THIS IS SEGREGATION NOT BY
CHOICE.
IT WASN'T UNTIL 1917 THERE WAS A
BUCHANAN V. WARLEY MANDATING
SEGREGATION WAS UNCONSTITUTIONAL
BUT IT SKDIDN'T STOP IT AND THE
NATIONAL ASSOCIATION OF REALTOR
WASN'T UNTIL 2020 THE REALTORS
THE ASSOCIATION GAVE AN APOLOGY
FOR A LOT OF THEIR ACTIONS.
IT WAS BAKED INTO THEIR OWN
POLICIES.
REAL ESTATE AGENTS SHOULDN'T
SELL TO AFRICAN AMERICANS AND
WHITE NEIGHBORHOODS.
COUGHANCE -- COVENANTS AND THE
SUPREME COURT DIDN'T ADDRESS IT
UNTIL 1948 AND HISTORY OF
VIOLENCE I'LL TALK ABOUT.
THIS IS A MAP OF D.C.
INTERESTINGLY, WASHINGTON, D.C.
THIS IS NEAR NATIONAL MALL DID
NOT HAVE RED LINING MAPS EITHER
LOST OR DIDN'T EXIST.
IF YOU GO TO THE MAPPING
SEGREGATION WEBSITE AND LOOKED
AT RESTRICTED SUBDIVISIONS ALL
THE AREAS MARK HERE WERE AREAS
IN THE WASHINGTON, D.C. WHERE
THERE WERE COVENANTS THAT SAID
THE HOMES COULD NOT BE SOLD TO
PEOPLE OF COLOR.
THIS IS WHAT THESE LOOK LIKE IN
THE SEATTLE AREA.
FOR EXAMPLE HERE IN CAPITOL HILL
WHICH IS A NICE AREA OF SEATTLE,
SOME OF THIS WAS RECENTLY FOUND
IN SOME OF THE DEEDS STILL THERE
IN THE PAPERWORK WHERE IT SAID
THESE HOMES COULD NOT BE SOLD OR
GIVEN TO NEGROES OR ANY PERSONS
OF NEGRO BLOOD.
NOT UNTIL RECENTLY HAS THERE
BEEN A SYSTEM TO REMOVE THE
RESTRICTIVE COVENANTS.
THEY'RE NOT ENFORCED BUT IT'S
STILL SENDING A MESSAGE IN A LOT
OF THESE DEEDS AROUND THE
COUNTRY.
THIS IS WASHINGTON, D.C. AGAIN,
1970 IN THE DARKER AREAS ARE
NON-WHITE POPULATIONS.
HERE IT IS 1970 AND THIS IS A
MAP I CREATED IN THE DARKER
AREAS ARE AFRICAN AMERICAN
POPULATIONS.
HERE'S THE WASHINGTON, D.C. MALL
HERE IN THE MIDDLE.
THIS IS THE SOUTH SIDE OF
CHICAGO.
THE GREEN BEING AFRICAN AMERICAN
AND HERE AGAIN THE RED LINE MAP.
CONTRACT SALES OF HOMES WERE THE
FACT WHEN PEOPLE WERE BUYING
HOMES AFRICAN AMERICANS MANY
TIMES WEREN'T BUYING THEM IN THE
TRADITIONAL SENSE.
THEY WERE SCIENCE CONTRACTS
WHERE THEY WERE STILL
RESPONSIBLE FOR THE MAINTENANCE
OF THE HOME AND REPAIRS BUT
DIDN'T OWN THE HOME AND MANY
WOULD LOSE IT BY BEING LATE WITH
A PAYMENT BY JUST A FEW DAYS.
THAT EXISTED.
EAST PALO ALTO WHERE STANFORD
UNIVERSITY IS FACEBOOK CAMPUS
AND IT REMAINS MOSTLY MINORITY
AREA WHICH SEEMS BIZARRE AS I
MENTIONED AT THE BEGINNING OF
THE TALK BUT A GOOD EXAMPLE
BLOCK BUSTING.
ONE AREA MOVED INTO THIS ALL
WHITE AREA OF PALO ALTO AND NOW
IT'S 82% AFRICAN AMERICAN.
AND WHAT BLOCK BUSTING REFERS TO
IS REAL ESTATES WOULD GO IN AND
SCARE WHITE PEOPLE TO LEAVE AND
GET AFRICAN AMERICANS TO BIKE IN
THE AREA AND THEY WOULD SELL FOR
LOW PRICES AND THE REAL ESTATE
AGENT WOULD SELL THEM TO BLACK
PEOPLE FOR MORE EXPENSIVE AND
MANY TIMES CONTRACTS INSTEAD OF
MORTGAGES.
THIS IS TODAY.
YOU CAN SEE THIS IS A MAP OF
AFRICAN AMERICANS.
STILL REMAINS HIGHER THAN THE
SURROUNDING AREAS FOR AFRICAN
AMERICANS.
HERE ON THE RIGHT IS HISPANICS
THAT MOVED INTO A LOT OF THESE
AREAS IN CALIFORNIA INCLUDING
HERE IN EAST PALO ALTO.
AND THIS IS AN OLD DOCUMENT
SHOWING EAST PALO ALTO IN 1977
IN THE AMOUNT OF TAX REVENUE.
I STILL REMEMBER THERE IN
COLLEGE EAST PALO ALTO DID NOT
HAVE BANKS, STORES, ANYTHING
EXCEPT FOR LARGE AFRICAN
AMERICAN POPULATION.
AND OF COURSE A HISTORY OF
VIOLENCE.
WHEN BLACK FAMILIES TRIED TO
MOVE INTO WHITE NEIGHBORHOODS
THERE WOULD BE VIOLENCE.
THIS REFERS TO ANN AND CARL
BRADEN WHO WERE PROGRESSIVES WHO
BOUGHT THE HOME AND TURNED IT
OVER TO THIS FAMILY AND THE HOME
WAS DYNAMITED AND THIS HAPPENED
IN KENTUCKY.
MARTIN LUTHER KING BEFORE HE
DIED THIS IS ABOUT A YEAR AND A
HALF, HE STARTED ADDRESSING
SEGREGATION WHICH WOULD HAVE
BEEN HIS HARDEST CHALLENGE AND
WENT TO A MARCH IN CHICAGO.
HE SAID I'VE SEEN DEMONSTRATIONS
IN THE SOUTH BUT NEVER SEEN
ANYTHING SO HOSTILE OR HATEFUL
AS I'VE SEEN HERE TODAY.
THIS IS BECAUSE OF SEGREGATION
HE WAS TRYING TO FIGHT UP
CHICAGO.
SEGREGATION IN MEDICINE ALSO
EXISTED.
AND LIKE MY PET PEEVE OF THE RED
LINING IT'S MORE THAN TUSKEGEE
AND THE RESEARCH ABUSE.
FOR EXAMPLE, WHITE FEMALE NURSES
COULD NOT CARE FOR AFRICAN
AMERICAN MALE MEN AND SEPARATE
WARDS FOR BLACK AND WHITE
PATIENTS AND SEPARATE HOSPITAL
ENTRANCES.
TREATMENT WAS ABLE FOR AFRICAN
AMERICANS BUT ONLY AFTER WHITE
PATIENTS WERE TREATED.
AND THEN HOWARD AND MEHARRY
STARTED MEDICAL SCHOOLS.
LIKE SOMEONE SAID IT'S NOT
EXACTLY A SAMPLE OF FAIR CHOICE.
THERE WAS THE HILL-BURTON ACT.
THREATENING TO WITHHOLD FEDERAL
FUNDING AND STOP THE MEDICAL
SEGREGATION.
HERE'S PROGRESSIVES AND
CONSERVATIVES OVER TIME.
A REMINDER THAT WE HAVEN'T BEEN
AROUND THAT LONG AND CHANGE
MOVES SLOW BUT SOME ARE
CHANGING.
AND SO LET'S SWITCH GEARS TO THE
RESIDENTIAL SEGREGATION AND
SOCIAL DETERMINATES OF HEALTH.
A COLLEAGUE HERE WITH ONE OF HIS
PAPERS.
AGAIN SEGREGATION IS LISTED.
ONE OF MY REASONS FOR TALKING
TODAY IS I THINK RED --
RESIDENTIAL SEGREGATION AFFECTS
EDUCATION AND ALL THESE OFFICIAL
DRIVERS OF HEALTH.
I THINK IT SHOULDN'T BE LISTED
AS A SMALL PART OF WHAT IS
DRIVING THIS.
EDUCATION IS HUGE.
TODAY MORE THAN THE HALF OF
NATION'S SCHOOLS ARE IN RACIALLY
SEGREGATED CONCENTRATED
DISTRICTS.
AND SCHOOL DISTRICTS THAT
PREDOMINANTLY SERVE STUDENTS OF
COLOR RECEIVE ABOUT $23 BILLION
LESS IN FUNDING THAN MOSTLY
WHITE SCHOOLS.
AND THIS IS SOMETHING I PULLED
ABOUT WASHINGTON, D.C. PUBLIC
SCHOOLS.
THINGS LIKE THE FACT THAT BLACK
STUDENTS ON AVERAGE 4.9 GRADES
BEHIND WHITE STUDENTS IN THE
WASHINGTON, D.C. AREA MORE
LIKELY TO BE DISCIPLINED IN THE
SEGREGATION INDEX IS INCREDIBLY
HIGH IN WASHINGTON, D.C.
AND THIS IS AN INTERESTING BOOK
THAT JUST CAME OUT JONATHAN
KOZOL SADLY WROTE ABOUT THIS IN
1969 CALLED DEATH AT AN EARLY
AGE AND IS NOW 88 AND WROTE THIS
SWAN SONG AND BASICALLY HE WROTE
THE ORIGINAL BOOK AS A TEACHER
IN BOSTON IN THE '60s AND
WRITING THIS NOW AS HE SAID
PROBABLY HIS LAST BOOK BUT
INCREDIBLY DISAPPOINTED THINGS
HAVE NOT CHANGED FOR EDUCATION.
AND THIS IS NOT HARD TO LOOK AT
THE PATHWAY.
FOR EXAMPLE, MOST SCHOOLS HAD
HIGH LEAD LEVELS AND SCHOOLS
HAVE HIGH TOXIN AND THE
INFRASTRUCTURE PACKAGE THAT
ORIGINALLY HAD $100 BILLION AND
WAS REMOVED BUT LARGE AMOUNTS OF
MONEY NEEDED BY LOCAL AND STATE
GOVERNMENTS TO REBUILD SCHOOLS.
I WANTED TO GO OVER JUST AGAIN
TALKING ABOUT WEALTH, THIS IS A
FASCINATING STUDY THAT LOOKED AT
WEALTH.
SO BASICALLY THIS IS JUST THE
NUMBER OF CHILDREN WE'RE TALKING
ABOUT IS IN THE MILLIONS IN THIS
STUDY.
WHAT IT LOOKED AT IS KIDS BORN
IN THE LATE '80s AND LOOKED AT
THE PARENTAL HOUSEHOLD INCOME
AND PULLED INCOME TAX RETURNS
FOR THE PARENTS AND THEN LOOKED
AT THE CHILDREN WHEN THEY WERE
IN THEIR 30s.
AS YOU CAN SEE, AT LEAST FOR
WHITE KIDS THE MEAN PERCENTILE
RANK WAS ABOUT 57.
THE KIDS THEN WERE FAIRLY
SIMILAR FOR WHITES.
EASIER TO SEE IN THIS FIGURE
THAT COMPARED TO WHITES WHERE
THEY WERE KIND OF IN THE HIGH
50s PERCENTILE FOR HOUSEHOLD
INCOME THERE WAS ALMOST NO
INCREASE FROM AFRICAN AMERICAN
KIDS TO THE PARENTS TO WHEN GREW
UP IN THE 30s AND NOTHING FOR
AMERICAN INDIAN AND HISPANICS
DID A LITTLE BIT BETTER BUT
STILL A BIG GAP.
ANOTHER WAY TO LOOK AT IT ALSO
IS THIS IS FROM THE UP SHOT IN
THE NEW YORK TIMES LOOKING AT
THE SAME DATA.
LOOKING AT IN THE DARK PURPLE
ARE AFRICAN AMERICAN KIDS THAT
GREW UP POOR COMPARED TO WHITES.
YOU CAN SEE THE DIFFERENCES OVER
TIME.
AFRICAN AMERICAN KIDS WERE MORE
LIKELY TO REMAIN POOR, LESS
LIKELY TO BECOME A RICH ADULT
WHEN YOU LOOK AT THE DIFFERENT
QUINTILES.
WHEN YOU LOOK AT KIDS THAT GREW
UP RICH, THE OPPOSITE IS TRUE.
AFRICAN AMERICAN KIDS ARE MORE
LIKELY TO END UP POOR COMPARED
TO WHITES AND WHITE MEN.
LOOKING COMPARED TO HISPANICS
AND BLACKS, AGAIN, HISPANIC KIDS
TEND TO DO A LITTLE BIT BETTER
REACHING WEALTH OR INCOME
LEVELS, FAMILY INCOME LEVELS
SIMILAR TO WHITES.
AND THIS IS ANOTHER WAY TO LOOK
AT THE WEALTH LAG.
THIS IS MEDIUM HOUSEHOLD WEALTH
BY RACE AND EDUCATION.
AND EVEN BY ADVANCED DEGREE
REMAINS FAIRLY HUGE AND
HOUSEHOLD WEALTH IS COMPARED TO
THE AMOUNT OF MONEY PEOPLE ARE
MAKING IN THE SUBURBS.
A SEPARATE TALK TO TALK ABOUT
OUR PRISON SYSTEM AND HOW UNFAIR
IT IS AND MASS INCARCERATION FOR
LOW-LEVEL CRIMES.
THIS IS SOMETHING A CONCEPT I
DIDN'T REALIZE UNTIL I VISITED
THE EASTERN STATE PENITENTIARY
IN PHILADELPHIA AND HAD AN
EXHIBIT ON MILLION DOLLAR
BLOCKS.
A CONCEPT THAT IN MANY
SEGREGATED NEIGHBORHOODS, MANY
MEN ARE IN JAIL -- MILLIONS ARE
BEING SPENT TO INCARCERATE
PEOPLE SO IT'S A HUGE INVESTMENT
OBVIOUSLY NOT GOING INTO THESE
NEIGHBORHOODS.
OTHER THINGS TO THINK ABOUT WITH
SEGREGATION IS THIS IS SOUTH
CENTRAL L.A. KIND OF THE WATTS
AREA I TALKED ABOUT 1970s.
MOSTLY AFRICAN AMERICAN AND YOU
CAN SEE OVER TIME IT HAS DROPPED
TO ALMOST NO AFRICAN AMERICANS
IN 2017.
AND IT'S THOUGHT A LOT OF THIS
HAS TO DO WITH THE BIG INFLUX OF
HISPANICS IN THESE AREAS.
AND ALSO IT'S THOUGHT TO HAVE
CONTRIBUTED TO THE HOMELESSNESS
CRISIS IN L.A.
8% OF L.A. COUNTY POPULATION IS
BLACK.
42% OF THE HOMELESS POPULATION
IS BLACK.
AND IT'S THOUGHT L.A.'S MOSTLY
RESPONSIBLE FOR THE NATIONAL
RISE IN HOMELESSNESS.
YOU CAN SEE HERE THIS IS SKID
ROW AN ACTUAL NAME IN L.A. A
PICTURE OF IT WHERE IT'S
BASICALLY HOMELESS ENCAMPMENT
FOR BLOCKS AND BLOCKS IN THE
SKID ROW AREA OF LOS ANGELES.
THIS IS L.A. NOW.
THIS IS WATTS.
THIS IS A MAP I CREATED OF THE
HISPANIC POPULATION AND YOU CAN
SEE MANY OF THESE TRADITIONALLY
HISTORIC AFRICAN AMERICAN
NEIGHBORHOODS HAVE BECOME MOSTLY
HISPANIC.
IT'S INTERESTING BECAUSE IT'S
NOT LIKE THE NEIGHBORHOODS HAVE
BEEN UPGRADED.
IT'S GOING TO BE INTERESTING TO
SEE WHAT THE HEALTH OUTCOMES ARE
OF HISPANICS IN THESE
NEIGHBORHOODS.
SO LET'S TALK A LITTLE BIT ABOUT
THE HEALTH OUTCOME.
SO WE KNOW WELL, THAT THERE'S A
BIG GAP IN THE DEATH RATES FOR
AFRICAN AMERICANS COMPARED TO
WHITES AND OBVIOUSLY HISPANICS
NOT EVERYONE KNOWS THIS BUT
HISPANIC DEATH RATES IN GENERAL
ARE LOW COMPARED TO WHITES AND
BLACKS.
DESPITE THE FACT HISPANIC
POPULATIONS HAVE A HIGH NUMBER
OF POOR SOCIO DRIVERS OF HEALTH.
THEIR INCOME LEVELS ARE LOW.
EDUCATION LEVELS ARE LOW.
ACCESS TO INSURANCE IS LOW.
BUT STILL THEIR DEATH RATES
REMAIN LOW EXCEPT FOR HISPANICS
WITH DIABETES.
SO RESIDENTIAL SEGREGATION I
WENT GO OVER EIGHT OF THE DATA
ON THIS BUT IT'S STRONGLY
ASSOCIATED WITH THE SURVIVAL GAP
WE SEE WITH WHITES AND BLACK AND
NOT FULLY EXPLAINED BY SOCIO
ECONOMIC INEQUITY.
THERE ARE PAPERS SHOWING THERE'S
CHANGES IN BLOOD PRESSURE WITH
HIGHER SEGREGATION, HIGHER
INCIDENT OF CARDIOVASCULAR
DISEASE, LUNG CANCER MORTALITY,
IT'S TIED TO POLICE SHOOTINGS,
FIREARM, HOMICIDES.
TIED TO AIR POLLUTION, TO THE
BURDEN OF CLIMATE CHANGE, TO
BLOOD LEAD LEVELS AND EVEN COVID
OUTCOMES.
I PULLED SOME RECENT PARTICLES
THAT CAME UP I DIDN'T HAVE TIME
TO REALLY LOOK AT DEEPLY BUT
LOOKED AT RED LINING AND THE
INCIDENTS OF DIABETES AND RED
LINING IS ASSOCIATED WITH ALL
THESE FACTORS AND DIABETES
PREVALENCE.
SO A LITTLE BIT OF TRYING TO
LOOK INTO CDC DATA.
THIS IS ANOTHER ONE RECENTLY
PUBLISHED IN THE AANNALS OF
INTERNAL MEDICINE AND LOOKING AT
THE AREAS AND SEEING THE MODEL
SHOWED THERE'S A CORRELATION
WITH PRESENT DAY NON-SUICIDE
FIREARM FATALITIES IN SEGREGATED
AREAS.
AND THIS LOOKS OVER ALL THE
WHITE-BLACK SURVIVAL.
THE CHANGES IN BLACK-WHITE
SURVIVAL FROM A DISSIMILARITY
INDEX AND IF YOU LOOK UNDER MEN,
THIS DIFFERENCE WAS ATTENUATED
IN THOSE DIFFERENT MODELS WHEN
YOU STARTED ADDING SOCIO
ECONOMIC VARIABLES BUT DID NOT
GO AWAY.
SO, SEGREGATION IS TIED TO THIS
WHITE-BLACK SURVIVAL GAP.
IN WASHINGTON, D.C. IT'S
INTERESTING, AGAIN, TRYING TO
PULL FROM LOCAL DATA BUT THIS
LOOKS AT MALES HERE.
THIS LOOKS AT FEMALES ON THE
RIGHT.
THESE ARE WHITE MEALS.
LIFE EXPECTANCY OF WASHINGTON,
D.C. WHITE MALES IS VERY HIGH.
THIS IS A U.S. FOR WHITE MALES.
FOR AFRICAN AMERICANS THOUGH
AROUND THE NATION IT'S ABOUT 72
BUT IN WASHINGTON, D.C. IT'S
MUCH LOWER.
THE SAME FOR WOMEN IT'S KIND OF
LOWER BUT DON'T KNOW WHY LIFE
EXPECTANCY IS SO HIGH FOR WHITE
MEN IN D.C. BUT FOR BLACK MEN
IT'S LOWER THAN EVEN THE
NATIONAL AVERAGES INCLUDING FOR
WOMEN.
THIS PAPER TO -- TRIED TO LOOK
AT CONTRIBUTORS.
ON THE LEFT ARE MALES.
ON THE RIGHT ARE FEMALES.
FOR MEN, PART OF THE
CONTRIBUTION TO THE GAP IN
SURVIVAL WAS HEART DISEASE.
HOMICIDES FOR YOUNG MEN, CANCER,
UNINTENTIONAL INJURIES AND FOR
WOMEN A LOT OF IT HAD TO DO WITH
HEART DISEASE AND NEOPLASMS.
THE SOCIAL DETERMINATES OF
HEALTH IN MOSTLY AFRICAN
AMERICAN AREAS HERE IN D.C. IN
THE EAST AND SOUTH.
AGAIN, THIS IS LOOKING AT LIFE
EXPECTANCY.
HERE IN THE MOSTLY WHITE AREAS
IT'S AGAIN VERY HIGH.
KIND OF IN THE '80s.
IN THE AREAS OF SEGREGATION IT'S
MUCH LOWER.
YOU LOOK AT PEOPLE LIVING IN
POVERTY IT'S HIGHEST IN THE
AFRICAN AREAS.
IF YOU LOOK AT UNEMPLOYMENT
RATES IT'S MOSTLY HIGH IN THE
AFRICAN AMERICAN SEGREGATED
AREAS.
IF YOU LOOK AT INCOME, IT'S
LOWEST IN THESE AREAS.
IF YOU LOOK AT PUBLIC
ASSISTANCE, IT'S LOWEST IN THESE
AREAS.
HEALTH INSURANCE COVERAGE IS
LOWER IN THESE AREAS.
IF YOU LOOK AT VIOLENT DEATH
RATES AGAIN HIGHER IN THESE
AREAS.
SO, IT'S VERY STRIKING WHEN YOU
LOOK AT THE MAPS.
LET ME SWITCH GEARS AND TALK A
LITTLE BIT ABOUT MY FIELD WHICH
IS LOOKING AT KIDNEY DISEASE AND
LOOKING AT THE PREVALENCE OF END
STAGE RENAL DISEASE.
MANY OF YOU KNOW THE PREVALENCE
OF END STAGE RENAL DISEASE IS
HIGHEST AMONG AFRICAN AMERICANS
OVER 6,000 PER MILLION CASES.
AND HERE IT IS FOR WHITES MORE
LIKE 1,000.
INCIDENT RATE HIGH FOR AFRICAN
AMERICANS ABOUT 600.
HISPANIC RATES ARE SOMEWHERE IN
BETWEEN.
THIS IS A PAPER THAT THEN LOOKED
AT THE RED LINE DISTRICTS.
I THINK THAT'S WHY IT'S
INTERESTING.
WE LOOKED AGAIN AT THE DATA I
SHOWED.
JUST REMEMBER THAT TO BE ON
DIALYSIS YOU'RE ALMOST ALWAYS
COVERED ON MEDICARE AND HAVE
FANTASTIC DATA OF PATIENTS ON
DIALYSIS AND LOOKING AT DATA AT
PATIENTS FROM 2012 TO 2019, THEY
LOOKED AT PATIENTS WHO LIVED IN
THE FORMER RED LINE AREAS AND
LOOKED AT AGE-ADJUSTED
DIFFERENCES AND END STABLE RENAL
DISEASE RATES.
INTERESTINGLY IT WAS
SIGNIFICANT.
HIGHER RATES OF INCIDENTS OF END
STAGE RENAL DISEASE MEANING YOU
NEED DIALYSIS OR NEED TO GET
TRANSPLANTED FOR ALL PATIENTS.
TRUE FOR BLACK PATIENTS.
TRUE FOR HISPANIC PATIENTS
LIVING IN THESE NEIGHBORHOODS.
TRUE FOR ASIAN PARENTS LIVING IN
THESE AREAS AND FOR WHITE
PATIENTS LIVING IN THESE AREAS
THAT ARE FORMERLY RED LINED.
THIS PAPER LOOKED AT TRANSPLANT
WHICH IS ANOTHER AREA OF
DISPARITIES IN NEPHROLOGY.
IT DID USE THE INDEX OF
CONCENTRATION AT THE EXTREMES
WHICH IS APPROPRIATE BECAUSE IT
WAS JUST DONE IN GEORGIA, NORTH
CAROLINA AND SOUTH CAROLINA.
THEY SAW AT THE DIFFERENT STEPS
OF TRANSPLANT REFERRAL, REFERRAL
FOR KIDNEY TRANSPLANT,
WAIT-LISTED, THAT IN
PREDOMINANTLY BLACK
NEIGHBORHOODS REFERRAL FOR
KIDNEY TRANSPLANT WAS LOWER TO
BE WAIT-LISTED RATES WERE LOWER
AND ALSO RECEIVING A LIVING
DONATED KIDNEY TRANSPLANT WERE
LOWER.
AGAIN AN IMPORTANT WAY TO LOOK
AT THIS AND TRYING TO FIGURE OUT
HOW TO ADDRESS THESE ISSUES.
ANOTHER AREA OF DISPARITIES IN
NEPHROLOGY IS HOME DIALYSIS AND
TRANSPLANT.
THIS IS ALL PATIENTS IN THE
COUNTRY IN 2021 WITH END STAGE
RENAL DISEASE AND THE GREEN ARE
TRANSPLANT PATIENTS AND WHITES
AND BLACKS AND HISPANICS.
VISUALLY YOU CAN SEE WHITES HAVE
A LARGER PERCENTAGE THAN
TRANSPLANTED.
LARGER PERCENTAGE ON PERITINEAL
DIALYSIS AND LOOKING AT BLACKS
AND HISPANICS AND NATIVE
AMERICANS.
THIS IS A PAPER I WROTE IN 2007.
WE LOOKED AT ALL PATIENTS ON
DIALYSIS.
ONE OF THE STRONGEST FINDINGS WE
FOUND WAS TRANSPLANT.
THESE ARE PERCENTAGE OF PATIENTS
THAT DID NOT RECEIVE A
TRANSPLANT.
HERE'S THE HIGHEST RATE AND THE
DIALYSIS PATIENTS WERE WHITE OR
BLACK PATIENTS WHO LIVED IN
PREDOMINANTLY BLACK
NEIGHBORHOODS PER ZIP CODE.
WE ALSO LOOKED AT QUALITY
STATISTICS AND DIALYSIS AREAS
FOUND IN PREDOMINANTLY BLACK
NEIGHBORHOODS AN HOME-BASED
THERAPIES WERE LESS LIKELY TO BE
OFFERED AND SURVIVAL WORSE.
MORE UNITS HAD STANDARD
MORTALITY RATIOS HIGHER THAN
EXPECTED IN SOME OF THESE AREAS.
PAUL KIMALL REPEATED A STUDY
SIMILAR TO WHAT WE DID BUT
MEASURED IT BY THE DISSIMILARITY
INDEX AND THE GINI INDEX WHICH
IS ABOUT INCOME.
THERE WASN'T A BIG DIFFERENCE
WITH INCOME BUT LOOKING AT
AFRICAN AMERICAN PATIENTS ON
HEMOOO -- HEMODIALYSIS AND THE
MORE SEGREGATED THE NEIGHBORHOOD
THE MORE MORTALITY.
I WROTE THIS PAPER ABOUT LOOKING
AT RACIAL DISPARITIES AND HEALTH
OUTCOMES WHICH IS SOMETHING I
CONTINUE TO BE VERY INTERESTED
IN.
THIS IS -- YOU CAN EASILY MAP
NEIGHBORHOODS AND LOOK AT FOR
EXAMPLE FIVE-STAR FACILITIES IN
CHICAGO IS WHAT I'M LOOKING AT
HERE.
THIS IS SOUTH SCENTRAL CHICAGO
AND THE WEST SIDE WHERE MORE
FACILITIES SEEM TO BE FOUND IN
THESE NON-AGGREGATED AREAS.
JUST WANT IT SHOW YOU SOME MAPS
OF HOW THIS COULD BE USED.
THIS IS A MAP I CREATED OF ALL
THE DIALYSIS UNITS ACROSS THE
COUNTRY.
YOU CAN DOWNLOAD THIS DATA
EASILY OFF THE CMS COMPARE
WEBSITE.
THIS IS WASHINGTON, D.C. AND ALL
THE DIALYSIS UNITS IN THE
WASHINGTON, D.C. AREA.
HERE'S THE WASHINGTON MALL.
YOU CAN SEE THIS IS A LARGE
AFRICAN AMERICAN COMMUNITY AND
IT MAKES SENSE YOU CAN HAVE A
LOT OF DIALYSIS UNITS THERE
BECAUSE 30% OF ALL PEOPLE ON
HEMODIALYSIS ARE AFRICAN
AMERICAN SO IT MAKES SENSE IT
WILL BE THERE.
HERE'S A WAY TO MAP THESE AND
LOOKING IN RED ARE FIVE-STAR
FACILITIES.
HIGHEST QUALITY AND SHOWS YOU
WHERE THE RED ONES CAN BE FOUND.
MOST OF YOU KNOW THESE
NEIGHBORHOODS BETTER THAN ME.
AND THIS IS AGAIN THE
WASHINGTON, D.C. AREA AND
WASHINGTON MALL.
THESE ARE DIALYSIS UNITS THAT
HAVE BETTER THAN EXPECTED WITH
BLUE ARROW POINTING UP AND RED
POINTING DOWN ARE DIALYSIS UNITS
WHERE THE SURVIVAL IS WORSE THAN
EXPECTED.
I JUST CREATED THESE OUT OF
INTEREST TO SHOW YOU.
THIS IS CALIFORNIA AND THIS IS
AGAIN DOWN IN THE WATTS AREA.
THIS IS WATTS HERE.
YOU CAN SEE IT'S INTERESTING
WHEN I LOOKED AT THIS DATA, THE
ARROWS POINTING DOWN ARE WORSE
THAN EXPECTED SURVIVAL IN THE
DIALYSIS PATIENTS.
THESE ARE BEVERLY HILLS OVER
HERE.
AND AGAIN THIS IS OUR HOME
DIALYSIS -- THESE ARE UNITS WITH
THE STARS THAT OFFER THOSE THAT
DON
DON'T.
AND I MAP I CREATED OF PUERTO
RICO.
THIS ISN'T PUBLISHED BUT IT'S
INTERESTING AND I WAS SURPRISED
MOST THE DIALYSIS UNITS HAVE
WORSE THAN EXPECTED MORTALITY
RATES.
SOME PAPERS HAVE BEEN PUBLISHED
SO JUST ABOUT THE MORTALITY
RATES THAT DIALYSIS PATIENTS BUT
I HAVEN'T REALLY LOOKED INTO WHY
THIS IS.
37 WORSE THAN EXPECTED MORTALITY
DIALYSIS UNITS OUT OF 7,726.
485 UNITS HAVE WORSE THAN
EXPECTED MORTALITY.
37 OF THEM WERE IN PUERTO RICO
OR 6%.
SO, I WENT THROUGH THAT PRETTY
QUICKLY.
I THINK THE HARDEST PART AND
BIGGEST CRITICISM I ALWAYS GET
WHEN I GIVE THE TALK OR ANYONE
WRITES BOOKS ABOUT THIS IS HOW
ARE YOU GOING TO ADDRESS THE
PROBLEM?
I GUESS THIS IS WHY I'D LIKE
DISCUSSION AT THE END NOT TO
REALLY FOCUS -- AGAIN, I'M NOT A
RESEARCHER OR CONSIDER MYSELF A
RESEARCHER, NOT NECESSARILY
ABOUT THE STUDIES AND METHODS
BUT HOW CAN THIS BE CHANGED FROM
A POLICY STANDPOINT.
I HOPE I'VE SHOWN YOU A LITTLE
BIT ABOUT HOW SEGREGATION IS
TIED TO ALL THE ISSUES ON HERE,
MASS INCARCERATION, POOR
EDUCATION AND WEALTH.
HOW IS THAT GOING TO BE
ADDRESSED?
AND YOU HAVEN'T READ THE COLOR
OF LAW, IT'S A FANTASTIC BOOK TO
READ BY RICHARD ROTHSTEIN IS EYE
OPENING TO READ HIS BOOK AND
THEN GOT THE SAME CRITICISM SO
NOW WHAT ARE YOU GOING TO DO
ABOUT IT AND WHAT SHOULD WE DO?
HE TEAMED UP WITH HIS DAUGHTER
WHO HAPPENS TO BE AN EXPERT IN
HOUSING POLICY AND WROTE THE
BOOK CALLED JUST ACTION WHICH
CAME OUT LAST YEAR.
THE BOOK WHICH I READ IN
PREPARATION FOR THIS TALK THESE
ARE SOME OF THE CHAPTERS ABOUT
LAYING THE GROUND WORK.
EXPANDING HOUSING OPPORTUNITIES
EVERYWHERE.
ADDRESSING THE LACK OF
GENERATIONAL WEALTH, CREDIT
SCORES, EDUCATION ON HOME
BUYING, ADDRESSING AFFORDABLE
HOUSING FOR MODERATE INCOME
HOUSEHOLDS.
ONE OF THE POINTS SHE MAKES IS
ABOUT AFRICAN AMERICANS IS EVEN
MODERATE INCOME HOUSEHOLDS ARE
LIVING IN THESE NEIGHBORHOODS.
SO IT'S NOT ALL ABOUT POOR
AFRICAN AMERICANS.
THOUGH THE POOR AFRICAN
AMERICANS THE RATE OF POVERTY IS
THREE TIMES THAT OF WHITE IT'S
NOT HUGE.
THIS IS AN ISSUE FOR MODERATE
INCOME HOUSEHOLDS ALSO.
SHE SPENT SOME TIME TALKING
ABOUT INVESTING IN SEGREGATION
IN BLACK NEIGHBORHOODS.
CONSCIENTIOUS GENTRIFICATION
INCLUDING INCLUSIONARY ZONING
INCLUDING MAKING SURE WAYS
PEOPLE CAN STAY IN THEIR HOMES
AND AREN'T PRICED OUT AND RENT
REGULATION AND JUST CAUSE
EVICTIONS.
MEANING NOT TO EVICT PEOPLE JUST
BECAUSE THEY'RE LATE BY A FEW
DAYS FOR PAYMENT BUT HAVE A JUST
CAUSE FOR RENTERS AND BAN THE
BOX.
SAYING IF YOU HAVE COMMITTED A
CRIME IN THE PAST TO CHECK THIS
BOX.
EVEN IF YOU HAVEN'T BEEN
CONVICTED WHICH IS THE CURRENT
SITUATION.
SHE TALKED A LITTLE BIT ABOUT
PROPERTY ASSESSMENT, LINE TRUST,
CONTRACT SALES.
IT GOES ON AND ON.
THERE'S A LOT OF POLICY IN THIS
AND AGAIN THAT'S PART OF WHAT
I'D LIKE TO TALK ABOUT.
IN THE END IS WHAT'S OUR ROLE.
WHAT'S THE ROLE OF THE INSTITUTE
OF NIH AND INSTITUTE OF V.A. TO
SOME OF THESE THINGS.
IT IS FRUSTRATING BECAUSE AS
I'VE SHOWN SEGREGATION HAS NOT
CHANGED DRAMATICALLY OVER TIME.
AND IT'S REALLY TIED TO A LOT OF
OUR HEALTH OUTCOMES.
ONE THING ABOUT THE 1968 FEDERAL
FAIR HOUSING ACT IS THAT IT
DIDN'T HAVE TEETH TO IT.
PART OF THE ACT WAS SOMETHING
CALLED AFFIRMATIVELY FURTHERING
FAIR HOUSING AND IT WASN'T UNTIL
THE OBAMA ADMINISTRATION HAD A
RULE IN PLACE TO BE ROLLED OUT
TO TRY TO KEEP COMMUNITIES AND
HOLD THEM TO ACCOUNT TO TRY TO
ADDRESS SEGREGATION.
UNFORTUNATELY THE LAST
ADMINISTRATION RESCINDED THE
RULE AND AS YOU REMEMBER BEN
CARSON WAS THE HOUSING SECRETARY
BACK THEN WHO THOUGHT THE RULE
WAS MANDATING SOCIAL ENGINEERING
SCHEME OR FAILED SOCIAL.
THE BIDEN ADMINISTRATION HAS
BEEN WORKING ON IT BUT
UNFORTUNATELY IT STILL HASN'T
BEEN ROLLED OUT.
HOPEFULLY THAT'S NOT BECAUSE OF
POLITICS.
WE'RE STILL WAITING FOR THE
AFFIRMATIVE FURTHERING HOUSE ACT
RULE TO GO IN EFFECT WHICH WILL
PROBABLY BE IMPORTANT TO ADDRESS
SEGREGATION.
OTHER CITIES ARE COMING OUT WITH
THEIR OWN BLUEPRINTS HOW TO
ADDRESS THIS AND THE COST OF
SEGREGATION.
THE BOOK I JUST TALKED ABOUT
FEATURED AN ARTIST WHO HAD A
PROJECT WHO CALLED THE FOLDED
MAP PROJECT FOLDING THE MAP OF
CHICAGO, THE SOUTH SIDE, NORTH
SIDE MATCHING HOMES WHICH ARE
WHITE AND BLACK AND TRYING TO
GET THOSE PEOPLE TO TALK TO EACH
OTHER.
THAT'S WHAT SHE MEANT BY LAYING
THE GROUND WORK IN HER BOOK.
SHE ALSO PUT SIGNS IN THESE
HOMES IN WHICH IS WHICH WERE
FORMALLY CONTRACT BUYING HOMES
WHERE PEOPLE THOUGHT THEY WERE
BUYING THE HOME OUT INSTEAD WERE
SIGNING THE CONTRACT AND THEN
LOST THEIR HOMES BECAUSE OF
STIPULATIONS OF THE CONTRACTS.
UNFORTUNATELY THIS IS AGAIN I
THINK PART OF WHY I DON'T LIKE
THE TERM RED LINING BECAUSE IT'S
A HISTORICAL.
THE MAPS WERE DRAWN IN THE '30s
AND '50s AND SEE THE ARTICLE
FROM AUGUST 13 OF THIS YEAR AND
THE CONSUMER AGENCY HAD A
CRACKDOWN ON THE CONTRACT TO
DEED HOME SALES.
THIS IS SOMETHING THAT HAPPENED
AFTER THE 2008 HOUSING CRASH
WHERE HOMES OF MINORITY
POPULATIONS WERE TARGETED AGAIN
TO BUY HOMES THEY EVENTUALLY
LOST.
NOT BY HOMEOWNERS THAT WERE
SELLING THEIR HOMES BUT
BUSINESSES THAT WERE BUYING
MASSIVE AMOUNTS OF HOMES THAT
LAD BEEN FORECLOSED AND SELLING
THEM TO POOR POPULATIONS ON THE
CONTRACTS.
AGAIN THESE HOME APPRAISAL
PROBLEMS WHERE THERE'S BIAS ON A
HOME APPRAISAL DEPENDING ON
WHETHER THE HOME OWNER IS WHITE
OR BLACK IS NOT FROM -- THIS IS
FROM NOVEMBER OF 2022.
OTHER MOVEMENTS ARE THINGS LIKE
THE YES IN MY BACK YARD.
THE REASON THINGS DON'T CHANGE
IS PEOPLE ARE PART OF THE NO,
NOT IN MY BACK YARD.
SO NO ONE WANTS BUILDINGS
MULTI-FAMILY HOMES BUILD IN
THEIR NEIGHBORHOODS.
THIS IS AN INTERESTING BOOK
ABOUT THE CALIFORNIA FIGHT.
ONE OF THE REASONS THERE'S SO
MUCH HOMELESSNESS IS THERE
AREN'T ENOUGH HOUSES IN
CALIFORNIA FOR EVERYONE.
AND IT TELLS THE STORY OF HOW
THE TOWN IN LAFAYETTE NEAR A
HIGHWAY AND NEAR PUBLIC
TRANSPORTATION, THE COMMUNITY,
WHICH WAS INCORPORATED SO THEY
CAN RESIST THESE CHANGES REALLY
FOUGHT AGAINST APARTMENT
BUILDINGS AND MULTI-FAMILY HOMES
TO BE BUILT NEAR THE FREEWAY
BECAUSE IT WOULD GOING TO CHANGE
THE CHARACTER OF THEIR
NEIGHBORHOOD.
THE YES IN MY BACK YARD MOVEMENT
IS TO HAVE ACTIVISTS SHOW UP AT
THE HEARINGS AND TALK ABOUT WHY
IT'S SO IMPORTANT TO BUILD NEW
HOMES.
NOT JUST TO FIGHT SEGREGATION
BUT TO FIGHT HOMELESSNESS AND
THE NEED FOR HOMES IN THIS BIG
CITIES.
SINGLE FAMILY ZONING IS
IMPORTANT.
OVER 70% OF ALL HOMES IN THE
U.S. ARE IN SINGLE FAMILY ZONING
AREAS.
WHICH OF COURSE MAKES IT HARD
FOR PEOPLE TO MOVE OUT OF POORER
AREAS IF YOU CAN MOVE INTO AN
APARTMENT OR AFFORDABLE HOUSING.
AND MINNEAPOLIS IS ONE WHERE
THEY GOT RID OF A LOT OF THEIR
SINGLE FAMILY ZONING AND THESE
ARE FOUGHT IN A LOT OF AREAS.
GENTRIFICATION HERE IN SEATTLE
IS VERY GENTRIFYGENTRIFYING.
AND THERE WERE STIPULATIONS
WHERE IF YOU COULD PROVE YOUR
FAMILY LIVED IN THAT DISTRICT
YOU COULD HAVE ACCESS TO LOWER
COST HOUSING.
THAT'S ONE OF THE WAYS IT FIGHT
THE GENTRIFICATION.
THERE'S A LOT OF RACISM TODAY
AND THESE ARE SOME EXAMPLES.
SEATTLE RIGHTS GO INTO TESTING
RENTAL MARKETS AND TESTERS WHICH
MEANS A WHITE AND BLACK TESTER
WITH THE SAME RESUME WILL GO
LOOK AT A HOUSE, THE SAME
ECONOMIC BACKGROUND BUT IF IT'S
A BLACK PERSON THEY'RE LESS
LIKELY TO BE OFFERED RENTAL
HOUSING AND AGAIN THIS IS NOT
THAT LONG AGO.
THIS IS WHY IT'S SO HARD TO
BREAK DOWN THE CURRENT SITUATION
WITH SEGREGATION AROUND THE
COUNTRY.
SCHOOLS, SOMETHING ELSE TO THINK
ABOUT.
WE'VE ALL GONE TO PTA AND HAVE A
FUNDRAISER.
PTAs AROUND THE COUNTRY.
SO IF YOU LIVE IN A WEALTHY
NEIGHBORHOOD IN NEW YORK, THESE
WEALTHY NEIGHBORHOODS RAISE
ABOUT $1.7 MILLION MORE THAN
LOW-POVERTY AREAS.
MORE THAN 1800 PER STUDENT IN
THE ONE SCHOOL.
AND THE LOW POVERTY AREA.
SOMETHING TO THINK ABOUT WHEN
YOU'RE AT YOUR AUCTION, AT
YOUR-PTA AT YOUR SCHOOL AND
DONATING MONEY THAT MAYBE OTHER
SCHOOLS NEED IT MORE THAN SOME
OF THE NEIGHBORHOODS OF URBAN
SCHOOLS.
PERSONALLY, WHAT I'D LIKE OUR
DISCUSSION TO FOCUS ON IS HOW
CAN HEALTH SYSTEMS, HOW CAN THE
NIH ADDRESS THESE INEQUITIES
BESIDES DOCUMENTING IT?
WE ALSO ARE CELEBRATING 20 YEARS
SINCE THE INSTITUTE OF MEDICINE
REPORT CAME OUT ON HEALTH
INEQUITIES AND I REMEMBER THE
MESSAGE BACK IN 2003 WAS IT'S
TIME TO MOVE AWAY FROM
DOCUMENTING THESE HEALTH
INEQUITIES AND DO SOMETHING
ABOUT IT.
BUT AGAIN 20 YEARS LATER I THINK
WE'VE MADE PROGRESS BUT NOT A
LOT AND DIALYSIS, I COMPARED
IT'S IMPORTANT TO LOOK AT THE
TOOLS WE HAVE TO ADDRESS MORE
OUTCOMES IN SEGREGATED OR UNDER
SERVED NEIGHBORHOODS.
AND BLUE CROSS AND BLUE SHIELD
CAME OUT WITH A PLAN HOW THEY
WANTED TO ADDRESS SOME OF THE
HEALTH INEQUITIES.
THE V.A.s DOING A FAIR AMOUNT.
THE OFFICE OF HEALTH EQUITY HAS
COME OUT WITH HEALTH EQUITY
DASHBOARDS OF PRIMARY CARE
PHYSICIANS.
AND HOPEFULLY NOW THEY'RE BEING
USED AND PILOTED TO ADDRESS
HEALTH METRICS ESPECIALLY AND
THE DASHBOARD LET'S YOU ZONE IN
ON RURAL AREAS, PREDOMINANTLY
AFRICAN AMERICAN AND POVERTY
AREAS AND WE CONTINUE IN THE
V.A. OR NATIONALLY TO TRY TO
INCREASE ACCESS TO HOME DIALYSIS
AND TRANSPLANTATION ESPECIALLY
IN THESE AGGREGATED AREAS.
I'LL END WITH THIS WHICH IS A
BIG MAN OF EDDIE GLAUDE A
PROFESSOR AT PRINCETON.
HE WAS AN MSNBC AFTER THE EL
PASO WAL-MART SHOOTING HE TALKED
ABOUT THIS IS US AND IF WE'RE
GOING TO GET PAST THIS WE CAN'T
BLAME IT ON HIM PEOPLE WE THINK
OF RACIST.
WE HAVE TO ADDRESS THIS IN ALL
OF US WHICH COMES TO MIND WHEN I
THINK ABOUT LIKE I SAID THE
HOUSING ZONING LAWS AND WHEN
IT'S IN OUR BACK YARD WE HAVE TO
KIND OF LOOK AT OURSELVES
SOMETIMES TO ADDRESS THIS IN THE
LONG RUN.
THR
THESE ARE SOME OF THE BOOKS I
READ FOR THIS TALK AND SOME OF
MY REFERENCES AND IT'S THE TOP
OF THE HOUR.
HOPEFULLY WE CAN HAVE A
DISCUSSION HOW HEALTH SYSTEMS
CAN ADDRESS THIS, MED SCHOOLS,
HOW THE INSTITUTE CAN ADDRESS
IT.
I LOOKED AT THE STRATEGIC PLAN.
I SAW SOME OF THIS IS ON IT TO
START ADDRESSING IT INCLUDING
YOUR COMMUNITY PARTNERSHIPS.
NIDDK HAD A WORKSHOP DESIGNING
INTERVENTIONS TO ADDRESS
STRUCTURAL RACISM AND I
PARTICIPATED AND GAVE A 10
MINUTE OF THIS TALK DURING THE
WORKSHOP AND CAME UP WITH SOME
AREAS AND PROMOTING STRUCTURAL
INTERVENTIONS LIKE HOUSING,
PROMOTING EFFECTIVE COMMUNITY
ENGAGEMENT ALSO TO START
ADDRESSING SOME OF THESE.
THAT IS MY TALK.
ENDING RIGHT AROUND 12:00 SO
THANK YOU FOR THAT AND HOPE TO
HAVE A DISCUSSION.
>> THANK YOU, SO MUCH, RUDY.
YOU CAN ASK QUESTIONS AND I
GUESS GINA WILL GIVE US TO ME
BECAUSE WE'RE ON VIDEOCAST.
THE AUDIENCE HERE ARE LIMITED.
I WANTED TO GET YOUR REFLECTIONS
AND THANK YOU FOR THAT TALK.
FIRST, ONE CAN GET THE SENSE
FROM LISTENING TO THESE HISTORY
OF ALMOST 100 YEARS OF
RESIDENTIAL SEGREGATION AND ALL
THE SEQUENCES, LIVING IN A
SEGREGATED NEIGHBORHOOD IS SORT
OF LIKE YOUR DESTINED TO DO NOT
WELL.
YOU'RE POOR, EVEN IF YOU'RE NOT
POOR, YOUR HEALTH IS WORSE.
LIFE EXPECTANCY.
IS THIS LIKE A DESTINY PEOPLE
HAVE OR ARE THERE WAYS -- IS
BEING POOR ALWAYS GOING TO BE
NOT BEING HEALTHY?
>> AGAIN, IT'S A BIG DRIVER.
THAT'S A POINT MADE IN THE BOOK
THAT IT ISN'T THAT WOE PROBABLY
NEED TO DISMANTLE ALL THE
DIFFERENCE.
THE NEIGHBORHOODS JUST NEED A
HUGE AMOUNT OF INVESTMENT AND I
THINK THE DESCRIPTION ABOUT SOME
MUCH THESE SCHOOLS IN THESE
AREAS ARE HORRIBLE.
THE DESCRIPTION OF THE
BATHROOMS, THE DESCRIPTION OF
THE PAINT AND TO ADDRESS THAT
FOR EXAMPLE WHEN CONGRESS WAS
GOING TO PASS INFRASTRUCTURE
BILL IT WOULD HAVE TAKEN $100
BEEN.
THAT'S WHAT THEY ARE WERE GOING
TO INCLUDE BEFORE IT WAS
REMOVED.
THIS KIND OF INVESTMENTS ARE
ALWAYS FOUGHT AT THE LAST MINUTE
AND TURN TO YOU TO THINK HOW TO
CHANGE THAT.
IN THESE AREAS THAT ARE THAT
POOR WITH HORRIBLE SCHOOLS
BECAUSE IT'S NOT TRUE OF ALL
THESE AREAS.
SOME AREAS ARE GENTRIFYING
BECOMING AREAS ATTRACTING MIDDLE
CLASS, WHITES AND AFRICAN
AMERICANS TO MOVE IN AND THINGS
WILL CHANGE OVER TIME BUT IN
OTHER AREAS IN CITIES I
MENTIONED THERE'S A LARGE
INVESTMENT AND SOMETIMES IT'S
IMPORTANT TO LOOK AT YOUR OWN
CITY BECAUSE I THINK THE STORY
OF SEGREGATION IS VERY DIFFERENT
IN EACH OF THESE CITIES.
SO IT'S HARD TO TALK ABOUT
NATIONALLY.
I WOULD SAY IT'S TRUE IN CERTAIN
NEIGHBORHOODS BUT SO FAR BEHIND
YOU NEED A MASSIVE AMOUNT OF
INVESTMENT.
>> RIGHT, TO RENOVATE, I
UNDERSTAND.
BUT MY QUESTION OR POINT IS
PEOPLE WHO LIVE IN POOR AREAS
CAN STILL HAVE GOOD REASONABLE
HEALTH.
IT'S NOT YOUR DESTINY YOU'RE
ALWAYS GOING TO BE UNHEALTHY IN
THESE AREAS.
ONE OF THE APPROACHES MIGHT
RELATE TO WELL SOME RESOURCES IS
CORRECT BUT ALSO COMMUNITY
ENGAGEMENT AND BEING ABLE TO
CREATE HEALTHIER COMMUNITIES
WITH APPROPRIATE LEADERSHIP
WITHIN THE COMMUNITY.
>> I AGREE.
I DIDN'T HIGHLIGHT A LOT OF
THINGS THAT HAVE BEEN DONE BUT
WE HEARD OF INITIATIVES OF
HEALTHY EATING IN SOME
NEIGHBORHOODS BECAUSE IT'S HARD
TO HAVE GOOD HEALTH WHEN YOU
LIVE IN THESE DESERTS.
THERE'S A LOT OF INTERVENTIONS.
I'M THINKING ABOUT IT IN A BROAD
PERSPECTIVE OF TURNING THIS
AROUND TAKE SOME HUGE INVESTMENT
BUT OBVIOUSLY A LOT OF GOOD WORK
IS BEING DONE TO ADDRESS SOME OF
THESE THINGS LIKE FOOD AND OTHER
THINGS.
>> AND THEN RELATED TO THAT IS
SO YOU'VE DONE ALL THIS
INCREDIBLE READING OF THESE
BOOKS WHICH I'M NOT GOING TO GET
TO.
WHAT THE PERSPECTIVE IS ON THE
PROGRESS THAT WAS MADE INITIALLY
AFTER THE 1960s CIVIL RIGHTS
MOVEMENT ON WHAT, FOR LACK OF A
BETTER TERM, PEOPLE CALL
INTEGRATION DRIVEN IN PART BY
BUSING NOT NOT EXCLUSIVELY BY
THAT WHERE THERE WAS AN EFFORT
AND GENTRIFY HAS A NEGATIVE
CONNOTATION BUT TO MAKE THE
NEIGHBORHOODS AND COMMUNITIES
MORE MIXED.
SO WEALTHY PEOPLE ARE NEVER
GOING TO LIVE WITH THE REST OF
US, THE REAL WEALTHY, RIGHT.
AND HOW DO YOU BRING A SPECTRUM
OF SOCIO ECONOMIC STATUS AND
RACE AND ETHNICITY.
THEY DON'T HAVE TO BE COMBINED
IN THE SAME COMMUNITY WITHIN AN
URBAN SETTING?
IT'S SORT OF LIKE WHAT YOU MIGHT
SEE IN A SMALLER TOWN THAT
MAINTAINS MORE COHESION.
AND THERE'S SOME EVIDENCE THAT
THAT HAS TO BE HEALTHIER WHEN
HAVE YOU THAT PHENOMENA HAPPEN
AND WE STOPPED THAT.
THAT WAS PARALYZED AFTER 1980 OR
SO AND THEN THOUGH THERE'S BEEN
SOME EFFORT TO REKINDLE.
THIS IS SOME OF THE STUFF THAT
HOUSING ACTIVISTS, IF YOU WISH,
OR PEOPLE IN HUD NOW WHO WOULD
THINK ABOUT WHAT KIND OF
DEMONSTRATION PROGRESS CAN THEY
SHOW TO IMPROVE THE HEALTH OF A
COMMUNITY STRUCTURALLY?
YOU'RE PROBABLY FAMILIAR WITH
THE MOVE TO OPPORTUNITY
EXPERIMENT RELOCATED OR GAVE
MOSTLY WOMEN, SINGLE MOMS,
SINGLE HEAD OF HOUSEHOLDS
VOUCHERS TO GET SECTION 8
HOUSING SUBSIDIES IN
NEIGHBORHOODS THAT WERE SOCIALLY
ECONOMICALLY BETTER.
THIS WAS A RANDOMIZED STUDY WITH
SIX CITIES AND AT LEAST IN SOME
THE INITIAL FOLLOW-UPS THE
HEALTH OF THE WOMEN AND THEIR
CHILDREN WHO MOVED BEFORE
ADOLESCENCE WHICH WAS MUCH
BETTER.
OF COURSE THE STUDY WASN'T
DESIGN FOR HEALTH OUTCOMES.
IT WAS CO-FOUNDED BY SOME NIH
INSTITUTES TO INCLUDE HEALTH
OUTCOMES IN ORDER TO SEE WHAT
THE EFFECT WOULD BE.
AND I THINK THAT'S SOME OF THE
DIRECTION THAT I THINK WE WOULD
WITH RESEARCH TO EXPAND ON TO
LOOK AT.
AND PROVING.
>> I DIDN'T TALK ABOUT THE
SECTION 8 HOUSING.
THE BOOK DOES MENTION SOME OF
WHAT YOU'RE TALKING ABOUT.
IN SCHOOLS ALSO I THINK YOU'RE
RIGHT, SCHOOLS BECAME MORE
SEGREGATED IN THE 1950s AND THEN
STARTED TO DROP TO WHERE IT IS
NOW.
OBVIOUSLY, BUSING AT SOME POINT
STOPPED AS YOU PROBABLY RECALL.
THAT'S WHAT KAMALA HARRIS TALKED
ABOUT BUT HERE IN SEATTLE WHEN I
FIRST MOVED HERE THE SUPREME
COURT RULED THAT PEOPLE NEEDED
TO GO TO SCHOOLS IN THEIR
NEIGHBORHOODS.
THERE ARE PROGRAMS AND
INTERVENTIONS WHERE YOU CAN DO
THAT.
SOME SUBURBAN NEIGHBORHOODS HAVE
OPENED UP THEIR SCHOOLS TO KIDS
FROM OTHER NEIGHBORHOODS AND
THERE'S BEEN SOME LITERATURE
LOOKING AT THOSE KIDS WHO HAVE
DONE WELL.
LOOKING BACK THEY SAY THEY HAD
TO PUT UP WITH SOME RACISM AND
COMMENTS BUT OVER ALL BENEFITTED
VERY MUCH FROM ATTENDING SCHOOLS
OUTSIDE THEIR NEIGHBORHOODS AND
THERE'S NO LAW AGAINST THAT.
IT'S MORE WHETHER THE SCHOOLS
WILL OPEN UP FOR THEM.
THESE WOULD BE SMALL
INTERVENTIONS BUT THEY SEEM TO
WORK.
>> WE HAVE A QUESTION FROM THE
AUDIENCE.
THIS IS DR. RODRIGUEZ FOR THE
REVIEW AND BOOK, THANKING YOU
FOR THE PRESENTATION AND BOOK
RECOMMENDATIONS.
I'M WONDERING ABOUT EFFECTIVE
STRATEGIES TO BRING IN
ACCOUNTABILITY NOW FROM
INSTITUTIONS VERSUS INDIVIDUALS
IN PARALLEL.
ARE INSTITUTIONS THAT HAVE
FORGOTTEN AND IGNORED SOME OF
THESE COMMUNITIES OFTEN LACK
RESOURCES STOPS MANY IDEAS NOT
NECESSARILY LACK OF INTEREST AND
COMMITMENT AT LEAST BY WHAT THEY
SAY.
>> I THINK WE WERE TALKING
EARLIER ABOUT IT'S ONE OF MY PET
PEEVES.
AFTER OVER THE LAST FIVE YEARS
THERE'S BEEN A FOCUS ON
DIVERSITY AND INCLUSION AND
EQUITY.
I AGREE THAT A LOT OF
INSTITUTIONS HAVE NOT PUT A BIG
EMPHASIS ON HEALTH EQUITY FROM
SCHOOLS OF MEDICINE, FROM
MEDICAL FACILITIES.
AND I THINK IT DOES TAKE ALL OF
US TO HOLD OUR LEADERS
ACCOUNTABLE TO START FOCUSSING
ON THESE NEIGHBORHOODS.
AND FINDING FUNDING TO ADDRESS
IT AND TO IDENTIFY NOT TO IGNORE
IT.
THAT WAS REALLY OBVIOUS DURING
COVID WHERE ALL OF US WERE
SCRAMBLING AND MANY INSTITUTIONS
I THINK IGNORED SOME
NEIGHBORHOODS.
PROBABLY THE KID WITH COVID.
OTHERS DID GOOD WORK.
I READ WHAT SAN FRANCISCO
GENERAL DID AND GOING INTO SOME
OF THEIR COMMUNITIES LOOKING AT
COVID WITH TESTING.
BUT NOT SURE I KNOW HOW TO KEEP
PEOPLE ACCOUNTABLE BESIDES SH
SHINING A LIGHT ON IT.
>> THERE ARE WAYS, I SUPPOSE,
THERE ARE WAYS ONE CAN ORGANIZE
SOCIAL RESPONSIBILITY, IF YOU
WISH.
AND THE ONE METHOD I'M FAMILIAR
WITH ALTHOUGH IT'S BARELY USED
IS HOSPITALS, NOT THE V.A. OF
COURSE WHICH IS A FEDERAL SYSTEM
BUT MOST OF OUR UNIVERSITY
HOSPITALS OR ALL OF THEM REALLY
ARE NON FOR PROFIT.
THAT WAY THEY GET EXEMPT ON
TAXES FOR THEIR MARGINS AND PART
OF THE RESPONSIBILITY OF BEING A
NON FOR PROFIT ORGANIZATION THEY
HAVE TO COMMIT TO SOME
COLLECTIVE SOCIAL WELL BEING
PROJECTS AND THIS IS PART OF THE
LEVERAGE THAT WAS USED IN SAN
FRANCISCO COUNTY AND
SUBSEQUENTLY IN LOS ANGELES
COUNTY TO CREATE UNIVERSAL
HEALTH ACCESS TO EVERYONE IN THE
COUNTY.
SO NOT INSURANCE BUT IF YOU ARE
A RESIDENT OF SAN FRANCISCO AND
DISTRICT OF COLUMBIA HAS THE
SAME THING NOW AND EACH OF THE
HEALTH ORGANIZATIONS COMMITTED
TO CONTRIBUTING SOMETHING AND
THIS IS PART OF THEIR NEED TO
CONTRIBUTE BECAUSE THEY ARE NON
FOR PROFIT INSTITUTIONS.
BLUE SHIELD/BLUE CROSS CREATED A
FOUNDATION TO MAKE UP FOR ALL
THE TAXES THEY DIDN'T PAY WHEN
THEY WERE NON FOR PROFIT.
AND THEY CREATED THIS FOUNDATION
THAT GAVE OUT GRANTS TO
COMMUNITIES AS WELL AS
RESEARCHERS AT LEAST IN
CALIFORNIA.
THAT'S WHAT THEY ARE DID.
>> I DON'T WANT TO SOUND LIKE AN
OLD MAN LIKE BILL MAHR BUT IT
WOULD BE GOOD DO SEE PEOPLE
PROTESTING AT UNIVERSITIES THESE
THINGS BUT I DON'T HEAR
PROTESTING GOOD SOME OF THESE
HEALTH EQUITIES ESPECIALLY
SEGREGATION WHICH IS RIGHT IN
FRONT OF US EVERY DAY.
>> ONE LAST QUESTION.
CAN YOU TALK ABOUT THE
ENVIRONMENTAL FACTORS THAT LEAD
TO THE ASSOCIATION BETWEEN
GEOGRAPHIC LOCATION AND POOR
HEALTH OUTCOMES?
AN EXAMPLE ARE NEIGHBORHOODS OR
TOWNS LOCATED CLOSER TO
FACTORIES THAT PRODUCE POTENTIAL
HARMFUL CHEMICALS OR OTHER
UNDESIRABLE ENVIRONMENTAL
IMPACTS.
IT DEPENDS.
EVERY AREA IS VERY DIFFERENT.
THE AREAS THAT WERE RED LINED OR
RED LINED FOR A REASON AND MANY
TIMES IT'S BECAUSE THEY WERE
NEAR HIGHWAYS OR HIGHWAYS IN
GENERAL WHERE THEY'RE IT EXISTED
WHEN I MENTIONED HUNTER'S POINT.
AND THERE'S REAL TOXIC AND
THERE'S A LOT OF ENVIRONMENTAL
EXPOSURES HAPPENING IN THESE
NEIGHBORHOODS DEPENDING ON WHAT
TOWN YOU'RE TALKING ABOUT.
OBVIOUSLY THESE ARE ASSOCIATED
WITH HEALTH OUTCOMES LIKE LEAD
EXPOSURE AND ASBESTOS AND MANY
OF THESE SCHOOLS THAT STILL
EXIST BUT BEING NEAR SOME OF
THESE REFINERIES AND OTHER
FACTORIES.
>> THE ISSUE OF THE REFINERIES
HAS BEEN ESPECIALLY QUITE
INTENSE IN PARTS OF THE
SOUTHWEST IN LOUISIANA, TEXAS
AND THE OIL INDUSTRY AND PEOPLE
LIVING RIGHT NEXT TO THESE
HIGHLY TOXIC AREAS WITH CLEAR
CUT CONSEQUENCES OF EARLY
CANCERS AND LUNG AND HEART
DISEASE.
YOU MENTIONED HUNTER'S POINT.
HUNTER'S POINT THE NAVAL BASE
WHICH WAS ALSO WHERE A SUPER
FUND SITE IS AND THAT WAS WAS A
MAIN CAUSE OF THE TOXICITIES
THERE AND SAN FRANCISCO BACK IN
THE 1950s PEOPLE WERE PLANNING
TO BUILD FREEWAYS THROUGH SAN
FRANCISCO LIKE LOS ANGELES AND
FORTUNATELY IT DIDN'T GET
IMPLEMENTED BUT BUILT ONE TO
CONNECT TO THE BAY BRIDGE AND
DIVIDED IN MANY WAYS AND
DESTROYED A NEIGHBORHOOD, I HEAR
FROM PEOPLE WHO WERE AROUND AT
THE TIME.
AND EXHAUST LEADING TO MORE
CONTAMINATION.
ONCE AGAIN, RUDY, THANK YOU FOR
YOUR PRESENTATION.
IT'S VERY CONSISTENT WITH
NIMHD'S FOCUS AND WE APPRECIATE
THE EFFORT YOU PUT INTO
TAILORING YOUR TALK TO THE
WASHINGTON, D.C. AREA.
I'M VERY FAMILIAR WITH MOST OF
THE AREAS YOU POINTED OUT.
PEOPLE HERE REFER TO THE AREA
YOU POINTED OUT AS BEING
PREDOMINATELY AFRICAN AMERICAN
THOUGH IT'S NOT THE ONLY ONE THE
EAST OF THE RIVER THE RIVER THAT
RUNS THROUGH THERE AND UNTIL
UNTIL RECENTLY THERE WASN'T A
FULL SERVICE GROCERY MARKET EAST
OF THE RIVER MUCH LIKE THE
EXPERIENCE IN BAY VIEW/HUNTER'S
POINT WHICH I DON'T KNOW IF
THERE IS A FULL GROCERY STORE IN
THAT NEIGHBORHOOD.
ANOTHER STRUCTURAL FACTOR THAT
CONTRIBUTES TO THIS.
THANK YOU, RUDY AND WE'LL BE IN
TOUCH.
>> THANK YOU VERY MUCH.
>> TAKE CARE.