MY NAME IS JEFF RESNICK, I'M CHIEF OF THE HISTORY AND MEDICINE DIVISION AT THE NATIONAL LIBRARY OF MEDICINE. THANK YOU FOR JOINING US TODAY TO HEAR THE TWELFTH ANNUAL JAMES H CASSADY MEMORIAL LECTURE IN THE HISTORY OF MEDICINE WHICH IS PART OF THE NATIONAL LIBRARY OF MEDICINE'S 2021 HISTORY OF MEDICINE LECTURE SERIES. THIS YEAR'S LECTURE IS CO- SPONSORED BY THE NATIONAL ENDOWMENT FOR THE HUMANITIES OFFICE OF DIGITAL HUMANITIES AS PART OF THE NLM'S ONGOING PARTNERSHIP WITH THAT AGENCY TO COLLABORATE ON RESEARCH, EDUCATION AND CAREER INITIATIVES THANKS VERY MUCH TO NIH AND ALL OF YOU FOLLOWING ON TWITTER THANKS FOR FOLLOWING ALONG USING HASHTAG NLMHISTOTALK. FOR THE PAST DOZEN YEARS BEEN HOSTING THIS LECTURE IN MEMORY OF OUR COLLEAGUE JAMES H CASSADY , 50 YEAR EMPLOYEE OF NLM AND EDITOR OF PRINTED BIBLIOGRAPHY OF THE NIS RI OF MEDICINE AND GREAT SUPPORTER OF IN ESSENTIAL RESEARCH TOOLS VALUED BY GENERATIONS OF SCHOLARS, DURING THE COFERS HIS DISTINGUISHED CAREER DR. CASSADY RECEIVED EVERY MAJOR HON NORP A THE NATIONAL PROCEED PHOTOFACIAL SOCIETY IN HIS FIELD COULD BESTOW, IN ADDITION TO THE WELCH MEDAL WHICH HE RECEIVED FOR HIS BOOK BOOKS AND STATISTICAL THINKING 1800 TO 1860 AND MEDICINE AND AMERICAN GROWTH 1800 TO 18 # 0 HE WAS AWARDED THE ASSOCIATION'S LIFETIME ACHIEVEMENT AWARD AND DELIVERED ITS HONORARY GARRISON LECTURE AND ALSO SERVED APPEARS PRESIDENT OF THE ASSOCIATION FROM 1982 TO '84 AND WORKED PASSIONATELY ON ITS MANY COMMITTEES. WITH RESPECT TO OUR FORMER COLLEAGUE, THEREFORE, IT IS MY GREAT PRIVILEGE TO INTRODUCE TODAY'S DISTINGUISHED SPEAKER, DR. NAA OYO QUAIT OF RUTGERS UNIVERSITY PROFESSOR OF AFRICAN-AMERICANA CAN -- RECEIVED Ph.D. IN CLINICAL PSYCHOLOGY FROM ST. JOHNS UNIVERSITY IN QUEENS NEW YORK. SHE COMPLETED HER POSTDOCTORAL TRAINING IN CANCER PREVENTION AND CONTROL AT MOUNT SINAI SCHOOL OF MEDICINE AND DEFINITELY HELD A FACULTY POSITION AT THE SCHOOL OF PUBLIC HEALTH AT COLUMBIA UNIVERSITY. DR. QUAIT'S RESEARCH -- DR. KWAT E'S RESEARCH FOCUSES ON SOCIAL DETERMINE ABILITIES OF AFRICAN-AMERICAN HEALTH, REFLECTING RACIAL INEQUALITIES IN THE UNITED STATES AND HOW RACISM DIRECTLY AND INDIRECTLY AFFECTS AFRICAN AMERICAN HEALTH. SHE'S RECIPIENT OF A NATIONAL INSTITUTES OF HEALTH DIRECTOR'S NEW INNOVATOR AWARD 2009 AND THE ROBERT WOOD JOHNSON FOUNDATION'S INVESTIGATOR AWARD IN HEALTH POLICY IN 2008. HER RESEARCH HAS ALSO BEEN FUND ED BY THE ROBERT WOOD JOHNSON FOUNDATION HEALTHY EATING RESEARCH PROGRAM AS WELL AS ITS NEW CONNECTIONS INITIATIVE, IT'S ALSO BEEN FUND ED BY THE DEPARTMENT OF DEFENSE BREAST CANCER RESEARCH PROGRAM. NOTABLY, SHE'S RECIPIENT OF A 2017 NLM G13 AWARD FOR SCHOLARLY WORKS IN BIOMEDICINE AND HEALTH PUBLICATIONS FOR HER PROJECT ENTITLED RACE AND THE TRANSFORMATION OF THE FOOD ENVIRONMENT. FAST FOOD AND AFRICAN AMERICANS AND THE COLOR LEAN 1955 TO 1995. THE BOOK FUNDED BY THIS GRANT IS NEARING COMPLETION, AS WELL, DR. KWATE'S NLM FUNDED RESEARCH PRODUCED 2019 PUBLICATION FROM UNIVERSITY OF MINNESOTA ENTITLED BURGERS AND BLACKFACE, ANTI- BLACK RAWNLTS THEN AND NOW, THIS VOLUME JOINS AN EXTENSIVE SERIES OF PUBLICATIONS INCLUDING ANOTHER FORTHCOMING BOOK EDITED BY HER AND WITH PHOTOGRAPHS ENTITLED AMERICAN INEQUALITY, A PHOTOGRAPHIC FIELD 2K3W50EUD IN THE STREETS OF CAMDEN, PUBLISHED BY RUTGERS UNIVERSITY PRESS SOON SHE'S ALSO AUTHORED AND CO-AUTHOR OF MANY ARTICLES AND JOURNALS SUCH AS DUBOIS REVIEW, APPLIED GEOGRAPHY, HEALTH AND PLACE, RACIAL AND SOCIAL RACE AND SOCIAL PROBLEMS AND JOURNAL OF URBAN HEALTH AND AMERICAN JUCIAL OF PUBLIC HEALTH. DR. KWATE DIRECTS RACE NAIBLEDZ AND AFRICAN AMERICAN HEALTH LAB AT RUTGERS AND YOU CAN LEARN MORE ABOUT HER RESEARCH THROUGH THE EXTENSIVE WEBSITE OF HER LAB WHICH YOU CAN FIND AT RNA-LAB .COM. PLEASE JOIN ME IN WELCOMING DR. KWATE TO THE NATIONAL LIBRARY OF MEDICINE TO DELIVER OUR 2021 JAMES CASSADY LECTURE ENTITLED SAVAGES CRY EASILY AND ARE AFRAID OF THE DARK, WHAT IT MEANS TO TALK ABOUT RACE AND AFRICAN AMERICAN HEALTH. DR. KWATE, WELCOME, AND THANK YOU VERY MUCH FOR JOANG US TODAY >> Naa Oyo A. Kwate: THANK YOU, DR. RESNIK, FOR QUITE THE INTRODUCTION. IT'S GREAT TO BE HERE AND I ALSO WANT TO THANK EVERYONE ELSE AT THE NIH THAT MADE THIS TALK POSSIBLE TODAY INCLUDING LINDSAY FRANZ WHO IS ADVANCING MY SLIDES FOR ME AND THE ASL INTERPRETERS WHO ARE MAKING THE TALK ACCESSIBLE TO MORE PARTICIPANTS. SO I'M REALLY DELIGHTED TO BE HERE. AS YOU HEARD, I HAVE THE FORTUNE OF BEING AN NLM GRANTEE FOR A BOOK PROJECT AS DR. RESNIK MENTIONED AND SO I'LL BE DESCRIBING THAT LATER IN THE TALK, AND THE TITLE FOR TODAY'S TALK COMES FROM MY VTION COME ACROSS THIS TEXT -- MY HAVING COME ACROSS THIS TEXT THAT WAS IN THE NLM'S DIGITAL COLLECTION. MORE ABOUT THAT ON THE NEXT SLIDE. FIRST THE PUNCHLINE FOR THE TALK UP FRONT AND SO THAT WHAT IT MEANS TALK ABOUT RACE AND AFRICAN AMERICAN HEALTH, IN FACT , IT'S REALLY HEALTH RISK. BUT WHAT IT MEANS TO TALK ABOUT AFRICAN AMERICAN HEALTH RISK IS TO TALK ABOUT RACISM. SO DR. RHEA BOYD AND COLLEAGUES WROTE ON THE HEALTH AFFAIRS JOURNAL BLOG IN 2020 WROTE RACISM KILLS, WHETHER THROUGH FORCE, DEPRIVATION OR DISCRIMINATION, IT IS A -- OR DISCRIMINATION, IT IS A FUND MEPTD AL CAUSE OF DISEASE AND HEALTH INEQUITIES -- AND ROOT OF INHE CAN TILTZ. RELATIVE ABSENCE OF INTERROGAT ING RACISM IN THE MEDICAL LITERATURE BUT EN STEAD TALKING ABOUT RACE TYPICALLY IN WAYS THAT INVOKE BIOLOGICAL UNDERSTANDINGS OF HEALTH DISPARITIES AS SOMETHING THAT, YOU KNOW, PREDISPOSES AFRICAN AMERICANS GENETICALLY TO DISEASE SO SUCH STUDIES CONCEPTUALIZE RACIAL DISPARITIES PERHAPS NOT IN LANGUAGE THAT'S STRIDENTLY RACIST AS WE WOULD SEE IN EARLY 20TH CENTURY RACE SCIENCE BUT THEY LOCATE HEALTH OUTCOMES IN PSYCHOLOGICAL BEHAVIORAL CULTURAL KINDS OF DEFECTS NONETHELESS. THIS IS THE BOOK THAT I SAW IN NLM COLLECTIONS, IT'S ENTITLED SAVAGE SURVIVALS WRITTEN BY A J. HOWARD MOORE AND PUBLISHED IN 1916. THE BOOK HAS NO INTRODUCTION SO I DON'T KNOW WHAT THE OVERARCH ING ARGUMENT OF THE BOOK S I FOUND WHILE I WAS DOING RESEARCH IN THE COLLECTIONS LOOKING TO SEE IF THERE WERE DOCUMENTS RELATED TO HEALTH AND EATING. AND SO IN PART 3 OF THE BOOK WHICH IS CALLED THE ORIGIN OF HIGHER PEOPLES, THE AUTHOR STATES THAT SUM RACISTS HAVE CHANGED SIGNIFICANTLY OVER EVOLUTIONARY TIME WHILE OTHERS HAVE NOT AND LAG BEHIND AND REMAIN IN A FIXED STATE. MOORE CONTENDS QUOTE WE CALL THESE LATTER SAVAGES. SAVAGES ARE MERELY PEOPLE WHO ARE IN THE INFANT STAGES OF HUMAN DEVELOPMENT THEY HAVE NEVER GROWN YOU. THEY ARE CHILD RACISTS. HE GOES ON TO SAY THAT AFRICANS RERT SAVAGES OR THEY ARE IN THE STATE OF BARBARISM WHICH IS IN BETWEEN SAVAGERY AND CIVILIZATION. QUITE IN CONTRAST, QUOTE, THE RACE WHICH HAS BEEN MOST ENTERPRISESING AND PLAYED THE MOST DISTINGUISHED ROAM IN THE AFFAIRS OF THE WORLD HASH THE WHITE RACE, END QUOTE. SO MOORE CONTINUES IN THAT VEIN AND MAKES AN ASSESSMENT OF THE SAVAGE TEMPER MENL AS FOLLOWS, QUOTE, SAVAGES CRY EASILY AND ARE AFRAID OF THE DARK. THEY ARE FOND OF PETS AND TOYS, HAVE WEAK LSES FEEBLE REASONING POWERS, FICKLE, UNRE RELIABLE, GIVEN TOAKS AJ RAITION OF THEIR OWN IMPORTANCE, END QUOTE. THE PROPENSITY TO SEE BLACK PEOPLE AS PATHOLOGICAL, BACKWARD , IRRATIONAL AND AS ULTIMATELY RESPONSIBLE NOT ONLY FOR THE HEALTH INIF HE CAN INEQUITIES BUT ALSO FOR CAUSING A DRAG ON THE NATION'S RESOURCES HAVE UNFORTUNATELY NOT GONE ANYWHERE. NEXT SLIDE, PLEASE. IN JUNE OF 2020 THE MEDIA REPORTED ON REMARKS MADE BY AN OHIO STATE SENATOR STEVEN HUFFMAN DURING A HEARING OF THE SENATE HEALTH COMMITTEE WHICH WAS ACTUALLY ABOUT WHETHER TO DECLARE RACISM AS A PUBLIC HEALTH CRISIS. MUSING ABOUT THE REASONS BLACK PEOPLE MIGHT BE MORE SUSCEPTIBLE TO COVID-19, HE STATED, QUOTE, COULD IT JUST BE THAT AFRICAN AMERICANS OR THE COLORED POPULATION DO NOT WASH THEIR HANDS AS WELL AS OTHER GROUPS OR WEAR A MASK OR DO NOT SOCIALLY DISTANCE THEMSELVES? COULD THAT BE THE EXPLANATION OF WHY THE HIGHER INCIDENCE? END QUOTE. DR. WHITNEY IN A PAPER ON RACIAL CAPITALISM AND INEQUITIES IN THE COVID-19 PANDEMIC POINTS OUT THAT IN CHICAGO DURING THE 1918 FLU EPIDEMIC RACIAL TROPES WERE USED TO SPREAD THE BLAME OF DISEASE ON BLACK RESIDENTS. TO SEE THE SAME TROPES AND SAME RACIAL DESIGNATION COLORED REVIVED TODAY REVEALS HOW DEEPLY ENTRENCHED THESE IDEAS ARE. CLASSIC TEXTS SUCH AS RACISM AND PSYCHIATRY AND GUTHRIE'S EVEN THE RAT WAS WHITE DOCUMENT THE LONG HISTORY OF SCIENTIFIC RACISM, WHICH PROMULGATES IDEAS ABOUT AFRICANS OR BLACK PEOPLE'S INFERIOR INTELLECTS, ABNORMAL PERSONALITIES, LACK OF IMPULSE CONTROL AND JUDGMENT, AND ON AND SO, ALL OF WHICH -- AND ON AND ON, ALL OF WHICH WERE THOUGHT TO BE FIXED TRAITS. THESE THEORIES CAST THEIR LONG SHADOW IN THE CONTEMPORARY MOMENT IN DIFFERENTIAL PSYCHIATRIC DIAGNOSES, FOR EXAMPLE, BLACK PATIENTS ARE MORE LIKELY TO BE DIAGNOSED AS PSYCHOTIC THAN AS HAVING A MOOD DISORDER SUCH AS DEPRESSION. OTHER INEQUITIES THAT WE SEE INCLUDE AFRICAN AMERICANS LOWER PROBABILITY OF RECEIVING OPIOID PAIN MEDICATION OR REALLY RECEIVING PAIN MEDICATION AT ALL A LEGACY OF PERSISTENT STEREOTYPES ABOUT HIGHER PAIN THRESHOLDS AMONG BLACK PEOPLE AS WELL AS STEREOTYPES AROUND CRIMINAL DRUG SYNCING. NEXT SLIDE. SO THE SENATOR, THE STATE SENATOR GAVE WHAT HE CALLED AN APOLOGY FOR HIS REMARKS IN A STATEMENT IN WHICH HE EXPLAINED, QUOTE, REGRETTABLY, I ASKED A QUESTION IN AN UNINTENTIONALLY AWKWARD WAY THAT WAS PERCEIVED AS HURTFUL AND WAS EXACTLY THE OPPOSITE OF WHAT I MEANT, END QUOTE. SO WHATEVER CRITIQUE HE FACED AND APPARENTLY HE WAS FIRED FROM HIS POST AS AN ER DOCTOR, IT WAS NOT ENOUGH TO KEEP HIM FROM BEING APPOINTED TO LEAD THE PANEL TASKED WITH REVIEWING LEGISLATION ABOUT HEALTH AND HUMAN SERVICES FOR THE STATE OF OHIO, WHICH IS WHAT WE SEE BEING REPORTED HERE ON THE SLIDE. NEXT SLIDE. AND SO IN THAT SAME ARTICLE THAT I JUST REFERENCED BY DR. HURDLE SHE CITED AN INTERVIEW WITH DR. J BLACKSTOCK AN EMERGENCY PHYSICIAN IN NEW YORK CITY, SO SHE HAD APPEARED TO THE PBS NEWS HOUR AND WAS EXPRESSING CONCERN ABOUT WHAT WAS GOING TO HAPPEN WHEN BLACK AND BROWN INDIVIDUALS PRESENTED TO THE ER WITH COVID SYMPTOMS, AND SHE WAS CONCERNED THAT, QUOTE, THEIR SYMPTOMS MAY BE DOWNPLAYED OR THEY MAY NOT BE TAKEN SERIOUSLY. END QUOTE. INDEED, THAT FEET BEFELL DR. SUSAN MOORE A BLACK WOMAN AND PHYSICIAN WHO DIED DESPITE HER EXPERTISE AS A DOCTOR AND HER ABILITY TO ADVOCATE FOR HER HEALTHCARE, AS R0R9D HERE BY THE NEW YORK TIMES -- REPORTED HERE BY THE NEW YORK TIME. STUDIES HAVE SHOWN PREETDLY BLACK PEOPLE RECEIVE DIPS SEPARATE CARE ESPECIALLY WITH REGARD TO SYMPTOMS NOT BEING TAKEN SERIOUS AM AND PAIN AND SUFFERING BEING SCOWNLTDED. BLACK WOMEN IN PARTICULAR STEREOTYPED AS AGGRESSIVE, REPORTEDLY AS SAVAGES WHO CRY EASILY AND ARE AFRAID OF THE DARK. NEXT SLIDE. CONTROVERSY ALSO EMERGED IN APRIL OF 2020 WHEN THEN SURGEON GENERAL DR. JEROME ADAMS DURING A CORONAVIRUS TASK FORCE BRIEF ING SEEMED TO SUGGEST THAT BLACK PEOPLE NEEDED TO GENERATE PARTICULAR KINDS OF SELF- REGULATION AND SELF- MONITORING AND THAT THE ONUS WAS ON THEM TO FLATTEN THE CURVE OF INFECTION. HAVING NOTED THAT BLACK PEOPLE COMPRISED DISPROPORTIONATE NUMBERS OF DEATHS IN RELATION TO THEIR PROPORTION IN THE POPULATION, HE ASKED, QUOTE, SO WHAT'S GOING ON? WELL, IT'S ALARMING BUT IT'S NOT SURPRISING THAT PEOPLE OF COLOR HAVE A GREATER BURDEN OF HEALTH CONDITIONS. AFRICAN AMERICANS AND NATIVE AMERICANS DEVELOP HIGH BLOOD PRESSURE AT MUCH YOUNGER AGES AND IT'S LESS LIKELY TO BE UNDER CONTROL AND DOES GREATER HARM TO THEIR ORGANS, END QUOTE. BUT POINTING OUT MORE SEVERE BURDENS OF HEALTH CONDITIONS SUCH AS HIGH BLOOD PRESSURE DOES NOT ACTUALLY TAKE THE BLAME OFF AFRICAN AMERICANS FOR WHOM PERVASIVE MEASURES FIND THEM AT FAULT FOR FAILURE TO TAKE RESPONSIBILITY FOR THEIR OWN HEALTH OR TO WILLFULLY ENGAGE IN BEAVERS WHICH FOSTER CHRONIC ILLNESS. ADAMS ACKNOWLEDGED THAT ONLY ABOUT ONE IN SIX BLACK PEOPLE WERE LIKELY TO HAVE JOBS WHERE THEY COULD WORK FROM HOME BUT STILL WENT ON TO SAY THAT THEY SHOULD STAY HOME IF FOBL POSSIBLE. CAUTIONING COMMUNITIES OF COLOR IN PARTICULAR HE DECLARED ARE QUOTE THE GOVERNMENT WILL BE DOING ALL IT CAN DAY AND NIGHT TO PROTECT REGARDLESS OF COLOR OR GEOGRAPHY. IT'S EVEN MORE IMPORTANT THAT IN COMMUNITIES OF COLOR WE ADHERE TO TASK FORCE GUIDELINES TO SLOW THE SPREAD. AVOID ALCOHOL, TOBACCO AND DRUGS , ESPECIALLY IN COMMUNITIES OF COLOR. WE NEED YOU TO STEP UP AND HELP STOP THE SPREAD SO WE CAN PROTECT THOSE WHO ARE MOST VULNERABLE, END QUOTE. SO THIS IS AN ODD COMMENT FOR MANY REASONS, CERTAINLY NOT USING THESE SUBSTANCES CAN SUPPORT OVERALL HEALTH, BUT OBVIOUSLY THESE RNLT BEHAVIORS IMMEDIATELY LINKED WITH INFECTION RISK FROM AN AIRBORNE PATHOGEN. CAUTIONING ESPECIALLY COMMUNITIES OF COLOR TO AVOID THESE SUBSTANCES MERELY REIFIES STEREOTYPES, ENDEMIC DRUG USE AND SUGGESTS THE NEED FOR THE GOVERNMENT OFFICIALS TO ATTEMPT TO TRY TO KEEP THEM IN CHECK. LACKING IN THIS ANALYSIS IS A CONSIDERATION OF WHAT SOCIOLOGIST DOCTORS BRUCE LINK AND JOE FAY LEN DEFINE AS FUNDAMENTAL CAUSES OF HEALTH. FUNDAMENTAL CAUSES ARE DISTAL, NOT PROXIMAL DRIVERS OF HEALTH LIKE SMOKING OR DRINKING. FUNDAMENTAL CAUSES DETERMINE ACCESS TO RESOURCES, MONEY, POWER, PRESTIGE, KNOWLEDGE, AND MORE, THAT SHAPE THE LIKELIHOOD PEOPLE FALL AT RISK OF HEALTH RISKS. THEY DETERMINE THE LIKELIHOOD OF BEING ILL AND HOW WELL PEOPLE CAN RECOVER FROM ANY ILLNESS THAT THEY DO DEVELOP AND MAY ALSO AFFECT MULTIPLE DISEASE OUT COMES THROUGH MULTIPLE PATHWAYS. NEXT SLIDE. SO FOR TALKING ABOUT TOBACCO, MISSING FROM THE SURGEON GENERAL 'S STATEMENTS IS A RECOGNITION OF IMPORTANT -- MENTHOL CIGARETTES TO AFRICAN AMERICAN MARKETING. MASTER SETTLEMENT AGREEMENT IN 1998 PROHIBITED OUTDOOR ADVERTISING FOR TOBACCO SO YOU WON'T SEE ADS LIKE THIS ANYMORE, BUT WHEN YOU DID, THEY WERE DISPROPORTIONATELY LOCATED IN BLACK NEIGHBORHOODS. AND THE FOCUS WAS ON MENTHOL CIGARETTES LIKE KOOL ADVERTISED HERE AS WELL AS NEWPORT AND SALEM. SO THIS COULD BE A WHOLE TALK IN ITSELF, HISTORIAN KEITH WALU HAS A BOOK COMING OUT ON THIS, BUT THE TOBACCO INDUSTRY HAS REAPED HUGE PROFITS FROM TARGETING BLACK CONSUMERS AND MUCH OF THAT TARGETING TOOK PLACE IN THE BUILT ENVIRONMENT AND STILL DOES AT A SMALLER SCALE IN POINT OF PURCHASE ADVERTISING. IN 1984 MARKETING EXPERTS SAW NEWPORT AS HAVING SUCCESS DUE IN PART TO ITS STRENGTH IN OUTDOOR ADVERTISING WHICH THEY FOUND QUOTE VERY EFFECTIVE AND APPEALING TO A BLACK AUDIENCE, END QUOTE. INDEED, REYNOLDS RELIED HEAVILY ON THIS ADVERTISING MEDIUM WHICH CAPITALIZES DIRECTLY ON MAKING CAPTIVE AUDIENCE OF BLACK LNT MUCH RESIDENTS, ALSO CITY VAN PROGRAM COMPANY REPRESENTATIVES WOULD DRIVE THROUGH A NEIGHBORHOOD, SET ON A STREET CORNER, PLAY MUSIC, HAND OUT CIGARETTE SAMPLES AND SO ON, BUT TO HEAR IT TOLD FROM NEWPORT EXECUTIVES QUOTE IT'S THANT NEW PORT WENT LOOKING FOR THOSE GROUPS, IT'S JUST THE WAY IT HAPPENED. IN FACT, MEN MENTHOL CIGARETTES ARE MORE HAZARDOUS THAN NON MENTHOL, CANE MORE NICOTINE AND TAR AND CONTAIN ADDITIONAL CARCINOGENS AND COOLING SENSATION CAUSE USERS TO INHALE MORE DEEPLY, MORE ADDICTIVE AND TOXINS. AGGRESSIVE METHODS OF CAN MARKETING IN BUILT ENVIRONMENT LAY FOUNDATION FOR LUNGS VULNERABLE TO COVID. NEXT SLIDE. IF WE REALLY WANTED TO THINK ABOUT ALCOHOL AND OFFER AMERICAN HEALTH THEN WE WOULD NEED TO QUESTION THE PRESUMPTION THAT THERE'S A HIGHER PROCEED PENCE PROPENSITY TO DRINK THAT REQUIRES SINGING OUT AS THE SURGEON GENERAL HAD. IN FACT, HEALTH DATA HAS CONSISTENTLY SHOWN THAT COMPARED TO WHITE COUNTERPARTS BLACK AMERICANS ARE LESS LIKELY TO DRINK, SO THIS DATA FOR ADULTS AGED 18 OR OLDER FROM THE NATIONAL HEALTH INTERVIEW SURVEY , THIS IS FROM THE 2015 SURVEY, AND SO IF YOU LOOK ON THE LEFT SIDE OF THE GRAPH, YOU CAN SEE THAT BLACK RESPONDENTS WHO ARE THE YELLOW BARS ARE ACTUALLY MORE LIKELY THAN WHITE COUNTERPARTS TO BE LIFETIME ABSTAINERS FROM ALCOHOL, SO THEY HAVE NEVER DRANK ALCOHOL, AND THEN ON THE RIGHT SIDE OF THE GRAPH IF YOU LOOK AT WHITE RESPONDENTS WHO ARE THE GREEN BARS, THEY ARE MORE LIKELY TO BE CURRENT REGULAR DRINKERS. NEXT SLIDE. THESE SAME PATTERNS BEAR OUT IN CONSUMER EXPENDITURE DATA, SUCH THAT AFRICAN AMERICANS SPEND LESS ON PURCHASING ALCOHOLIC BEVERAGES. SO THIS IS A MAP SHOWING ALCOHOLIC BEVERAGE SPENDING ACROSS THE NEW YORK CITY METRO. THIS IS FROM 2017. SO THE DARKER THE SHADING, THE HIGHER THE EXPENDITURES, AND THE DARKEST AREAS ARE PREDOMINANTLY WHITE. SO THERE'S A SIGNIFICANT MISMATCH BETWEEN CONSUMER BEHAVIOR AND WHERE THE LIQUOR STORES ARE AND WHERE THE OUTDOOR ADVERTISEMENTS FOR ALCOHOLIC BEVERAGES ARE. NEXT SLIDE, PLEASE. BLACK COMMUNITIES HAVE RESORT TO WHAT'S BEEN CALLED WHITEWASHING WHERE RESIDENTS PAINT OVER ADS, IT WAS A FREQUENTLY USED TACTIC IN THE 1990S AND LED TO OUTDOOR ADVERTISERS MAKING CONCESSIONS THAT THEY WOULD REFRAIN FROM ADVERTISING ALCOHOL AND AGAIN AT THE TIME TOBACCO NEAR SENSITIVE SITES WHERE YOUTH GATHER SUCH AS SCHOOLS, CHURCHES, AND PLAYGROUNDS, THEY DON'T ACTUALLY ADHERE TO THESE GUIDELINES, BUT THIS IS WHAT THE KIND OF SELF- REGULATORY MECHANISM THEY PURPORTED TO USE AT THE TIME. SO THIS IS A FUNKY OSK I TOOK A PICTURE OF -- A FUN A PHONE KIOSK I TOOK A PICTURE OF IN BROOKLYN IN 2005. THIS IS THE OTHER SIDE OF THE PHONE KIOSK. WHAT'S HIDDEN BEHIND THAT CARDBOARD IS HEINEKIN BOTTLE SH THIS IS AN AD FOR HEINEKIN BEER. YOU CAN SEE THE TAG LINE AT THE TOP STILL WHAT'S REALLY GOOD AND SOMETHING ELSE AT THE BOTTOM WHICH IS CUT OFF BUT IT SAYS IT'S ALL ABOUT SOMETHING AND THEN TO CONSUME, IT ENCOURAGES YOU TO CONSUME HEINEKIN RESPONSIBLY. SO NOW OF COURSE THERE AREN'T REALLY PHONE KIOSKS BECAUSE EVERYBODY HAS CELL PHONES. SO MOST OF THESE IN NEW YORK HAVE BEEN CHANGED TO I GUESS LIKE WIFI HOT SPOTS AND PHONE CHARNING STATIONS AND SO FORTH -- CHARGING STATIONS AND SO FORTH. NEXT SLIDE. BUT SOMETHING WE NEVER SAW BACK WHEN THEY STILL HAD PHONE KIOSKS IN BLACK NEIGHBORHOODS AT THE TIME IN CENTRAL BROOKLYN AND IN HARLEM WERE ADS LIKE THESE, FOR WATER. SO THIS IS A FOAFT OH THAT I TOOK IN CHELSEA IN MANHATTAN. A PHOTO THAT I TOOK. NEXT SLIDE. SO THIS WAS TAKEN PLACE DURING A STUDY OF MYSELF AND SEVERAL STUDENTS WHO WORKED WITH ME ON PROJECT REACH WHICH WAS A STUDY OF THE SEPARATE INFLUENCES OF THE ALCOHOL ENVIRONMENT AND ALSO EXPERIENCES WITH RACISM ON ALCOHOL CONSUMPTION AMONG BLACK WOMEN IN HARLEM. NEXT SLIDE. THIS IS A MAP OF OUTDOOR ADVERTISING IN CENTRAL HARLEM, SO EACH DOT IS AN AD SPACE. SO WHETHER IT BE PHONE KIOSK OR OTHER KINDS OF STREET FURNITURE AND OTHER AD PANELS. SO WE GATHERED INFORMATION ON ALL THE STANDARD OUTDOOR MEDIA BY WALKING UP AND DOWN THE STREETS THROUGHOUT THE NEIGHBORHOOD AND REPORTING THE LOCATION OF EACH AD SPACE COUNTING A TOTAL OF 534, THAT'S WHAT YOU SEE HERE, AND THEN AFTER WE HAD MAPPED OUT WHERE THE AD SPACES WERE, WE TROWRND SEE IF THEY CONTAINED ALCOHOLIC BEVERAGE ADVERTISEMENTS. NEXT SLIDE. SHEER A SAMPLE OF THE KINDS OF ADS WE SAWCH AND THE OUTDOOR MEDIA FORMATS IN WHICH THEY APPEARED, AGAIN, SOME OF WHICH ARE NOW OBSOLETE NOW LIKE PHONE KIOSKS BUT OTHERS ARE NOT. THE BIGGEST WRUNS THE WALLSCAPES WHICH ELEVATE BOTTLES OF LIQUOR IN THE SKY TO BE AMONG THE MOST VISUALLY PROMINENT FEATURES IN THE NEIGHBORHOOD. ON THE TOP MIDDLE SQUARE THERE, WITH THIS AD SAYING STILL REAL, FEATURING FAT JOE, SO THIS IS A WALLSCAPE AND TO GIVE YOU A SENSE OF THE SCALE, IF YOU THROOK THE TOP RIGHT CORNER YOU CAN SEE SCAFFOLDING THERE THAT PEOPLE USE FOR EXAMPLE TO CLEAN WINDOWS AND SO ON. IN THIS CASE, PROBABLY TO PUT UP THE AD. BUT WHEN YOU SEE HOW SMALL THAT SCAFFOLD SG IN RELATION TO THAT WALLSCAPE, IT GIVES YOU A SENSE OF HOW BIG THAT AD IS. SIMILARLY ON THE TOP ROW BUT ON THE RIGHT THE TANQUERAY AD WHICH IS COVERING THESE APARTMENT WINDOWS SUPPOSEDLY YOU'RE SUPPOSED TO BE ABLE TO SEE OUT FROM BEHIND THE AD, I DON'T KNOW IF THAT'S ACTUALLY TRUE. IN ANY CASE, THAT'S WHAT THEY SAY. BUT WHAT YOU CAN SEE IS THAT THE AD IS FOUR STORIES TALL IN TERMS OF THE WINDOWS THAT IT'S COVERING. SO THE PERVASIVE MARKETING OF ALCOHOL IS A TOXIC EXPOSURE BECAUSE OF COURSE IT'S A PRODUCT THAT CAN BE TOXIC TO HEALTH BUT WE DWHROOND THE IMAGES ASK MESSAGES USE MED IN THE ADVERTISEMENTS THEMSELVES REPRESENT A TOXIC EXPOSURE. THEMATICALLY HARLEM RESIDENTS WERE MOSTLY ASKED TO CONSIDER INTOXICATION AS A MEANS THROUGH WHICH TO MOVE ACROSS CLASS BOUNDARIES, EXPRESS AN AUTHENTIC BLACK SELF AND PURSUE THE GOOD LIFE. AS WELL, THE USE OF SEXUAL IMAGERY AND THEMES HAS PARTICULAR SALIENCE GIVEN THE WAYS IN WHICH BLACK WOMEN EMBODY DEVIANT SEXUALITY IN THE AMERICAN IMAGINARY. AGAIN, THESE ARE LONG-STANDING KINDS OF RACIAL TROPES AND STEREOTYPES. SO ON THE BOTTOM RIGHT, FOR EXAMPLE, WE HAVE AN AD FOR COLT 45 MALT LIQUOR, ECHO BEING THE ADVERTISING CAMPAIGN FROM THE 1980S, WHICH WAS THE POWER OF COLT 45, IT WORKS EVERY TIME, A MESSAGE THEN DELIVERED BY THE ACTOR BILLY D WILLIAM. HERE A SHORTER MESSAGE EVERY TIME IS NO LESS EXPLICIT. RIGHT? COLT 45 IS A CATALYST FOR THE ACQUISITION AND SEXUAL DOMINATION OF READY AND AVAILABLE BLACK WOMEN IS WHAT THIS SUGGESTS. NEXT SLIDE. THEN I WANT TO HIGHLIGHT THIS AD THAT WAS ON THE BOTTOM ROW FOR AN EXPENSIVE COGNAC AT THE TIME WE DID THE STUDY, COURVOISIER, RETAILING FOR $144 PER BOTTLE, THOSE BOTTLES WERE NOT LARGE, THIS WAS BEING MARKETED IN A COMMUNITY WHERE THE MEDIAN HOUSEHOLD INCOME WAS ABOUT $20,000. THE AD SAYS YOU CAN ACHIEVE ANYTHING IN AMERICA. WELL, ALMOST. SO WHAT DOES THAT MEAN? WELL, IT SUGGESTS THAT WHILE THE LONG SOUGHT GOALS TO ACHIEVE JUSTICE, INEQUALITY IN AMERICA SO DEAR TO BLACK RESIDENTS NOT ONLY IN HARLEM BUT EVERYWHERE ELSE IN THE COUNTRY, THOSE THENGZ MIGHT BE JUST BEYOND REACH, RIGHT? BUT CONSUMING AN EXPENSIVE ALCOHOLIC BEVERAGE IS NOT. NEXT SLIDE. AND THEN HERE IS ANOTHER IN THAT SERIES, AND THE SAME IDEA HERE, IF THIS GENTLEMAN WOULD JUST LOOK UP, HE COULD BE HAVING A TOTALLY DIFFERENT AND BETTER LIFE. NEXT SLIDE. SO THEN WHAT DID EXPOSURE TO ALL THAT ADVERTISING MEAN FOR HEALTH WE CONDUCTED LOGISTIC REGRESSION TO MODEL THE ODDS OF BEING A PROBLEM DRINKER, WHICH MEANT DRINKING PATTERNS THAT WERE SUGGESTIVE ABUSE OR DEPENDENCE, SO AGAIN THIS IS A SAMPLE OF BLACK WOMEN. SO THE PRIMARY EXPLANATORY VARIABLE OF INTEREST HERE IS ON THAT TOP ROW, THE ALCOHOL AD EXPOSURE. SO WE'RE BASICALLY MAPPING WHERE ALL THE ADS ARE IN RELATION TO WHERE THE WOMEN LIVED IN THE NEIGHBORHOOD, AND AFTER CONTROLLING -- SO THAT'S THE PRIMARY EXPOSURES. AND THEN AFTER CONTROLLING FOR THE OTHER VARIABLES IN THE TABLE , FIREARM, A FAMILY HISTORY OF HAVING ALCOHOL PROBLEMS, WE STILL FOUND THAT EACH ADDITIONAL AD WAS ASSOCIATED WITH 13 PERCENT GREATER ODDS OF PROBLEM DRINKING. SO ALL THE ADVERTISING DID MATTER. SO THESE FINDINGS ILLUSTRATE THE IMPORTANCE OF UNDERSTANDING CONTEXTUAL FACTORS AND FUNDAMENTAL CAUSES AND WHAT PUTS PEOPLE AT RISK OF RISKS. NEXT SLIDE. SO I WANT TO CONTINUE WITH THIS THEME OF FOOD AND DRINK BUT IN A QUITE DIFFERENT VEIN. SO HERE I'M GOING TO DISCUSS RESTAURANTS THAT USE EXPLICITLY RACIST BRANDING, WHETHER IN LOGO S, THE NAME, IMAGES, ARCHITECTURE, ALL FEATURES THAT ARE CENTRAL TO THE DINING EXPERIENCE. MANY ARE AWARE THAT THE '80S HAS A LONG HISTORY OF USING RACIAL CAIRKT TOUR TO SELL -- CARICATURE TO SELL PACKAGED FOODS. WE HAVE ALL SAW RECENTLY THAT UNCLE BEN'S AND AUNT JEMIMA CAME UNDER FIRE AND TWO DAYS AGO PEPSICO, WHO OWNS QUAKER OATS WHICH IS WHERE AUNT JEMIMA BRAND IS, THEY JUST ANNOUNCED THEY HAVE NEW BRANDING WHICH WILL NOW BE CALLED INSTEAD OF AUNT JEMIMA , THE PEARL MILLING COMPANY, SO THIS IS APPARENTLY THE NAME OF THE COMPANY FROM WHENCE AUNT JEMIMA ACTUALLY ORIGINATED. SO IN ANY CASE, SO WE ALL KNOW ABOUT THE FOOD, THE FOOD PRODUCTS, BUT THERE ARE ACTUALLY A NUMBER OF RESTAURANTS, UNABASH ED IN THE MOCKERY OF BLACKNESS WHICH HAVE REMAINED LARGELY UNKNOWN. NEXT SLIDE. AND I CAME ACROSS THESE EXPLICITLY ANTI-BLACK RESTAURANTS WHILE CONDUCTING ARCHIVAL RESEARCH FOR THE LARGER BOOK PROJECT THAT DR. RESNIK MENTIONED IN THE INTRO, WHICH IS ABOUT FAST FOOD, AND SO GOING DOWN THAT RABBIT HOLE CULMINATED IN THE 2019 PUBLICATION OF BURGERS IN BLACKFACE, ANTI-BLACK RESTAURANTS THEN AND NOW, PUBLISHED AT THE UNIVERSITY OF MINNESOTA PRESS' FORERUNNER SERIES FOR SHORT WORKS. SO THIS IS A SCREENSHOT FROM THE E-BOOK. SO THIS WORK AND THEN THE LARGER ORIGINALLY PLANNED BOOK CAME FROM THE NLM FUNDING THAT I RECEIVED. SO BURGERS IN BLACKFACE LOOKS AT FOUR RESTAURANTS, I'LL JUST BRIEFLY DESCRIBE TWO OF THEM HERE, ONE OF WHICH IS DEFUNCT AND THE OTHER IS STILL IN OPERATION. NEXT SLIDE. THE COON CHICKEN INN OPENED IN MID 1920S BY MAXIMUM GRAHAM AND HIS WIFE ADD LYNN. MAXIM OBTAINED FRIED CHICKEN RECIPE AND $2,000 IN A BUSINESS DEAL, WHICH IS ABOUT 29,000 IN TODAY'S DLARKZ HE AND HIS WIFE OPENED A MODEST ESTABLISHMENT THAT SOLD SANDWICHES, BURGERS AND OTHER ITEMS, SIMPLE DISHES BURKT THE BAISH BUT THE SIGNATURE DISH WAS THE COON CHICKEN. SMALL STAND GREW INTO THE LARGE HE RESTAURANT DEPICTED HERE. WHAT YOU SEE ON THE LEFT OF THE IMAGE, THIS LARGE GRINNING WINK ING FAITION OF A BLACK MAN WEARING A PORTER'S CAP, ACTUALLY FORMED THE ESTABLISHMENT'S ENTRANCE, SO THAT GAP IN THE FRONT TEETH THAT YOU SEE THERE IS THE DOORWAY. SO YOU WALK THROUGH THE MOUTH TO ENTER THE RESTAURANT. AS ONE NEWS REPORT DESCRIBED AT THE TIME, QUOTE, THE BUILD BE HAS BEEN CONSTRUCTED TO REPRESENT A SOUTHERN LOG CABIN. A HUGE REPLICA OF THE HEAD OF A COLORED MAN, THE OFFICIAL TRADEMARK OF THE COMPANY, SMILES FROM THE FRONT OF THE BUILDING DISPLAYING A ROW OF GLEAMING WHITE TEETH, END QUOTE. THE IMAGERY WAS QUICK VISUAL SHORTHAND FOR THE IDEA OF BLACK PEOPLE IN THEIR NATURAL PLACE AS SERVANTS AND COOKS AND THE RACIAL CHARACTER MOCKS ASK DE HUMANIZES BLACK PEOPLE. THE ENTRANCE BECK ONS WITH THE MANY GOOD THINGS WHITE PATRONS COULD ENJOY INSIDE, NOT JUST A GOOD MEAL BUT ALSO A REINFORCEMENT OF THEIR WHITENESS IN THE NOSTALGIC FRAMEWORK. OLD SOUTH. NEXT SLIDE. THE LOGO ACTUALLY FOUND ITS WAY INTO SPIKE LEE'S 2000 SATIRE BAM BOOZLE, HAVING WATCHED IT THE FIRST TIME IT WAS RELEASED, I REALIZED A MONTH AGO, THIS IS A SCREENSHOT FROM THE ACADEMY AWARDS WEBSITE. RACISM OF THE COON CHICKEN I KNOW OBVIOUSLY HASN'T GONE ANYWHERE. THERE ARE RACIST IMAGES THAT CONTINUE TO CIRCULATE, AS WITH THIS CARD OF COONS COONING AVAILABLE ON ETSY, SO THAT RACISM CONTINUES TO CONSTITUTE A MARKETABLE GOOD. NEXT SLIDE. THEN THE SECOND RESTAURANT, SO THE COON CHICKEN INN IS NO LONGER, BUT IT WENT OUT OF BUSINESS IN THE MID 1950S. A SECOND RESTAURANT THAT EMPLOYED RACIST BRANDING WAS SAM BO'S, WHICH IS STILL IN OPERATION, ALTHOUGH IT JUST CHANGED THE NAME. SO ALSO AGAIN IN THE MIDST OF THE SORT OF RACIAL RECKONING THAT THE COUNTRY HAS BEEN UNDER GOING AND THESE BRANDS THAT CAME UNDER FIRE SAMBO'S FINALLY DECIDE TO DO CHANGE IT NAME. SO ONCE A NATIONWIDE CHAIN, SAMB O'S BEGAN IN 1-9D 57 AS A PANCAKE HOUSE IN SANTA BARBARA AND THE OWNERS PURPORTED THAT THE NAME CAME FROM AN A AMALGAM OF THEIR NAMES BUT IT CLEARLY CAME FROM THE CHILDREN'S STORY LITTLE BLACK SAMBO WHICH WAS A STORY FIRST PUBLISH IN THE UK IN 1899. I CAN SAY MORE ABOUT THE PLOT IF PEOPLE ARE INTERESTED IN THE Q & A BUT BASICALLY THE STORY RE COUNTS A LITTLE BOY'S ENCOUNTERS WITH TIGERS AND THE ADVENTURES IN HIM HAVING A MEAL OF PANCAKES. SO THE BOOK WAS PUBLISHED IN THE UK IN 1899, QUICKLY CROSSES THE THROONG THE U.S. AND IS -- CROSSES THE ATLANTIC IN THE U.S. AND IS ASIM LAIPTD INTO THE UNITED STATES RACIAL TROPES SO WHAT'S SHOWN SHEER A SERIALIZED VERSION OF THE STORY WHERE THEY WERE PRINTING THE STORY AND SEGMENTS IN THE NEWSPAPER AS A COMIC STRIP SO THAT THE CHILDREN COULD COLLECT THEM AND THEN FASHION THEIR OWN LITTLE BOOKLET OUT OF IT. AS WE SEE, SAMBO IS PITCH-BLACK RS HE AND HIS PARENTS ARE THE SAME COLOR APPEARS THE IRON SKILLET THAT HIS MOTHER WEELDS WHILE MAKING THEIR PANCAKES. NEXT SLIDE. AND DESPITE REPEATED PROTESTS AND EVEN LAWSUITS OVER THE RACIST NAME, THE CHAIN THRIVED FOR MANY YEARS BEFORE EVENTUALLY GOING BANKRUPT IN THE EARLY 1980 S. IT WAS THEN REVIVED YEARS LATER IN 1998 BY CHAD STEVENS, THE GRANDSON OF ONE OF THE FOUNDERS, SO HE REFURBISHED THE ORIGINAL LOCATION IN SANTA BARBARA AND THEN IN SO DOING REIGNITED ALL THE DEBATES THAT DODGED HIS FORBEARERS. THIS IS A SCREENSHOT FROM THE WEBSITE OF THE RESTAURANT A COUPLE YEARS AGO, SO IT LASTED UNTIL A FEW MONTHS AGO WHEN SAMBO'S FINALLY CHANGED THE NAME STEVENS HAS CHANGED THE RESTAURANT TO CHAD, THIS IS WHEN IT WAS STILL SAMBO'S. STEVENS HAD UNTIL THEN REMAINED STEADFAST IN KEEPING THE SAMBO'S NAME, SEEING NO HARM IN IT AND THIS WAS TRUE FOR THE TRAWNT AS WELL AND THE IDEA IS THAT IT COULDN'T POSSIBLY BE RACIST. RIGHT? ANTI-BLACK RESTAURANTS LIKE SAMBO'S SUGGESTS TO AMERICA THAT REAL RACISM IS MANIACAL KIND OF ANIMUS BUT STEREOTYPES THAT MERELY DEHUMANIZE BLACK PEOPLE COULDN'T POSSIBLY BE RACIST IF THEY ELICIT SMILES. NEXT SLIDE. THE HEALTH RISK OF RESTAURANTS LIKE SAMBO'S THEN IS NOT IN THE FOOD THEY SERVE BUT IN THEIR UNABASHED DEGRADATION OF BLACK MEN. RACIAL EPITHETS IN THE NAME CONSTITUTE A AN ASSAULT. SUBORDINATION OF BLACKNESS THAT THESE RESTAURANTS CHAMPION IS ALSO UNRESTRICTED HEALTH AND SOCIAL POLICIES AND WHAT LIES AT THE FOUNDATION OF THE RACIAL EMPATHY GAP THAT SCHOLARS HAVE ARGUED UNDERMINE POLITICAL WILL TO FOSTER HEALTH EQUITY. DRS. DAVID WILLIAMS AND RUTH WILLIAMS MORRIS ARGUED THE AGE OLD PROVERB THAT STICKS AND STONES CAN BREAK MY BONES BUT WORDS WILL NEVER HURT ME DOES NOT RING TRUE IN BELIEVING, THAT NEGATIVE WORDS AND IMAGES CAN HAVE ON AN INDIVIDUAL'S HEALTH. NEXT SLIDE. SO DR. JONATHAN METZEL ARGUES IN HIS BOOK DYING OF WHITENESS, ARGUES THAT WHITENESS IS MORE THAN A A SYMBOLIC. WHITE MEN WERE VEHEMENTLY OPPOSED TO OBAMACARE EVEN THOUGH IT WOULD SAVE THEIR LIVES, FOR EXAMPLE, IF THEY HAD SERIOUS ILLNESSES THAT WOULD REQUIRE CARE. ONE RESPONDENT QUOTE, AIN'T NO WAY I WOULD EVER SUPPORT OBAMACARE OR SIGN UP FOR T I WOULD RATHER DIE. NO WAY I WANT MY TAX DOLLARS PAYING FOR MEXICANS OR WELFARE QUEENS, END QUOTE. THAT WORLD VIEW OF BEING WILLING TO DIE AND WILLING TO PUT ONE'S WHITE BODY ON THE LINE OF UP HOLDING RACIAL -- THEY CASUALLY DEHUMANIZE BLACK PEOPLE THEY EMBODY THE RACIST IDEALS TO WHICH MANY WOULD RATHER FLEE THAN TO SUPPORT SOCIAL REFORMS THAT WOULD BENEFIT EVERYONE. NEXT SLIDE. SO I'LL TURN NOW TO FAST FOOD RESTAURANTS WITH THE FOCUS ON HEALTH HAS UNSURPRISINGLY BEEN MORE ON THE NUTRITIONAL CONTENT OF THE FOOD AND THE FACT THAT DISPROPORTIONATE DENSITIES INCREASE CHRONIC DISEASE AND OBESITY RISK. SO THE BOOK PROJECT TENT TISM TITLED PAINTED BLACK, RACE TRANSFORMATION AND FAST FOOD IN AMERICA AND UNDER CONTRACT IN MINNESOTA. IN THE BOOK I EXAMINED FAST FOOD 'S TRAJECTORY FROM WHITE PRIMARILY SUBURBAN SPACE AND WHITE CONSUMERS TO BLACK CENTRAL CITY COMMUNITIES SO I CAME TO THE PROJECT AFTER HAVING PUBLISHED QUANTITATIVE STUDIES ON THE DISTRIBUTION OF FAST FOOD IN NEW YORK CITY. NEXT SLIDE. IN THIS HEAT MAP DARKER COLORS ARE INDICATE GREATER FAST FOOD DENSITY ACROSS FIBERS OF NEW YORK CITY. AT THE TOP IS THE BRONX, SKINNY, ON THE LEFT, QUEENS, BROOKLYN AND STANTON ISLAND AT THE BOTTOM SO WHAT WE FOUND IS THAT OUTSIDE OF COMMERCIAL AND BUSINESS DISTRICTS TRANSPORTATION EXPHUBZ THURS DESTINATIONS FAST FOOD WAS MOST DENSE IN THE BRONX ACROSS HARLEM, TSIEN CENTRAL BROOKLYN AND PORTIONS OF QUEENS, SHADING IS DARKEST IS WHERE THE AVERAGE EXPOSURE TO FAST FOOD IS HIGHEST AND WE SHOWED THAT THE PERCENTAGE OF BLACK RESIDENTS WAS THE STRONGEST PREDICTOR BY FAR OF THIS FAST FOOD DENSITY MAP. IT WAS NOT DRIVEN BY INCOME. IT WAS NOT DRIVEN BY OTHER KINDS OF TSIEN CENSUS VARIABLES, POPULATION DENSITY AND SO ON. THIS IS A FINDING THAT SEVERAL STUDIES HAVE DOCUMENTED. AND THOUGH FINDINGS ARE MIXED, THERE'S SUBSTANTIAL EVIDENCE THAT LIVING PROXIMAL TO HIGHER DENSITIES OF FAST FOOD IS ASSOCIATED WITH HIGHER BMI AND OBESITY. THESE STUDIES ILLUMINATE AGAIN WHAT PUTS BLACK COMMUNITIES AT RISK OF HEALTH RISKS, AND THE STUDY THAT WE DID HERE IN NEW YORK ALONG WITH SOME OTHER RESEARCH THAT MY COLLEAGUES AND I COMPLETED BOTH IN NEW YORK AND IN OTHER CITIES LED ME TO THE BOOK PROJECT BECAUSE THE QUESTION WAS HOW DO THESE PATTERNS COME TO PASS? BECAUSE FAST FOOD DID NOT LOCATE IN BLACK NEIGHBORHOODS WHEN IT FIRST BEGAN, SO WHAT WAS THE PATH THAT FAST FOOD TRAVERSED IN MOVING TO ITS ORIGINS IN EARLY CHAINS LIKE WHITE CASTLE AND SUBURBAN IN LATER CHAINS LIKE M cDONALD'S AND KFC TO BECOME VIRTUALLY SYNONYMOUS WITH BLACK URBAN SPACE? SO THAT'S THE CENTRAL QUESTION TO THE BOOK. NEXT SLIDE. CONTINUED HIGHER REATS OF RESIDENTIAL SEGREGATION IN U.S. CITIES MEANS THAT IF CORPORATIONS WISH TO TARGET BLACK PEOPLE AS A GROUP IT'S AN ENDEAVOR ACHIEVED. BLACK NEIGHBORHOODS ARE FREQUENTLY AWASH IN FAST FOOD SO MUCH THAT SOME COMMUNITIES HAVE ACTUALLY ENACTED LEGISLATION TO STEM THE TIED, THAT WAS THE CASE IN LOS ANGELES IN 2008 BUT FAST FOOD ACTUALLY CAME QUITE LATE TO BLACK NEIGHBORHOODS, PASSED OVER THESE COMMUNITY NOT SIMPLY BECAUSE THE INDUSTRY WAS IGNORANT OR DISMISSIVE OF A PROFITABLE CONSUMER GROUP THOUGH IT WAS AND IT DID, BUT ALSO BECAUSE THESE COMMUNITIES WERE INCOMPATIBLE WITH THE RACIAL LOGICS AND SYMBOLIC MEANINGS OF THESE RESTAURANTS. NEXT NEXT SLIDE. KFC AND BURGER KING BOTH PRECEDED McDONALD'S BUT THEY ALL CAME ABOUT AT AROUND THE SAME TIME, EARLY TO MID 50s AND ALL OF THEM OPENED IN SUBURBAN COMMUNITIES. RAY CROCK OPENED HIS FIRST Mc DONALD'S IN DES PLAINES IN 1955, A VERY WHITE SUBURB ABOUT 20 MILES NORTH OF CHICAGO, SO THIS IS WHAT THE SITE LOOKED LIKE IN 2013. THIS IS NOT THE ORNL RESTAURANT BUT THIS IS WHAT THE RESTAURANT LOOKED LIKE THAT THE RESTAURANT WAS DEM MONTHLY LISHED IN THE YEAT AND McDONALD'S ERECTED THIS REPLICA. SO WHEN IT OPENED FOR CROCK, YOU KNOW, INTENDING TO SEEK OUT A FAMILY TRADE MEANT ALL AMERICAN DOMESTICITY WHICH MEANT THE UN WIELDING WHITENESS OF MID CENTURY SUBURBAN SPACES. McDONALD'S WANTED CAREFUL INVESTMENT IN THE RIGHT KIND OF COMMUNITY SO THAT AUTOMATICALLY MEANT CON FLAILTING FAMILY LIFE WITH -- CONFLATING FAMILY LIFE WITH WHITENESS AND SO WITH THAT IN MIND, NOT JUST McDONALD'S BUT AGAIN BURGER KING, KFC AND OTHERS LEFT BLACK COMMUNITIES OFF THE MAP INCITING THEIR -- IN SITING THEIR RESTAURANTS AND MARKETING THEIR PRODUCTS. NEXT SLIDE. OR AS THIS COMMENTER ON AN INSTAGRAM POST FOR THE 2016 FILM THE FOUNDER STARRING MICHAEL KEATON AS RAY CROCK PUT IT QUITE SIMPLY, SO WE GONNA SIT HERE AND ACT LIKE THOSE AIN'T WHITE START OFFICE AS WHITES EAT BURGERS. WHITE CASTLE LITERALLY ELM 3W0ED ED WHITENESS, IMPLIED RACIAL PURITY. DECADES PASSED BEFORE THE INDUSTRY REALIZED THAT BLACK CONSUMERS WERE AN UNTAPPED CONSUMER SEGMENT. NEXT SLIDE. QUITE A SHIFT McDONALD'S FOR EXAMPLE MADE FROM THE ALL AMERICAN WHITENESS OF 1959 HARTFORD CONNECTICUT WHICH YOU SEE THE ON LEFT TO THE NOW DEFUNCT BLACK CONSUMER TARGETED WEBSITE 365 BLACK ON THE RIGHT. AFRICAN AMERICAN COMMUNITIES UNDERWENT A TRANSITION FROM A POSITION OF MARKET EXCLUSION TO A POSITION OF MARKET EXPLOITATION. SO THE BOOK WILL SHOW THAT IT WAS NOT A QUICK AND LINEAR PATH ACTUALLY. SO FAST FOOD MADE STRATEGIC CHOICES ABOUT HOW TO ENGAGE OR REJECT BLACK PEOPLE BOTH AS CONSUMERS AND AS ENTREPRENEURS. IT MELDED WITH DOMINANT RACIAL CURRENTS, AROUND IDEAS ABOUT THE PRODUCTS IT SERVED, REFLECTING AND PUSHING FORWARD EXISTING RACIAL IDEAS AND SOLUTIONS. NEXT SLIDE. CRITICALLY, AS FAST FOOD BEGAN ARRIVING IN BLACK NEIGHBORHOODS IN GREATER NUMBERS IN THE 1970S AND 1980S, COMMUNITIES VIGOROUSLY PROTESTED THEIR ENTREE, PHYSICAL AND SOCIAL DISORDER, CONCERNS SUCH AS LOITERING, CRIME, NOISE AND ARE LITER. IN MOST CASES THE RESTAURANTS WERE BUILT ANYWAY. BUT THE FREQUENT PROTESTS CONTRADICT NARRATIVES OVER DEMAND IN BLACK COMMUNITIES. NONETHELESS, WHETHER FAST FOOD OR SOUL FOOD, MANY HEALTH RESEARCHERS STUDY AFRICAN AMERICANS WITHIN A FRAMEWORK OF RACIAL TROPES THAT PERPETUATE IDEAS ABOUT DEVIANCE AND IRRELEVANT RESPONSIBILITY. -- AND IRRESPONSIBILITY. NEXT SLIDE. MEDIA HEADLINES IN 2018 EXTENSIVELY COVERED A STUDY DONE AT THE UNIVERSITY OF ALABAMA THAT WAS PUBLISHED IN JAMA WHICH REPORTED THAT CONSUMING A SO-CALLED SOUTHERN DIET WAS RESPONSIBLE FOREIGN TRANSLATIONAL RESEARCHED RACIAL DISPARITIES AND HYPERTENSION. THE PREMISE WAS THAT CARDIOVASCULAR DISEASE IS THE BIGGEST CONTRIBUTOR OF DIFFERENTIAL MORTALITY BETWEEN WHITE AND BLACK AMERICANS, AND THE AUTHORS ARGUE THAT, QUOTE, THE REASONS FOR THE DIFFERENCE IN THE INCIDENCE AND PREVALENCE OF HYPERTENSION BETWEEN THE BLACK AND WHITE POPULATIONS REMAIN UNKNOWN, END QUOTE. ON THIS POINT THE AUTHORS CITED AN EDITORIAL PUBLISHED IN 2011 WHICH HIGHLIGHTED BIOLOGICAL DIFFERENCES AS POTENTIAL CAUSES. SO THAT SAYING THAT HYPERTENSION THAT, THE DIFFERENCES IN HYPER TENSION WERE REALLY DUE TO SOMETHING BIOLOGICAL ABOUT BLACK PEOPLE AND THEY TALKED ABOUT THE ARTICLE TALKED ABOUT DIFFERENCES IN GENOTYPE AND DISCUSSED THE SO-CALLED SLAVERY HYPERTENSION HYPOTHESIS, A DEBUNGT THEORY ABOUT BLACK BODIES BEING PREDISPOSED TO RETAIN SALT AFTER UNDERGOING THE MIDDLE PASSAGE. NEXT SLIDE. BUT THE REASONS FOR DIFFERENCES IN HYPERTENSION ARE NOT REALLY UNKNOWN, NOT IN THE WAY THAT THAT ARTICLE SUGGESTED. ACTUALLY THERE'S QUITE A GREAT DEAL OF EVIDENCE SHOWING THAT RACISM IS ASSOCIATED WITH HYPER TENSION, AND SO THIS SLIDE SHOWS SOME OF THE VOLUMINOUS LITERATURE ON RACISM IN AFRICAN AMERICAN HEALTH INCLUDING BUT NOT LIMITED TO CARDIOVASCULAR HEALTH. AND APART FROM THAT, THERE'S ALL THE LITERATURE OF THE WHITE HEALTH STUDIES CONDUCTED IN UK SHOWING THAT HOLDING IMRMENT WHERE YOU HAVE LESS CONTROL AT WORK, LESS AUTHORITY OVER DECISIONS, LESS ABILITY TO ALLOCATE YOUR TIME AND USE OF SKILLS IS ALSO ASSOCIATED WITH HEART DISEASE AND OTHER ILLNESS ES. THEN THERE'S THE LITERATURE ON JOHN HENRYISM, THE CONCEPT OFFERED BY DR. SHERMAN JAMES WHICH SHOWS THAT HIGH EFFORT COPING AND PERCEPTIONS THAT SUCCESS CAN BE ACHIEVED WITH THIS KIND OF BLOODY MINDED DETERMINATION TO ACHIEVE IN THE FACE OF SIGNIFICANT BARRIERS AND ADVERSITY, AGAIN, IS ASSOCIATED WITH HIGH BLOOD PRESSURE. THEN THERE'S ALSO THE LITERATURE ON WEATHERING, A CONSTRUCT ARTICULATED SHOWING THAT THE CUMULATIVE WEAR AND TEAR OF STRESS PARTICULARLY AS IT RELATES TO RACISM LITERALLY AGES BLACK PEOPLE FASTER. NEXT SLIDE. AND THAT RACISM MAY TAKE THE SHAPE OF THE DEEPLY INSTITUTIONALIZED RACISM THAT CONSTRAINS OPPORTUNITIES AND HEIGHTENS EXPOSURE TO HEALTH RISK, AND THEN THERE'S ALSO THE SORT OF DAY TO DAY VERSION, RIGHT? SO AS BLACK RESPONDENTS IN OUR NEW YORK CITY STUDY OF RACISM AND HEALTH REPORTED, YOU KNOW, THEY'RE THE MORE ROUTINE INTER PERSONAL KINDS OF INTERACTIONS THAT TELL BLACK PEOPLE THAT THEIR HUMANITY IS SUSPECT. SO THAT CAN MANIFEST AS RUDENESS , UNDUE OR INAPPROPRIATE ATTENTION OR BEING TREATED AS INVISIBLE OR UNIMPORTANT. SO THE QUOTES HERE ARE FROM BLACK RESPONDENTS IN NEW YORK, AND AS YOU CAN SEE, THEY'RE EXAMPLES OF JUST THAT KIND OF CASUAL DISREGARD FOR BLACK PEOPLE AND THEIR EXPERIENCE. NEXT SLIDE. BUT THE JAMA STUDY SOUGHT TO INVEST GAIFT THE IMPACT OF A SOUTHERN DIET ON HYPERTENSION. SO WE'RE SETTING ASIDE ALL THE KNOWLEDGE WE KNOW ABOUT RACISM AND HOW THAT AFFECTS HEALTH. SO BUT LOOKING AT DIET, THE DIET WAS DEFINED, THE SOUTHERN DIET WAS DEFINED AS, QUOTE, HIGH INTAKE OF FRIED FOODS, ORGAN MEATS, PROCESSED MEATS, EGG AND EGG DISHES, ADDED FATS, HIGH FAT DAIRY FOODS, SUGAR SWEETENED BEVERAGES AND BREAD, END QUOTE. SO OTHER THAN ORGAN MEATS, WHICH AREN'T REALLY WIDELY CONSUMED TODAY, THAT PRETTY MUCH SOUNDS LIKE THE AMERICAN DIET. AND SO THIS REMINDS ME OF A GREAT TALK ACTUALLY FOR THIS NLM HISTORY TALK SERIES WHERE DR. RA DEN TALKED ABOUT THE FALLACY OF THINKING THAT YOU'RE WORK WITH RAW DATA, RIGHT? SO SHE SAYS, QUOTE, DATA IS ALWAYS ALREADY COOKED. SO THIS VARIABLE SOUTHERN DIET IS COOKED NOT RAW, IT REFLECTS DECISIONS. THE RESEARCHERS COULD HAVE CATEGORIZED SOUTHERN DIET AS AN ABUNDANT CONSUMPTION OF GREENS, OKRA, BEANS, ROOT VEGETABLES, FRESH FRUITS AND OTHER FOODS REFLECTIVE OF A HISTORY AND FOOD CULTURE BUT THEY DIDN'T SO THE RESULTS WHICH BLAIRD OUT ACROSS THE MEDIA FIT NEATLY INTO EXISTING SCRIPTS, THAT BLACK PEOPLE AND THEIR CULTURAL PRACTICES ARE ALWAYS ALREADY PROBLEMATIC. SO THIS IS WHY DR. ADAMS' STATEMENT THE FORMER SURGEON GENERAL ABOUT BLACK PEOPLE BEING MORE LIKELY TO HAVE HYPERTENSION DOESN'T ACTUALLY NECESSARILY LOOK TO UPSTREAM CAUSES. RIGHT? IT'S PROBABLY JUST ABOUT BLACK PEOPLE'S BAD BEHAVIOR. SO ANOTHER COOKED VARIABLE IN THE STUDY WAS DOES NOT EXERCISE. SO PARTICIPANTS WERE ASKED TO INDICATE THE NUMBER OF TIMES PER WEEK THAT THEY EXERCISE ENOUGH TO SWEAT, AND THIS WAS DICHOTOMIZED INTO SOME VERSUS NONE. BUT WHAT IF THE VARIABLE WAS INSTEAD STRUCTURALLY UNABLE TO EXERCISE? WHAT IF PARTICIPANTS WERE ASKED INSTEAD OF, YOU KNOW, HOW OFTEN DID YOU EXERCISE ENOUGH TO SWEAT WHAT IF YOU WERE ASKED HOW MANY DAYS PER WEEK DO YOU LEAVE HOME EARLY IN THE MORNING TO BEGIN A LONG SEDENTARY COMMUTE TO A LOW- PAYING JOB FAR FROM HOME, WORK ALL DAY AT EXHAUSTING WORK AND RETURN HOME LATE AT NIGHT? THAT WOULD TELL YOU SOMETHING VERY DIFFERENT AND WOULD BEGIN TO GET AT THE DISTAL CAUSES OF HEALTH MAKING MOTIVATIONAL ATTRIBUTIONS THAT WE STRUCTURE UNINTERROGATED. OKAY. NEXT SLIDE. BUT THAT STUDY AND ITS BREATH LESS COVERAGE IN THE MEDIA REVEALS THAT NOT ONLY ENDURING RACIALIZED NARRATIVES ABOUT BLACKS' HEALTH BEHAVIOR MAKES SOME MESSAGES MORE READILY HEARD AND DISSEMINATED BUT ALSO THE CONVERSE THAT WHITE HEALTH BEHAVIORS ARE NORMALIZED. PART OF WHAT IT MEANS TO TALK ABOUT AFRICAN AMERICAN HEALTH AS DR. JONES POINTS OUT IS NOT JUST THE RACISM THAT BLACK FOLKS EXPERIENCE BUT ALSO THE BENEFITS OF MYRIAD ADVANTAGES AND POWER THAT ARE UNFAIRLY BESTOWED TO WHITE COUNTERPARTS. KEY AMONG THESE ARE BENEFIT OF THE DOUBT, TRUST, LAXITY AND RULE ENFORCEMENT AND DAY-TO-DAY BREAKS THAT MOST WHITES FAIL TO EVEN NOTICE. SO IN THAT POINT, THESE ARE SCREEN SHOTS FROM 2014 NEW YORK TIMES ARTICLE TITLED YOU PROBABLY DON'T WANT TO LOOK IN THE CHRIS SPER, WHICH REVEALED WHAT APPARENTLY RENOWNED WHICH HE WAS HAD IN THEIR FRIDGES AT HOME. SO IF WE LOOK AT THESE PICTURES, THAT INCLUDED PLENTIFUL ALCOHOL, RANGE FRG PABST BLUE RIBBON TO OTHER KIND OF BEER AND OTHER KIND OF CHAMPAGNE, LOTS OF CHAMPAGNE, REALLY WEIRD AMOUNT OF CHAMPAGNE. THAT'S A LOT OF CHAMPAGNE. WHAT ELSE DO THEY HAVE? THEY HAD CONDIMENTS, VARIOUS KIND OF KIT CAT CANDY BARS, APPARENTLY THE ONE THERE ON THE TOP WAS WASABI FLAVORED KITKAT, THEY HAD DOE NUTS THAT THE CHEF IN QUESTION ADMITTED TO OCCASIONAL NEEGHT A BOWL WITH MILK LIKE THEY WERE CEREAL, AND COOKIE DOUGH CONTAINING RENDERED LADDER. AND WHAT WE DON'T -- RENDERED LA RD. WE DON'T SEE MUCH OF IS FRUITS AND VEGETABLES. BUT THESE WHICH HE WAS ARE BUT THESE CHEFS ARE GEFN BENEFIT OF THE DOUBT. NOT CONCEPTIONS OF MORAL FAILURE WHITENESS LENDS MORAL SI TO. BENEFITS THAT OUGHT TO BE REALIZED IN DAY TO DAY LIEVMENT NEXT SLIDE. IN DAY-TO-DAY LIFE. NEXT SLIDE. MY COLLEAGUE MELODY GOODMAN AND I FOUND EVIDENCE OF THIS IN A STUDY IN BOSTON, SO WE TOOK NOTE OF AN INTERESTING FINDING IN A STUDY BY DR. SUBERMINIAN AND COLLEAGUE AND FOUND HA METRO AREAS WITH HIGHER PROBABILITIES OF POOR HEALTH FOR WHITES WERE THOSE IN WHICH THE WHITE-BLACK HEALTH DISPARITY WAS NARROW. IN OTHER WORDS, THE ABSOLUTE HEALTH OF WHITES WAS BETTER WHERE THEY HELD A LARGER RELATIVE ADVANTAGE TO BLACK COUNTERPARTS. AND WHY MIGHT THAT BE? PERHAPS THE PSYCHOLOGICAL WAGES ACCRUED FROM WHITENESS BENEFIT HEALTH. POOR MITES MAY HEALTH HEALTH RISKS NOT MERELY DUE TO MEAGER RISK -- IF WHITENESS CONFERS EXPECTATIONS OF PREF THEN WHITES MAY FARE BETTER WHEN THE RELATIVE GAP TO BLACKS IS LARGER BECAUSE THOSE GAPS ARE KENT WITH SUBTLE EXPECTATIONS FOR WHITENESS. SO IN BOSTON WE EXAMINED THREE NEIGHBORHOODS THAT COULD BE CHARACTERIZED AS RICH, RICHER AND RICHEST. THE MEDIAN INCOMES IN THE THREE AREAS ARE SUPERIMPOSED THERE ON PHOTOS FROM THE STREETSCAPES, AND IN THE TWO MOST AFFLUENT NEIGHBORHOODS, WHICH WERE ALSO THE MOST RACIALLY HOMOJEANNE YAS NEIGHBORHOODS, WHITE RESIDENTS WHO PERCEIVED BLACK PEOPLE TO BE WELCOME IN THEY ARE COMMUNITIES ENJOYED BETTER SELF-RATED HEALTH IN CONTRAST IN THE LEAST RICH NEIGHBORHOOD WHERE THERE WAS GREATER ECONOMIC DIVERSITY AND MANY MORE BLACK RESIDENTS, THOSE SAME PERCEPTIONS AT BEST CONFERRED NO HEALTH BEEN ITS IF OR AT WORST THEY WERE ASSOCIATED WITH POORER SELF-RATED HEALTH. IT MAY BE THAT THOSE RESIDENTS UNABLE TO REALIZE THE NORM OF EXCLUSIONARY WHITE SPACE EXPERIENCED A RELATIVE SOCIAL STATUS WHERE WHITENESS WAS MORE PRECARIOUS AND THEREFORE HARMFUL TO HEALTH. HE. NEXT SLIDE. THE STUDY FINDINGS SUGGEST THAT ADHERENCE TO AND RELIANCE ON REACIALIZED -- A RACIALIZED SOCIAL SYSTEM THAT PUTS WHITENESS AT THE TOP OF THE HIERARCHY HARMS WHITE FOLKS TOO. THE COVID PANDEMIC HAS THROWN INTO BOLD RELIEF HOW DAMAGING THE SUBTLE EXPECTATIONS OF WHITENESS CAN BE. MASK WEARING FOR EXAMPLE A SIMPLE AND EFFECTIVE WAY OF REDUCING THE SPREAD. VIRUS HAS BEEN A POLITICIZED AND RACIALLY CONTENTIOUS ISSUE. PEER REPORTED -- HERE REPORTED IN JUNE AND AUGUST OF 2020 THAT WHITE AND REPUBLICAN RESPONDENTS WERE THE LEAST LIKELY TO WEAR MASKS AND THIS SLIDE SHOWS DATA FROM OCTOBER 2020 IN WHICH REPUBLICANS ACCOUNTED FOR 92 PERCENT OF THOSE WHO EXPRESSED SKEPTICISM OR OPPOSITION TO MASKS AND YOU JUST HAVE A COUPLE QUOTES OF WHY PEOPLE THOUGHT SO ON THE SLIDE. THE FACT IS THAT WEARING A MASK TO PROTECT OTHER PEOPLE IS SIMPLY NOT COMPELLING WHEN THE MOST VULNERABLE ARE OFTEN BLACK AND BROWN. JUST LAST MONTH THE WASHINGTON POST REPORTED ON RESTAURANTS IN MICHIGAN THAT HAVE BEEN IGNORING PUBLIC HEALTH GUIDANCE FILLING TO CAPACITY AND ESCHEWING MASKS. BUSTLING CROWDS MANY OF WHOM COME FROM HOURS AWAY AS TOURISTS SEEK BEING THE COMPANY OF OTHERS WHO DISDAIN MASKS. ONE PARTICULAR OWNER RECEIVED A CEASE-AND-DESIST OWNER FROM THE COUNTY HEALTH DEPARTMENT AND THE RESTAURANT CONTINUED TO OPERATE UNREPENTTIVELY. THE SHERIFF SHOWED UP AND OWNER QUERIED WHAT HIS PUNISHMENT WOULD BE AND THE SHERIFF REPLIED NOTHING, I'LL BE SEEING YOU TOMORROW FOR COFFEE AND BREAKFAST. END QUOTE. WE HAVE HEARD ARGUMENTS THAT WEARING A MASK INFRINGES ON INDIVIDUAL LIBERTY. HOW THEN SHOULD WE UNDERSTAND LIBERTY? NEXT SLIDE. TRACY MIRRORS A LAW PROFESSOR AT YALE HAS ARGUED THAT AT ITS BASE FRO DOM IS. HERE SHE REFERRED TO SUCH FEARS AS, KILLED BY THE POLICE. IN THE CONTEXT OF COVID MANY CIRCUMSTANCES EXIST THAT WE WOULD RATHER BLACK FOLKS WOULD HAVE NO CAUSE TO FEAR. BLACK PEOPLE RNLT AFRAID OF THE DARK, UNLESS THAT DARKNESS IS DEFINED BY FELLOW AMERICANS WHO WOULD RATHER DIE FOR RACIAL HIERARCHY THAN TO LIVE FOR THE INTERESTS OF THE PUBLIC'S HEALTH , UNLESS IT'S A STATE UNDER THE PREVIOUS ADMINISTRATION THAT COULD FULLY ADVOCATE ITS ROLE AS WELL-BEING OF POPULUS AS HUNDREDS OF THOUSANDS DIE OR UNLESS IT'S HAVING TO WATCH BLACK DEATHS BE TALLIED AND NOT COUNTED. THE PANDEMIC HAS BROUGHT INTO SHARP FOCUS THAT WHAT IT MEANS TO TALK ABOUT AFRICAN AMERICAN HEALTH RISK IS TO TALK ABOUT THE FATE OF THE NATION. WHEN JAMES BALDWIN WAS INTERVIEWED ARE IN 1968, DICK CA VETT ASKED WHY BLACK PEOPLE WEREN'T MORE OPTIMISTIC GIVEN THE SUBSTANTIAL PROGRESS THAT HAD BEEN MADE SO THAT WE HAVE BLACK MAYORS AND BLACK SPORTSMEN AND SO ON AND QUERIED QUOTE IS IT AT ONCE GETTING MUCH BETTER AND STILL HOPELESS? SO BALDWIN REPLIED, QUOTE, WELL, I DON'T THINK THERE'S MUCH HOPE FOR T YOU KNOW, TO TELL YOU THE TRUTH, AS LONG AS PEOPLE ARE USING THIS PECULIAR LANGUAGE, IT'S NOT A QUESTION OF WHAT THOOPS THE NEGRO HERE TORQUES THE BLACK MAN HERE, THAT'S A VERY VIVID QUESTION FOR ME , YOU KNOW, BUT THE REAL QUESTION IS WHAT'S GOING TO HAPPEN TO THIS COUNTRY, I HAVE TO REPEAT THAT, END QUOTE. NEXT SLIDE. SO I WILL STOP THERE AND I WANT TO ACKNOWLEDGE THE GRANTS AND FELLOWSHIPS THAT MADE THE STUDIES I DISCUSSED AND THE RECENT BOOK PROJECTS POSSIBLE. UNFORTUNATELY I CAN'T FIT ALL THE RESEARCH STAFF AND WONDERFUL COLLABORATORS WHO US A CONTRIBUTED BUT THEY HAVE MY THANKS AS WELL. AND YEAH, I LOOK FORWARD TO QUESTIONS. >> DR. KWATE, THANK YOU VERY MUCH FOR THAT VERY IMPORTANT AND ENGAGING PRESENTATION, AND CONGRATULATIONS ON YOUR RESEARCH >> Naa Oyo A. Kwate: THANKS. >> THANK YOU VERY MUCH. WE DO HAVE SOME TIME FOR QUESTIONS, AND I HAVE RECEIVED SEVERAL. THE FIRST ONE IS IN RESEARCH LOOKING AT SMOKING AND HEALTH RISK, MANY STUDIES SUGGEST THAT PER PACK YEARS, BLACKS DO WORSE THAN WHITES. SOME BELIEVE THIS MAY BE DUE, MAY BE THE MENTHOL EFFECT. OTHERS ALSO SUGGEST THAT BLACKS SMOKE SHORTER BUTTS THAN WHITES. WHAT ARE YOUR THOUGHTS ON THIS DIFFERENCE IN PACK YEARS COMPARED TO HEALTH RISK BY RACE? >> Naa Oyo A. Kwate: WELL, I HAVE TO SAY I AM NOT A SMOKING EXPERT, BUT I KNOW THAT, RIGHT, THE SAME KIND OF THING THAT COMES UP WITH ALCOHOL IS THAT, YOU KNOW, BLACK PEOPLE MAY CONSUME -- THEY MAY BE LESS LIKELY TO DRINK BUT THEY STILL FACE WORSE HEALTH OUTCOMES FROM THE DRINK THAT GO THEY DO, AND I THINK THAT JUST SPEAKS TO THE BROADER CONTEXT OF AGAIN WHAT PUTS PEOPLE AT RISK, OF RISK, THAT THERE ARE A NUMBER OF STRUCTURAL FACTORS, YOU KNOW, OPERATING TO WORSEN HEALTH OUT COMES EVEN IF THE BEHAVIOR ITSELF MAY NOT BE AT THE SAME LEVEL OF SEVERITY AS OTHERS. >> THANK YOU. UNDERSTOOD. ANOTHER QUESTION THAT WE RECEIVED, THANK YOU FOR THIS EXCELLENT ALBEIT DISTURBING PRESENTATION, THIS PERSON WRITES , HOW DO YOU RECONCILE THE AGGRESSIVE ADVERTISING OF ALCOHOL IN PREDOMINANTLY BLACK NEIGHBORHOODS WITH THE SURVEY RESULTS INDICATING THAT FEWER AFRICAN AMERICANS DRINK REGULARLY AS COMPARED TO WHITE AMERICANS? >> Naa Oyo A. Kwate: YEAH, I MEAN, SO THAT'S THE IMPORTANT MISMATCH IS THAT IT'S CLEARLY NOT DRIVEN BY DEMAND, RIGHT? THAT'S THE POINT I THINK I WANT TO MAKE CLEAR IS THAT WHEN YOU SEE ALL OF THAT ADVERTISING OR IF YOU SEE IN THE CASE OF FOR EXAMPLE LIQUOR STORES WHICH ARE ALSO CONSISTENTLY FOUND TO BE DISPROPORTIONATELY DENSE IN BLACK NEIGHBORHOODS AND THAT THEY'RE NOT ATTRIBUTABLE TO INCOME IS THAT THE IMMEDIATE SORT OF THOUGHT IS OKAY, WELL THEN IT MUST BE BECAUSE THOSE ARE THE COMMUNITIES ARE THERE'S THE GREATER DEMAND. BUT WE KNOW THAT NOT TO BE THE CASE BOTH FROM THE CONSUMER DATA AND FROM THE HEALTH DATA AND SO IT REFLECTS A NUMBER OF THINGS. I MEAN, IT REFLECTS COMPANIES SEEKING MORE CONSUMERS FOR PRODUCTS, SO FOR EXAMPLE, WITH SMOKING, THEY WERE VERY DELIBERATE IN RECOGNIZING THAT AS SMOKING REATS DECLINE, THEY NEEDED MORE BLACK SMOKERS TO TAKE UP THAT SLACK. WITH ALCOHOL, IT'S AGAIN THE SAME KIND OF THING IS SOME OF IT IS JUST DISREGARD FOR THE COMMUNITY WISHES, SO THAT'S WHY YOU SEE COMMUNITIES HAVING TO ENGAGE IF WHITEWASHING, THERE'S NO DEMAND, THEY DON'T WANT THE ADVERTISING, THEY DON'T WANT THE PRODUCTS, BUT THE CORPORATIONS THAT ARE INTERESTED HAD THEIR BOTTOM LINE HAVE ENTIRELY -- AN ENTIRELY DIFFERENT SET OF GOALS OR NEEDS THAN WHAT THE COMMUNITY DOES. >> THANK YOU. JUST A BASIC QUESTION. SEVERAL INDIVIDUALS HAVE WRITTEN TO SAY THIS IS A FABULOUS AND INFORMATIVE PRESENTATION, FACT PACKED AND SOME EVEN WROTE TRIPLE EXCELLENT. AND ON THE HEELS OF THAT I WOULD LIKE TO SAY TO THESE INDIVIDUALS WHO KIND OF WROTE IN, THIS WILL BE ARCHIVED, THIS TALK, AS ARE ALL OF OUR HISTORY TALKS HERE AT THE NATIONAL LIBRARY OF MEDICINE AND AVAILABLE THROUGH THE NIH VIDEOCASTING SYSTEM, SO YES, THIS TALK WILL BE ARCHIVED AND AVAILABLE PROBABLY WITHIN A COUPLE OF DAYS. DR. KWATE, ANOTHER QUESTION, YOU MENTIONED THAT SOME COMMUNITIES NOAFTBLY LOS ANGELES TOOK STEPS TO STEM THE TIDE OF FAST FOOD RESTAURANTS MOVING INTO AND EXPLOITING AFRICAN AMERICAN NEIGHBORHOODS. WHAT DID THAT LOOK LIKE? CAN YOU SAY MORE? WHAT DID THESE COMMUNITIES DO TO TRY TO STEM THE TIDE? >> Naa Oyo A. Kwate: YEAH, SO THE LOS ANGELES CASE IS REALLY INTERESTING. SO THIS WAS IN 2008, AND ESSENTIALLY WHAT HAPPENED IS THE CITY COUNCIL PROPOSED LEGISLATION THAT, SO THEY CREATED AN ORDINANCE THAT STARTED OUT AS TEMPORARY AND THEN BECAME PERMANENT AFTER THAT , BUT THE ORDINANCE WAS MEANT TO PROHIBIT THE ENTRY OF ADDITIONAL FAST FOOD RESTAURANTS IN COMMUNITIES THAT WERE ALREADY HEAVILY SATURATED, THIS WAS SOUTH LA, BALDWIN HILLS, EAST LOS ANGELES, I THINK, AND SO ON THE ONE HAND IT WAS A REALLY INTERESTING KIND OF INTERVENTION , BUT ON THE OTHER, IT WAS ALSO LIMITED BECAUSE OF THE WAY THAT IT WAS DEFINED AND THAT WAS PROBABLY A REFLECTION OF THE FACT THAT THEY DIDN'T WANT TO BE SEEN AS ENGAGING IN THE TOTAL OVERAGE BUT BASICALLY IT SAID OKAY YOU CAN'T HAVE NEW RESTAURANTS THAT ARE FREESTANDING LIKE SORT OF IF YOU THINK OF LIKE A FAST FOOD RESTAURANT ON THE CORNER WITH A DRIVE THRU AND THE WHOLE THING, SO IT PROHIBITED NEW FREESTANDING RESTAURANTS THAT -- FROM COMING IN BUT THAT DIDN'T MEAN NO NEW RESTAURANTS AT ALL. SO YOU COULD STILL HAVE FAST FOOD COME IN IF IT WAS, SAY, IN A STRIP MALL. SO THEN IT'S NOT A FREESTANDING RESTAURANT. AND IT ALSO OBVIOUSLY DIDN'T -- AND IT ALSO IBILITYD PR, THOUGH, EXPANSIONS OF FLOOR SPACE AND IT ALSO PROHIBITED ADDING A NEW DRIVE THRU WINDOW TO AN EXISTING RESTAURANT. SO, YOU KNOW, ON THE ONE HAND, IT'S MAKING IT IMPOSSIBLE FOR NEW RESTAURANTS TO COME IN IN A PARTICULAR VERY NARROW KIND OF SET OF CRITERIA, SO THE DENSITIES, THE FASTER THE FAST FOOD DENSITIES THIS THOSE COMMUNITIES WERE DEALING WITH WASN'T NECESSARILY LESSEN HE HAD THE THE IDEA WAS THEY THOUGHT, WELL, IF WE CAN STEM THE TIDE AND SORT OF RURPS THE NUMBER OF -- REUMS THE NUMBER OF FAST -- REDUCE THE NUMBER OF FAST FOOD RESTAURANTS COMING IN, THAT MIGHT OPEN UP THE POSSIBILITIES OF SIT DOWN RESTAURANTS AND A WIDER RANGE OF HEALTHFUL OPTIONS THAT WERE MORE PRECEDENT IN LOS ANGELES AND OTHER COMMUNITIES THAT WERE PRIMARILY WHITE BUT THAT DIDN'T REALLY HAPPEN AND THAT'S A REFLECTION THAT BLACK AND BROWN NEIGHBORHOODS ARE REDLINED FOR ALL KIND OF RETAIL AND JUST BECAUSE YOU TARGET A REDUCTION IN FAST FOOD, THAT'S NOT GOING TO LIMB NAIPT THE RACISM THAT KEEPS THE OTHER RESTAURANTS THAT YOU WANT -- ELIMINATE THE RACISM THAT KEEPS THE OTHER RESTAURANTS THAT YOU WANT FROM -- IT'S NOT GOING ON ATTRACT THEM TO COME IN , RIGHT? JUST BECAUSE THAT OTHER SET. SO IT WAS BOTH PRO AND CON, BUT I THOUGHT IT WAS A REALLY INTERESTING AND AN IMPORTANT KIND OF INTERVENTION THAT WAS MADE FROM THE COMMUNITY, WAS DETERMINED FROM THE COMMUNITY. YEAH. >> THANK YOU. WE HAVE A COUPLE MORE QUESTIONS, IF YOU DON'T MIND, AND YOU CAN STAY WITH US, WE WOULD BE GRATEFUL. THERE HAS INCREASE IN LITERATURE ON CHILDHOOD STRETCH ON HEALTH OUTCOMES. DID YOU LOOK INTO IMPACTS OF RACISM ON CHILDREN IN BLACK COMMUNITIES? >> I HAVE NOT. DR. ELEANOR SWEETON, OFF THE TOP OF MY HEAD I'M BLAPGING BUT THERE ARE A NUMBER OF RESEARCH ERS WHO HAVE LOOKED AT CHILD CHILDHOOD AND ADOLESCENT DEVELOPMENT STAGES, I HAVEN'T PERSONALLY, BUT IT'S THE SAME KIND OF ISSUES AND CONCERNS THAT YOU SEE IN THE ADULT POPULATIONS >> THANK YOU. ANOTHER INDIVIDUAL HAS WRITTEN IN, EXTREMELY IMPORTANT WORK. WELL PRESENTED. THANK YOU. YOU SHOWED SOME DATA REGARDING IMPACT OF ADVERTISING. IS THERE DATA ON EDUCATIONAL APPROACHES THAT ARE MORE EFFECTIVE IN COMBATING ADVERTISING? >> WELL, WE WERE DOING THE FIRST ON MY KNOWLEDGE STUDY AT LOOKING HOW THE OUTDOOR ADVERTISING ACTUALLY AFFECTED BEHAVIOR, SO THERE HAD BEEN A NUMBER OF STUDIES TO SHOW THAT THE ADVERTISING WAS DISPROPORTIONATE LY DENSE AS A FUNCTION OF RACE BUT HADN'T ACTUALLY MADE THE LINK TO WHAT'S THE IMPACT ON BEHAVIOR, SO. SO ANY OF THAT LET TOUR YOU SEE AROUND EDUCATION WILL PROBABLY BE AROUND PRINT OR FOCUSED ON YOUTH AND IT'S NOT ACTUALLY LOOKING AT ADVERTISING THE IN BUILT ENVIRONMENT ITSELF. I THINK WHAT'S IMPORTANT IS THAT IN OUR STUDY IT'S HARD TO TEASE APART, WE FOUND THE MORE ADS THERE WERE THE MORE LIKELY YOU WERE TO HAVING THE ODDS OF HAVING A PROBLEM DRINKING BUT THE MECHANISM FOR THAT IS UNCLEAR. SO IS IT JUST THE NUMBERS OF ADS OR DO YOU HAVE TO -- OR IS IT SOMETHING ABOUT THE MESSAGING IN THE ADS? THERE ARE A NUMBER OF ASPECTS ABOUT THAT ADVERTISING THIS COULD BE AFFECTING BEHAVIOR. SO IF YOU WERE GOING ON DEVELOP SOMETHING FROM AN EDUCATIONAL PERSPECTIVE, WHICH OF THOSE ASPECTS WOULD YOU NEED TO TARGET WOULD BE THE QUESTION. SO THAT'S NOT A STEP WE HAVE TAKEN PERSONALLY. >> THANK YOU. TWO MORE QUESTIONS, AND THEY'RE RELATED. AND THEY'RE IMPORTANT. AND I WOULD LIKE TO ASK THEM. BOTH THESE INDIVIDUALS THANK YOU VERY, VERY MUCH FOR YOUR PRESENTATION. WOULD YOUR FINDINGS AND CONCLUSIONS APPLY TO ANY MARCH GENERALLYIZED GROUP IN THE UNITED STATES, TO NATIVE AMERICANS, TO LATINOS, THIS PERSON WRITES, AND THE OTHER INDIVIDUAL WRITES: HOW ARE WE TO CHANGE THE SYSTEMIC INEQUALITY WITHIN THE SYSTEM AND WHAT CAN INDIVIDUALS DO IN THEIR OWN LIVES TO MAKE CHANGE? GREAT PRESENTATION. THANK YOU. >> Naa Oyo A. Kwate: THANK YOU. SO I WOULD SAY SOME OF WHAT I DISCUSSED, I MEAN, THE FACT THAT HARMS HEALTH IS SOMETHING THAT HAS BEEN SHOWN, YES, IN DIFFERENT MARGINALIZED COMMUNITIES. THAT IS TRUE. I WOULDN'T SAY THAT THE SPECIFIC FINDINGS THAT I REPORTED ON SHOULD BE GENERALIZED IN THE SAME WAY TO ALL THE POPULATIONS BECAUSE THERE'S SPECIFICITY IN WHAT, YOU KNOW, WHAT RAISES -- WHAT RACISM LOOKS LIKE AND AGAIN WHAT I WAS TRYING TO HOE IS THAT SOME OF THOSE LONG-STANDING RACIAL TROPES THAT ARE SPECIFIC TO BLACKNESS THAT CAN STILL CONTINUE TO OPERATE TODAY AND ARE MANIFEST IN THESE DIFFERENT KINDS OF UNIQUE AND SPECIFIC WAYS THAT AFFECT BLACK PEOPLE, SO I WOULDN'T WANT TO TRY TO SAY THAT YOU CAN JUST PICK THOSE UP AND APPLY THEM TO ALL GROUPS BECAUSE THAT'S NOT THE CASE, ALTHOUGH AGAIN, EXPERIENCING RACISM HAS BEEN SHOWN TO BE HARMFUL TO HEALTH FOR PEOPLE FROM OTHER BACKGROUNDS OTHER THAN PEOPLE OF AFRICAN AMERICAN OR PEOPLE OF AFRICAN DESCENT. THEN AS TORPEDO THE QUESTION AS TO HOW DO WE CHANGE THE SYSTEM, I MEAN, I THINK IT DEPENDS ON WHAT THE SYSTEM IS, SO THAT, YOU KNOW, CLEARLY WHAT WE SEE HAPPENING RIGHT NOW IN TERMS OF, YOU KNOW, THE PROTESTS THAT HAVE BY SOME MEASURES BEEN SEEN AS THE LARGEST IN U.S. HISTORY, I MEAN, I THINK THOSE KIND -- THAT KIND OF ACTION IS IMPORTANT AND NECESSARY AND WE'RE SEEING THE IMPACT OF IT, BUT I ALSO THINK THAT IF YOU'RE TALKING ABOUT HOW DO WE CHANGE, FOR EXAMPLE, WHAT WE SEE IN HEALTHCARE, WHERE BLACK PATIENTS ARE MORE LIKELY TO RECEIVE DISPARATE KINDS OF CARE IN THIS ONE REALM, HOW DO WE CHANGE THE SYSTEM AS IT RELATE TO EDUCATION, AS IT RELATES TO HOUSING AND RETAIL AND AS IT RELATES TO -- I MEAN, THERE ARE SO MANY DIFFERENT ENDPOINTS FOR THAT SYSTEMIC WORK THAT I THINK PEOPLE -- THAT WHAT INDIVIDUALS SHOULD DO IS REALLY BASED ON WHERE THEY ARE IS TRY ON MAKE A CHANGE BASED ON WHAT YOU KNOW TO BE UNJUST IN WHATEVER REALM, WHICHEVER SYSTEM , YOU KNOW, YOU CAN ACT. YOU MAY NOT HAVE ACCESS TO MAKING A DIFFERENCE IN HEALTHCARE, BUT I THINK STARTING SMALL IN YOUR COMMUNITY OR IN SCHOOL SYSTEMS AND SO ON IS WHERE PEOPLE CAN MAKE THEIR MOST DIRECT CONNECTION. >> THANK YOU, DR. KWATE. AND ON THAT VERY IMPORTANT NOTE, I WANT TO THANK YOU AGAIN FOR AN OUTSTANDING PRESENTATION, FOR TAKING THE TIME TO PREPARE IT AND PRESENT IT TODAY. WE HAD OVER 400 VIEWERS REMOTELY , AND IT'S A TESTIMONY TO THE IMPORTANCE OF YOUR WORK, AND WE LOOK FORWARD TO YOUR FUTURE PUBLICATIONS COMING UP SOON AND LOOK FORWARD TO KEEPING IN TOUCH. THANK YOU AGAIN VERY, VERY MUCH, AND I WESH YOU MUCH SUCCESS IN THE NEXT STEPS IN YOUR RESEARCH. THANK YOU.