1 00:00:07,666 --> 00:00:08,600 >> GOOD AFTERNOON. 2 00:00:08,600 --> 00:00:10,802 MY NAME IS DAVID MURRAY, I AM 3 00:00:10,802 --> 00:00:13,571 THE ASSOCIATE DIRECTOR FOR 4 00:00:13,571 --> 00:00:15,407 PREVENTION AT NIH AND THE 5 00:00:15,407 --> 00:00:17,042 DIRECTOR OF THE OFFICE OF 6 00:00:17,042 --> 00:00:17,676 DISEASE PREVENTION. 7 00:00:17,676 --> 00:00:20,578 I'M PLEASED TO WELCOME YOU TO 8 00:00:20,578 --> 00:00:23,148 THE 2024 ROBERT S. GORDON JR. 9 00:00:23,148 --> 00:00:23,748 LECTURE IN EPIDEMIOLOGY. 10 00:00:23,748 --> 00:00:27,686 THIS IS PART OF THE NIH 11 00:00:27,686 --> 00:00:29,454 DIRECTOR'S WEDNESDAY AFTERNOON 12 00:00:29,454 --> 00:00:31,189 LECTURE SERIES, WHICH IS I 13 00:00:31,189 --> 00:00:32,357 GENERALLY DESCRIBE AS THE MOST 14 00:00:32,357 --> 00:00:33,858 IMPORTANT LECTURE SERIESOT 15 00:00:33,858 --> 00:00:34,259 CAMPUS. 16 00:00:34,259 --> 00:00:36,094 THE GORDON LECTURE IS AWARDED 17 00:00:36,094 --> 00:00:39,431 EACH YEAR TO A TESTIFY WHO MADE 18 00:00:39,431 --> 00:00:40,732 HUGE CONTRIBUTIONS TO THE FIELD 19 00:00:40,732 --> 00:00:41,766 OF RESEARCH OR TRAINING IN 20 00:00:41,766 --> 00:00:43,335 EPIDEMIOLOGY OR IN THE CONDUCT 21 00:00:43,335 --> 00:00:44,202 OF CLINICAL TRIALS. 22 00:00:44,202 --> 00:00:45,270 THE SPEAKER SELECTION IS 23 00:00:45,270 --> 00:00:46,438 COORDINATED BY THE OFFICE OF DEC 24 00:00:46,438 --> 00:00:48,206 PREVENTION AND THIS IS THE 25 00:00:48,206 --> 00:00:50,608 29th YEAR THAT ODP HAS 26 00:00:50,608 --> 00:00:52,877 SPONSORED THE GORDON LECTURE. 27 00:00:52,877 --> 00:00:55,680 THE LECTURE WAS ESTABLISHED IN 28 00:00:55,680 --> 00:00:57,549 TRIBUTE ROBERT S. GORDON JR. FOR 29 00:00:57,549 --> 00:00:59,384 HIS DEDICATION TO THE FIELD OF 30 00:00:59,384 --> 00:01:00,352 EPIDEMIOLOGY AND HIS 31 00:01:00,352 --> 00:01:02,520 DISTINGUISHED SERVICE TO NIH. 32 00:01:02,520 --> 00:01:04,756 OVER THE COURSE OF 30 YEARS, 33 00:01:04,756 --> 00:01:06,891 DR. GORDON SERVED IN NUMEROUS 34 00:01:06,891 --> 00:01:07,959 SENIOR LEADERSHIP POSITIONS, 35 00:01:07,959 --> 00:01:09,494 INCLUDING SPECIAL ASSISTANT TO 36 00:01:09,494 --> 00:01:11,629 THE DIRECTOR, AND CHIEF ADVISOR 37 00:01:11,629 --> 00:01:14,933 FOR CLINICAL PRACTICES AND 38 00:01:14,933 --> 00:01:15,200 RESEARCH. 39 00:01:15,200 --> 00:01:16,634 DR. GORDON WAS AN EARLY 40 00:01:16,634 --> 00:01:17,936 ORGANIZER OF EFFORTS TO ADDRESS 41 00:01:17,936 --> 00:01:19,771 THE EMERGING PROBLEM OF HIV/AIDS 42 00:01:19,771 --> 00:01:22,073 AND IT BECAME A KEY COORDINATOR 43 00:01:22,073 --> 00:01:24,275 OF AIDS RESEARCH AT NIH. 44 00:01:24,275 --> 00:01:27,645 BEFORE WE GET STARTED, I HAVE A 45 00:01:27,645 --> 00:01:28,179 FEW HOUSEKEEPING ITEMS. 46 00:01:28,179 --> 00:01:33,151 THE CME CODE FOR TODAY IS 50125. 47 00:01:33,151 --> 00:01:35,220 I WILL REPEAT THAT IN A MOMENT. 48 00:01:35,220 --> 00:01:36,888 IF YOU HAVE QUESTIONS DURING 49 00:01:36,888 --> 00:01:39,057 TODAY'S TALK AND YOU'RE WATCHING 50 00:01:39,057 --> 00:01:41,559 ONLINE, PLEASE SUBMIT THEM VIA 51 00:01:41,559 --> 00:01:42,227 THE VIDEOCAST WEBSITE. 52 00:01:42,227 --> 00:01:45,363 YOU CAN DO SO BY CLICKINGOT WORD 53 00:01:45,363 --> 00:01:46,431 SEND LIVE FEEDBACK. 54 00:01:46,431 --> 00:01:48,066 THIS FEATURE IS JUST BELOW THE 55 00:01:48,066 --> 00:01:50,502 VIDEO DISPLAY FOR THE LECTURE. 56 00:01:50,502 --> 00:01:53,304 THOSE OF YOU WHO ARE IN THE ROOM 57 00:01:53,304 --> 00:01:55,607 WITH US, WE WILL OPEN THE 58 00:01:55,607 --> 00:01:56,608 MICROPHONES FOR QUESTIONS AT THE 59 00:01:56,608 --> 00:01:58,676 END OF THE LECTURE AND ALL YOU 60 00:01:58,676 --> 00:02:00,612 HAVE TO DO IS STEP UP TO 1 OF 61 00:02:00,612 --> 00:02:04,215 THE 2 MICROPHONES AND WE'LL CALL 62 00:02:04,215 --> 00:02:04,749 ON YOU. 63 00:02:04,749 --> 00:02:06,284 WE'LL OPEN THE FLOOR TO 64 00:02:06,284 --> 00:02:08,153 QUESTIONS AT THE END OF THE 65 00:02:08,153 --> 00:02:08,386 LECTURE. 66 00:02:08,386 --> 00:02:09,754 PLEASE FEEL FREE TO SUBMIT 67 00:02:09,754 --> 00:02:10,522 QUESTIONS ANY TIME, YOU DON'T 68 00:02:10,522 --> 00:02:12,724 HAVE TO WAIT UNTIL THE END. 69 00:02:12,724 --> 00:02:14,159 A VIDEO RECORKING OF THIS 70 00:02:14,159 --> 00:02:17,061 LECTURE WILL BE POSTED ON OUR 71 00:02:17,061 --> 00:02:19,564 WEBSITE, PREVENTION.NIH.GOV IN 72 00:02:19,564 --> 00:02:21,232 APPROXIMATELY 2 WEEKS, IT WILL 73 00:02:21,232 --> 00:02:23,568 ALSO BE AVAILABLE ON THE NIH 74 00:02:23,568 --> 00:02:24,335 VIDEOCAST WEBSITE. 75 00:02:24,335 --> 00:02:27,705 AGAIN THE CME CODE FOR TODAY IS 76 00:02:27,705 --> 00:02:28,306 50125. 77 00:02:28,306 --> 00:02:37,515 TODAY'S SPEAKER IS DR. LEONARD 78 00:02:37,515 --> 00:02:39,818 EDGDE, HE IS THE PROFESS 79 00:02:39,818 --> 00:02:40,552 OVERLAPPING OF MILWAUKEE 80 00:02:40,552 --> 00:02:41,453 COMMUNITY CHAIR OF HEALTH AND 81 00:02:41,453 --> 00:02:45,957 RESEARCH AT THE MEDICAL COLLEGE 82 00:02:45,957 --> 00:02:47,492 OF WISCONSIN, HE'S ALSO CHIEF OF 83 00:02:47,492 --> 00:02:49,360 THE MEDICAL CENTER AND DIRECTOR 84 00:02:49,360 --> 00:02:50,628 FOR CENTER FOR ADVANCING 85 00:02:50,628 --> 00:02:52,664 POPULATION SCIENCE MUCH AS A 86 00:02:52,664 --> 00:02:54,199 NATIONALLY RECOGNIZED HEALTH 87 00:02:54,199 --> 00:02:55,333 DISPARITIES RESEARCH FOCUSES ON 88 00:02:55,333 --> 00:02:57,068 DEVELOPING AND TESTING 89 00:02:57,068 --> 00:02:59,170 INNOVATIVE INTERVENTIONS TO 90 00:02:59,170 --> 00:03:00,505 REDUCE AND/OR ELIMINATE HELT 91 00:03:00,505 --> 00:03:05,109 DISPARITIES RELATED TO RACE 92 00:03:05,109 --> 00:03:06,544 ETHNICITY, SOCIOECONOMIC STATUS 93 00:03:06,544 --> 00:03:08,079 AND GEOGRAPHIC LOCATION FOR 94 00:03:08,079 --> 00:03:14,552 CHRONIC MEDICAL AND MENTAL 95 00:03:14,552 --> 00:03:17,288 HEALTH CONDITIONS. 96 00:03:17,288 --> 00:03:17,922 DR. CERTAINLY--CERTAINLY GEDE IS 97 00:03:17,922 --> 00:03:23,127 THE WIN AREY OF 5 NIH CLINICAL 98 00:03:23,127 --> 00:03:25,029 AWARDS, NOT MANY PEOPLE CAN SAY, 99 00:03:25,029 --> 00:03:28,900 AND HE HAS PUBLISHED MORE THAN 100 00:03:28,900 --> 00:03:30,401 450 MANUSCRIPTS AT THE PROVIDER 101 00:03:30,401 --> 00:03:32,604 AND SYSTEM LEVEL INFLUENCE 102 00:03:32,604 --> 00:03:34,639 OUTCOMES, HIS WORK ALSO EXAMINED 103 00:03:34,639 --> 00:03:36,474 THE IMPACT OF SOCIAL RACISM, 104 00:03:36,474 --> 00:03:38,142 SOCIAL DETERMINANTS OF HEALTH 105 00:03:38,142 --> 00:03:40,712 AND SOCIAL RISK ON HEALTH 106 00:03:40,712 --> 00:03:43,014 OUTCOMES, EFFECTIVE RESEARCH ON 107 00:03:43,014 --> 00:03:45,350 TELEHEALTH AND TELEMEDICINE AS 108 00:03:45,350 --> 00:03:47,151 DELIVERING CLINICAL CARE AND 109 00:03:47,151 --> 00:03:48,019 IMPROVED UNDERSTANDING OF THE 110 00:03:48,019 --> 00:03:50,154 ROLE OF BEHAVIORIAL ECONOMEC ON 111 00:03:50,154 --> 00:03:51,656 HEALTH AND HEALTH OUTCOMES WITH 112 00:03:51,656 --> 00:03:53,291 INDIVIDUALS WITH CHRONIC 113 00:03:53,291 --> 00:03:53,525 DISEASE. 114 00:03:53,525 --> 00:03:55,393 HADIS PRESENTATION IS TITLED 115 00:03:55,393 --> 00:03:57,428 ADDRESSING HELT DISPARITY ANDS 116 00:03:57,428 --> 00:03:58,062 DIABETES. 117 00:03:58,062 --> 00:04:00,131 INTERSECTION OF STRUCTURAL 118 00:04:00,131 --> 00:04:02,200 RACISM, SOCIAL DETERMINANTS AND 119 00:04:02,200 --> 00:04:02,901 RACIAL ETHNIC DISPARITIES, 120 00:04:02,901 --> 00:04:08,172 PLEASE JOIN ME IN WELCOMING THE 121 00:04:08,172 --> 00:04:12,810 2024 ROBERT S. GORDON JR. 122 00:04:12,810 --> 00:04:17,081 LECTURE RECIPIENT DR. LEONARD 123 00:04:17,081 --> 00:04:17,282 EGEDE. 124 00:04:17,282 --> 00:04:18,483 >> THANK YOU. 125 00:04:18,483 --> 00:04:19,784 IT'S DEFINITELY AN HONOR TO BE 126 00:04:19,784 --> 00:04:21,486 HERE AND REEVE THIS AWARD BUT 127 00:04:21,486 --> 00:04:23,087 ALSO TO GIVE THIS PRESENTATION 128 00:04:23,087 --> 00:04:24,756 AND I USUALLY LIKE TO START OFF 129 00:04:24,756 --> 00:04:29,627 MY PRESENTATION BY GIVING 130 00:04:29,627 --> 00:04:31,829 CONTEXT, SO I'M AN IMMIGRANT, 131 00:04:31,829 --> 00:04:34,332 MOVED HERE IN 1995 TO THE UNITED 132 00:04:34,332 --> 00:04:36,100 STATES AND I REALLY LOVE THIS 133 00:04:36,100 --> 00:04:36,334 COUNTRY. 134 00:04:36,334 --> 00:04:38,436 I HAVE HAD A LOT OF BENEFIT FROM 135 00:04:38,436 --> 00:04:40,305 BEING HERE BUT ALSO JUST 136 00:04:40,305 --> 00:04:41,372 WATCHING OVER THE YEARS, I'VE 137 00:04:41,372 --> 00:04:44,475 SEEN A LOT OF GAPS IN WHAT WE 138 00:04:44,475 --> 00:04:47,579 COULD BE AS A SOCIETY, SO I COME 139 00:04:47,579 --> 00:04:48,580 FROM THIS PERSPECTIVE OF 140 00:04:48,580 --> 00:04:52,283 [INDISCERNIBLE], SO IT'S NOT ALL 141 00:04:52,283 --> 00:04:53,718 BAD, BUT THERE ARE THINGS WE CAN 142 00:04:53,718 --> 00:04:54,719 DO TO GET BETTER. 143 00:04:54,719 --> 00:04:55,987 THAT IS THE CONTEXT I HAVE TO 144 00:04:55,987 --> 00:05:00,024 GIVE, I HAVE NO DISCLOSURES AND 145 00:05:00,024 --> 00:05:02,226 REALLY THE GOAL OF THIS TALK IS 146 00:05:02,226 --> 00:05:04,495 TO FOCUS ON SOME OF THE NATIONAL 147 00:05:04,495 --> 00:05:06,030 DATA RELATED TO DISPARITIES IN 148 00:05:06,030 --> 00:05:08,967 THE SCARE TO DEFINE HEALTH 149 00:05:08,967 --> 00:05:11,102 DISPARITIES AND DISCLOSE THE 150 00:05:11,102 --> 00:05:12,203 INTERSECTION OF STRUCTURAL 151 00:05:12,203 --> 00:05:14,572 RACISM AND HEALTH AND HEALTH 152 00:05:14,572 --> 00:05:18,076 DISPARITIES AND THEN DISCUSS 153 00:05:18,076 --> 00:05:19,677 EMERGING INTERVENTIONS TO 154 00:05:19,677 --> 00:05:20,712 DISCUSS DETERMINANTS AND REDUCE 155 00:05:20,712 --> 00:05:21,846 DISPARITIES IN CLINICAL OUTCOMES 156 00:05:21,846 --> 00:05:22,647 FOR DIABETES. 157 00:05:22,647 --> 00:05:24,682 I HAVE STUDIED DIABETES MY WHOLE 158 00:05:24,682 --> 00:05:25,984 CAREER, BUT I FOUND DIABETES TO 159 00:05:25,984 --> 00:05:27,385 BE A VERY GOOD MARKER FOR A LOT 160 00:05:27,385 --> 00:05:29,787 OF THE WORK THAT WE ACTUALLY DO 161 00:05:29,787 --> 00:05:33,791 BECAUSE IT'S VERY PREVALENT. 162 00:05:33,791 --> 00:05:35,693 BIOLODGE IIC MEASURES ARE EASY 163 00:05:35,693 --> 00:05:37,095 TO TRACK BUT ALSO HAVE YOU A LOT 164 00:05:37,095 --> 00:05:38,529 OF SOCIAL FACTORS THAT DRIVE THE 165 00:05:38,529 --> 00:05:41,299 OUTCOME SO VERY GOOD FOR US TO 166 00:05:41,299 --> 00:05:42,800 WORK IN THAT SPACE. 167 00:05:42,800 --> 00:05:46,237 SO I WANT TO GO BRIEFLY OVER 168 00:05:46,237 --> 00:05:47,472 DIABETES, THOSE ARE WHO ARE NOT 169 00:05:47,472 --> 00:05:49,841 FAMILIAR WITH DIABETES, SO YOU 170 00:05:49,841 --> 00:05:51,709 LOOK AT PREVALENCE, YOU KNOW 171 00:05:51,709 --> 00:05:55,046 ALMOST 15% OF THE U.S. 172 00:05:55,046 --> 00:05:56,614 POPULATION HAVE DIABETES. 173 00:05:56,614 --> 00:05:58,716 IN THE AREAS, WE USED TO TALK 174 00:05:58,716 --> 00:05:59,684 ABOUT UNDIAGNOSED DIABETES AND 175 00:05:59,684 --> 00:06:01,619 THOSE NUMBERS ARE GETTING LESS 176 00:06:01,619 --> 00:06:06,090 AND LESS AS WE DO BETTER WORK AT 177 00:06:06,090 --> 00:06:07,625 TRACKING, BUT AGAIN, YOU HAVE 178 00:06:07,625 --> 00:06:08,426 STILL ABOUT 33% OF INDIVIDUAL 179 00:06:08,426 --> 00:06:10,294 WHO IS ARE UNDIAGNOSED, BUT WITH 180 00:06:10,294 --> 00:06:13,598 WE LOOK AT DIABETES BY RACE, YOU 181 00:06:13,598 --> 00:06:15,767 SEE THERE ARE DIFFERENCES BY 182 00:06:15,767 --> 00:06:16,634 RACIAL GROUPS. 183 00:06:16,634 --> 00:06:19,404 AND SO RACIAL AND ETHNICITY, IF 184 00:06:19,404 --> 00:06:21,939 YOU LOOK AT WHITE, NONHISPANIC 185 00:06:21,939 --> 00:06:24,709 IT'S ABOUT 14% AND YOU LOOK AT 186 00:06:24,709 --> 00:06:28,079 BLACK NONHISPANIC ABOUT 17 AND 187 00:06:28,079 --> 00:06:29,814 HALF%, ASIAN NONHISPANIC ALMOST 188 00:06:29,814 --> 00:06:31,883 10%, AND HISPANIC BY 16%, SO YOU 189 00:06:31,883 --> 00:06:35,687 SEE GAPS IN PREVALENCE OF 190 00:06:35,687 --> 00:06:36,354 DISEASE BY RACE. 191 00:06:36,354 --> 00:06:39,323 SO NOW I JUST WANT TO TALK ABOUT 192 00:06:39,323 --> 00:06:43,695 WHAT IS HOW DISPARITIES AND SOME 193 00:06:43,695 --> 00:06:44,562 LANGUAGE THAT'S REALLY IMPORTANT 194 00:06:44,562 --> 00:06:48,933 TO GRIND US AND SO NOW MOST NOW 195 00:06:48,933 --> 00:06:50,702 ARE FAMILIAR WITH THE RISK AS A 196 00:06:50,702 --> 00:06:51,536 SOCIAL CONSTRUCT. 197 00:06:51,536 --> 00:06:54,005 WHEN I WAS IN TRAINING WE TREAT 198 00:06:54,005 --> 00:06:55,673 RACE AS BIOLOGY AND WE ALL 199 00:06:55,673 --> 00:06:57,508 RECOGNIZE THAD THERE WAS A VERY 200 00:06:57,508 --> 00:06:58,943 BIG DIFFERENCE SEEING IT AS A 201 00:06:58,943 --> 00:07:01,045 SOCIAL CONSTRUCT AS SEEING IT AS 202 00:07:01,045 --> 00:07:02,046 A BIOLOGICAL CONSTRUCT SO THESE 203 00:07:02,046 --> 00:07:03,381 ARE VERY IMPORTANT FOR US TO LAY 204 00:07:03,381 --> 00:07:04,749 THE FOUNDATION FOR THE TALK. 205 00:07:04,749 --> 00:07:07,018 BUT THE OTHER THING THAT'S ALSO 206 00:07:07,018 --> 00:07:08,853 IMPORTANT IS ETHNICITY, WE TALK 207 00:07:08,853 --> 00:07:10,321 ABOUT RACE ETHNICITY AS IF THAT 208 00:07:10,321 --> 00:07:11,856 MAKES IT BETTER, IF YOU LOOK AT 209 00:07:11,856 --> 00:07:14,559 ETHNICITY, IF YOU LOOK AT 210 00:07:14,559 --> 00:07:15,860 HISPANIC, IT INCLUDING 211 00:07:15,860 --> 00:07:16,561 400 MILLION PEOPLE FROM MANY 212 00:07:16,561 --> 00:07:18,162 DIFFERENT ETHNIC GROUPS IN MORE 213 00:07:18,162 --> 00:07:19,697 THAN 20 DIFFERENT COUNTRY, SO IF 214 00:07:19,697 --> 00:07:23,034 YOU ARE LUMPING PEOPLE TOGETHER, 215 00:07:23,034 --> 00:07:24,035 WITH SOMEWHAT VARIABILITY, IT 216 00:07:24,035 --> 00:07:25,203 REALLY BEGS THE QUESTION, WHAT 217 00:07:25,203 --> 00:07:26,971 ARE YOU ACTUALLY MEASURING BUT 218 00:07:26,971 --> 00:07:29,373 THIS IS THE BEST MEASURE WE HAVE 219 00:07:29,373 --> 00:07:31,542 RIGHT NOW SO WE HAVE TO FIND 220 00:07:31,542 --> 00:07:32,744 WAYS TO MAKE THIS WORK AND THIS 221 00:07:32,744 --> 00:07:34,445 IS PART OF WHAT THIS 222 00:07:34,445 --> 00:07:35,213 CONVERSATION, AND WHAT IS 223 00:07:35,213 --> 00:07:37,582 CULTURE AND HOW DOES IT PLAY OUT 224 00:07:37,582 --> 00:07:39,550 AND MANY THINGS WE'RE DRIEBING, 225 00:07:39,550 --> 00:07:41,352 ARE ACTUALLY CONNECTED TO OUR 226 00:07:41,352 --> 00:07:43,688 CULTURE AND CULTURE OF VALUES, 227 00:07:43,688 --> 00:07:44,922 SO AGAIN, JUST SEPARATE THOSE 228 00:07:44,922 --> 00:07:45,790 TERMS AS WE GO FORWARD. 229 00:07:45,790 --> 00:07:48,826 THE NEXT THING IS, WHAT DO WE 230 00:07:48,826 --> 00:07:50,528 MEAN BY DISPARITIES, DIFFERENCES 231 00:07:50,528 --> 00:07:51,496 AND DISCRIMINATION, BECAUSE 232 00:07:51,496 --> 00:07:52,997 EVERYBODY ASSUMES THE ONLY SAME 233 00:07:52,997 --> 00:07:53,998 THING BUT WE'RE VERY DIFFERENT. 234 00:07:53,998 --> 00:07:55,666 SO IF YOU LOOK AT THIS, THIS IS 235 00:07:55,666 --> 00:07:57,835 A SLIDE THAT'S ACTUALLY VERY 236 00:07:57,835 --> 00:07:58,803 HELPFUL IN HELPING UNDERSTAND 237 00:07:58,803 --> 00:08:00,505 WHAT DOES IT REALLY MEAN, SO 238 00:08:00,505 --> 00:08:03,875 WHEN YOU TAKE 2 GROUPS, 239 00:08:03,875 --> 00:08:04,742 NONMINORITY AND MINORITY GROUP 240 00:08:04,742 --> 00:08:08,012 AND THERE'S SOMETHING THAT'S 241 00:08:08,012 --> 00:08:09,147 DIFFERENT, LET'S SAY PREVALENCE 242 00:08:09,147 --> 00:08:10,314 OF DISEASE, ALL YOU CAN SAY AT 243 00:08:10,314 --> 00:08:13,384 THAT POINT IS JUST A DIFFERENCE, 244 00:08:13,384 --> 00:08:14,952 AND DIFFERENCES DO NOT REALLY 245 00:08:14,952 --> 00:08:16,087 MEAN ANYTHING AND YOU BEGIN TO 246 00:08:16,087 --> 00:08:18,456 DELVE INTO WHAT ARE THE 247 00:08:18,456 --> 00:08:19,223 DIFFERENCES DUE TO. 248 00:08:19,223 --> 00:08:22,193 SO WHEN THE DIFFERENCE IS DUE TO 249 00:08:22,193 --> 00:08:24,195 CLINICALLY APPROPRIATENESS AND 250 00:08:24,195 --> 00:08:25,196 PATIENT PREFERENCES, THEN, 251 00:08:25,196 --> 00:08:28,065 THAT'S A DIFFERENCE AND IT'S 252 00:08:28,065 --> 00:08:29,734 ACTUALLY NOT BAD BECAUSE NOT 253 00:08:29,734 --> 00:08:31,736 GOOD, ONCE IT BECOMES TIED TO 254 00:08:31,736 --> 00:08:32,436 THE OPERATIONAL HEALTHCARE 255 00:08:32,436 --> 00:08:34,305 SYSTEM AND LEGAL AND REGULATORY 256 00:08:34,305 --> 00:08:36,374 CLIMATE THEY START TO TALK ABOUT 257 00:08:36,374 --> 00:08:38,810 DISPARITY AND WHEN YOU HAVE 258 00:08:38,810 --> 00:08:40,711 DISCRIMINATION, BIAS AND 259 00:08:40,711 --> 00:08:42,180 PREJUDICE TERIO TYPING 260 00:08:42,180 --> 00:08:43,881 UNCERTAINTY THEN THAT IS 261 00:08:43,881 --> 00:08:45,149 DISCRIMINATION. 262 00:08:45,149 --> 00:08:46,884 SO DISCRIMINATION AND DISPARITY 263 00:08:46,884 --> 00:08:49,921 ARE 1 CATEGORY, DIFFERENCES 264 00:08:49,921 --> 00:08:50,488 EXPLAINS EVERYTHING. 265 00:08:50,488 --> 00:08:52,390 SO WHENEVER YOU SEE A DIFFERENCE 266 00:08:52,390 --> 00:08:53,558 BETWEEN DIFFERENT GROUPS, THE 267 00:08:53,558 --> 00:08:55,393 FIRST QUESTION IS THIS DIFFERENT 268 00:08:55,393 --> 00:08:56,694 DUE TO APPROPRIATENESS, IS IT 269 00:08:56,694 --> 00:08:58,029 CLINICALLY APPROPRIATE FOR THAT 270 00:08:58,029 --> 00:08:59,730 TO EXIST, IT THAT'S THE CASE, 271 00:08:59,730 --> 00:09:00,832 THEN IT'S JUST DIFFERENCE, BUT 272 00:09:00,832 --> 00:09:02,433 WHEN YOU DRILL DOWN TO BIASES 273 00:09:02,433 --> 00:09:04,468 AND THINGS LIKE THAT, YOU START 274 00:09:04,468 --> 00:09:05,670 TALKING ABOUT DISCRIMINATION, 275 00:09:05,670 --> 00:09:06,404 IT'S REALLY IMPORTANT BECAUSE 276 00:09:06,404 --> 00:09:08,806 MANY TIMES WE USE THE 277 00:09:08,806 --> 00:09:10,341 TERMINOLOGY AS IF THEY'RE ALL 278 00:09:10,341 --> 00:09:11,742 INTERCHANGEABLE AND WE ACTUALLY 279 00:09:11,742 --> 00:09:13,044 THEN DO NOT CLARIFY WHAT WE MEAN 280 00:09:13,044 --> 00:09:16,347 WITH SOME OF THESE TERMS. 281 00:09:16,347 --> 00:09:18,850 SO NOW I WANT TO GO OVER--I 282 00:09:18,850 --> 00:09:20,251 SHOWED YOU DETERMINE NABTS OF 283 00:09:20,251 --> 00:09:22,119 HEALTH WHICH IS THE FIRST TIME 284 00:09:22,119 --> 00:09:23,855 WE TARTED WORKING ON SOCIAL 285 00:09:23,855 --> 00:09:25,790 DETERMINANTS WAS WITH MY Ph.D. 286 00:09:25,790 --> 00:09:26,858 STUDENTS IN 2010 AND AT THAT 287 00:09:26,858 --> 00:09:29,660 TIME WE WERE JUST ANY PHASE OF 288 00:09:29,660 --> 00:09:30,695 SOCIAL DETERMINANTS, WE ACTUALLY 289 00:09:30,695 --> 00:09:31,529 DIDN'T HAVE GOOD MEASURES AND 290 00:09:31,529 --> 00:09:34,932 NOW WE HAVE ALL THESE GREAT 291 00:09:34,932 --> 00:09:35,466 MEASURES SO WHAT 292 00:09:35,466 --> 00:09:35,967 [INDISCERNIBLE]. 293 00:09:35,967 --> 00:09:39,437 THE W. H. O. DEFINES SOCIAL 294 00:09:39,437 --> 00:09:42,240 DETERMINANTS AS THE CONDITIONS 295 00:09:42,240 --> 00:09:46,477 WE ARE BORN, GROW, WALK AND AGE, 296 00:09:46,477 --> 00:09:51,415 AND THESE CIRCUMSTANCES ARE 297 00:09:51,415 --> 00:09:52,683 SHAPED BY THE DISTRIBUTION OF 298 00:09:52,683 --> 00:09:55,253 MONEY, POWER AND RESOURCES AT A 299 00:09:55,253 --> 00:09:58,956 GLOBAL, NATIONAL AND LOCAL 300 00:09:58,956 --> 00:09:59,190 LEVELS. 301 00:09:59,190 --> 00:10:01,225 SO I THINK BEING ABLE TO 302 00:10:01,225 --> 00:10:01,993 UNDERSTAND THESE DIFFERENCES 303 00:10:01,993 --> 00:10:03,694 ALLOW US TO CALL AND BE VERY 304 00:10:03,694 --> 00:10:05,563 CLEAR WHAT WE MEAN WHEN WE SAY, 305 00:10:05,563 --> 00:10:07,398 WHEN WE USE THE WORD SOCIAL 306 00:10:07,398 --> 00:10:10,501 DETERMINE NABTS, PEOPLE SAY, I'M 307 00:10:10,501 --> 00:10:11,669 MEASURING SOCIAL DETERMINANTS, 308 00:10:11,669 --> 00:10:13,137 AND THEN MY QUESTION IS WHAT ARE 309 00:10:13,137 --> 00:10:13,604 YOU MEASURING? 310 00:10:13,604 --> 00:10:15,806 YOU NEED TO BE VERY CLEAR WHAT 311 00:10:15,806 --> 00:10:18,009 YOU ARE MEASURING, SO THIS IS A 312 00:10:18,009 --> 00:10:19,310 CLEAR FRAMEWORK FROM THE W. H. 313 00:10:19,310 --> 00:10:20,912 O. TO DEFINE HOW WE THINK ABOUT 314 00:10:20,912 --> 00:10:22,179 THE FRAMEWORK, THE CDC FRAMEWORK 315 00:10:22,179 --> 00:10:24,248 BUT THIS IS THE FRAMEWORK WE USE 316 00:10:24,248 --> 00:10:26,684 BECAUSE IT'S A VERY--IT'S A 317 00:10:26,684 --> 00:10:27,385 GREAT ORGANIZING FRAMEWORK FOR 318 00:10:27,385 --> 00:10:29,553 SOME OF THESE ISSUES, SO IF YOU 319 00:10:29,553 --> 00:10:33,925 LOOK AT--IF YOU GO FROM MY RIGHT 320 00:10:33,925 --> 00:10:37,061 TO YOUR LEFT, YOU GO PRACTICES 321 00:10:37,061 --> 00:10:38,729 IMPACT AT AN INDIVIDUAL LEVEL, 322 00:10:38,729 --> 00:10:42,333 YOU GO BACKWARDS, YOU SEE 323 00:10:42,333 --> 00:10:43,167 MATERIALISTIC CIRCUMSTANCES, 324 00:10:43,167 --> 00:10:43,968 BEHAVIORS, PSYCHOSOCIAL FACTORS, 325 00:10:43,968 --> 00:10:45,736 YOU HAVE THE HEALTH SYSTEM, YOU 326 00:10:45,736 --> 00:10:47,271 GO BACKWARDS YOU LOOK AT 327 00:10:47,271 --> 00:10:49,206 ECONOMIC SPOGZ, SOCIAL CLASS, 328 00:10:49,206 --> 00:10:49,840 EDUCATIONAL OCCUPATIONAL INCOME 329 00:10:49,840 --> 00:10:51,642 AND THE--BUT GO EVEN FURTHER 330 00:10:51,642 --> 00:10:57,415 BACK, YOU START SEEING THINGS, 331 00:10:57,415 --> 00:10:57,882 GOVERNMENTS, MACROAND 332 00:10:57,882 --> 00:10:58,950 MICROPOLICIES, SO WE SPEN A LOT 333 00:10:58,950 --> 00:11:00,117 OF TIME AT THE INDIVIDUAL LEVEL 334 00:11:00,117 --> 00:11:03,220 AND WE DON'T PAY ATTENTION TO 335 00:11:03,220 --> 00:11:04,121 DEFINE THE ORGANIZATION FACTORS 336 00:11:04,121 --> 00:11:05,790 THAT DRIVE THE DIFFERENCES. 337 00:11:05,790 --> 00:11:07,658 SO THE MORE I'VE DONE THIS WORK 338 00:11:07,658 --> 00:11:09,560 NOW, I FOUND A SPEND A LOT OF 339 00:11:09,560 --> 00:11:11,162 TIME IN THE FIRST DECADE OF MY 340 00:11:11,162 --> 00:11:12,229 CAREER JUST TO FOCUS ON THE 341 00:11:12,229 --> 00:11:12,630 INDIVIDUAL LEVEL. 342 00:11:12,630 --> 00:11:15,566 I REALIZE YOU DO ALL THESE 343 00:11:15,566 --> 00:11:16,534 INTERVENTIONS AND THESE FACTORS 344 00:11:16,534 --> 00:11:18,269 CAN YOU EXPLAIN, SO NOW I MOVE 345 00:11:18,269 --> 00:11:19,737 BACKWARDS AND WE ASK OURSELVES 346 00:11:19,737 --> 00:11:23,107 HOW DO YOU HAVE IMPACT AT THAT 347 00:11:23,107 --> 00:11:23,574 NEXT LEVEL. 348 00:11:23,574 --> 00:11:25,509 SO I'M JUST GOING TO SHOW WITH 349 00:11:25,509 --> 00:11:27,511 YOU SOME OF THE WORK YOU'VE DONE 350 00:11:27,511 --> 00:11:27,778 OVER TIME. 351 00:11:27,778 --> 00:11:29,780 WE'VE HAD A VERY GOOD TEAM AND I 352 00:11:29,780 --> 00:11:31,382 REALLY BELIEVE IN WORKING IN 353 00:11:31,382 --> 00:11:32,717 TEAMS AND HAVE HAD MENTEES WHERE 354 00:11:32,717 --> 00:11:35,119 THEY CONTRIBUTED ALL THIS WORK, 355 00:11:35,119 --> 00:11:36,554 AND MANY OF THIS PRESENTING THE 356 00:11:36,554 --> 00:11:38,923 Ph.D. WORK OR SOME OF MY 357 00:11:38,923 --> 00:11:40,324 MENTEES, VERY EARLY ON IN THEIR 358 00:11:40,324 --> 00:11:42,193 CAREER, SO THIS IS 1 STUDY WE 359 00:11:42,193 --> 00:11:45,162 DID WHERE WE TOOK ABOUT 650 360 00:11:45,162 --> 00:11:46,097 INDIVIDUALS WITH TYPE 2 DIABETES 361 00:11:46,097 --> 00:11:49,166 AND WE DID A VERY DETAILED ARK 362 00:11:49,166 --> 00:11:50,234 ASSESSESMENT OF SOCIAL 363 00:11:50,234 --> 00:11:51,369 DETERMINANTS OF HEALTH FACTORS 364 00:11:51,369 --> 00:11:54,105 OR IF WE BROUGHT THEM INTO 365 00:11:54,105 --> 00:11:55,206 PSYCHOSOCIAL BUILT ENVIRONMENT 366 00:11:55,206 --> 00:11:57,708 AND MULTIPLE ASPECTS AND I 367 00:11:57,708 --> 00:11:59,443 REMEMBER THAT STUDY BECAUSE 368 00:11:59,443 --> 00:12:01,712 DR. WALKER AND IT WAS 1 OF THE 369 00:12:01,712 --> 00:12:03,247 INDIVIDUALS, RECRUITING PATIENTS 370 00:12:03,247 --> 00:12:06,484 WITH THE UNIVERSITY FROM THE VA, 371 00:12:06,484 --> 00:12:08,819 FROM THE COMMUNITY, AND THE 372 00:12:08,819 --> 00:12:09,954 SURVEYS WERE REALLY LONG. 373 00:12:09,954 --> 00:12:11,288 WE HAD 70 PAGES JUST TO CAPTURE 374 00:12:11,288 --> 00:12:13,057 ALL THIS INFORMATION BUT WHAT WE 375 00:12:13,057 --> 00:12:15,559 ALMS WANTED TO DO WAS GO BEYOND 376 00:12:15,559 --> 00:12:17,228 REGULAR REGRESSION, YOU KNOW CAN 377 00:12:17,228 --> 00:12:20,398 QUESTIONS USING A LITTLE BIT 378 00:12:20,398 --> 00:12:21,365 MORE SOPHISTICATED APPROACH, 379 00:12:21,365 --> 00:12:22,233 SHOWING STRUCTURAL MODELING 380 00:12:22,233 --> 00:12:23,634 WHERE YOU COULD LOOK AT PATH, 381 00:12:23,634 --> 00:12:26,737 WHAT IS THE PATHWAY FOR THIS AND 382 00:12:26,737 --> 00:12:27,872 WHAT WE ACTUALLY FOUND VERY 383 00:12:27,872 --> 00:12:30,241 QUICKLY IS THAT IN THIS CONCEPT 384 00:12:30,241 --> 00:12:32,076 OF FRAMEWORK, YOU COULD SEE THE 385 00:12:32,076 --> 00:12:33,277 DRIVERS OF GLYCEMIC CONTROL AND 386 00:12:33,277 --> 00:12:35,379 HOW PROCESSES OF CARE ACCESS TO 387 00:12:35,379 --> 00:12:36,313 CARE, AND SELF-CARE ACTUALLY 388 00:12:36,313 --> 00:12:39,617 PLAY THE ROLE, BUT THEN THIS 389 00:12:39,617 --> 00:12:40,918 FACTOR, THIS PSYCHOSOCIAL FACTOR 390 00:12:40,918 --> 00:12:43,087 ACTUALLY HAD DIRECT EFFECT. 391 00:12:43,087 --> 00:12:45,122 ASK SO THIS IS 1 OF THE STUDIES 392 00:12:45,122 --> 00:12:46,524 THAT BEGAN OR RAISE THE REQUESTY 393 00:12:46,524 --> 00:12:47,825 THAT SOCIAL FACTORS WERE 394 00:12:47,825 --> 00:12:48,893 ACTUALLY IMPORTANT BECAUSE WHEN 395 00:12:48,893 --> 00:12:50,728 I WAS TRAINING, I WAS TOLD IT 396 00:12:50,728 --> 00:12:53,197 WAS ALL ABOUT BIOLOGY, YOU KNOW, 397 00:12:53,197 --> 00:12:54,932 JUST TAKE YOUR MEDICATIONS AND 398 00:12:54,932 --> 00:12:57,268 THINGS WILL GO WELL, WE BEGIN TO 399 00:12:57,268 --> 00:12:59,303 SO NOW, IT'S MORE THAN JUST THE 400 00:12:59,303 --> 00:13:00,438 MEDICATIONS, IT'S ENVIRONMENT, 401 00:13:00,438 --> 00:13:02,506 ALL THESE OTHER FACTORS, HOW 402 00:13:02,506 --> 00:13:03,774 DOES DEPRESSION PLAY A ROLE, 403 00:13:03,774 --> 00:13:05,176 SOCIAL SUPPORT, SO WE BEGIN TO 404 00:13:05,176 --> 00:13:08,345 DEMON TRAIT THAT THIS FACTORS 405 00:13:08,345 --> 00:13:09,747 ACTUALLY ARE INDEPENDENT OF OUR 406 00:13:09,747 --> 00:13:10,948 USUAL PATHWAYS AND THIS IS 1 OF 407 00:13:10,948 --> 00:13:12,883 THE FITTER STUDIES THAT SHOWED 408 00:13:12,883 --> 00:13:13,084 THAT. 409 00:13:13,084 --> 00:13:14,018 --FIRST STUDIES THAT SHOWED 410 00:13:14,018 --> 00:13:14,385 THAT. 411 00:13:14,385 --> 00:13:20,324 ONE OF MY OTHER MENTEES D 412 00:13:20,324 --> 00:13:21,158 R. DAWSON, WAS LOOKING AT 413 00:13:21,158 --> 00:13:22,326 DISCROSS EXAMINEINATION, AT THAT 414 00:13:22,326 --> 00:13:25,096 TIME WE KNOW THERE WAS 415 00:13:25,096 --> 00:13:25,930 DISCRIMINATION, IT IMPACTS YOU 416 00:13:25,930 --> 00:13:26,964 BUT HOW DOES IT DO IT. 417 00:13:26,964 --> 00:13:30,201 WHAT IS THE MECHANISM IN THIS IS 418 00:13:30,201 --> 00:13:32,903 WITH THE METHODOLOGY, WE 419 00:13:32,903 --> 00:13:34,538 IDENTIFIED AND HYPOTHESIZED THAT 420 00:13:34,538 --> 00:13:35,406 DISCRIMINATION WOULD IMPACT 421 00:13:35,406 --> 00:13:38,542 STRESS AND THAT STRESS WOULD 422 00:13:38,542 --> 00:13:39,810 IMPACT SELF-CARE AND YOUR 423 00:13:39,810 --> 00:13:40,878 GLYCEMIC CONTROL AND THAT'S WHAT 424 00:13:40,878 --> 00:13:42,379 WE FOUND IN THE STUDY BUT WHAT 425 00:13:42,379 --> 00:13:45,249 WE ACTUALLY FOUND WAS THAT 426 00:13:45,249 --> 00:13:46,217 SOCIAL SUPPORT BUFFERED THAT 427 00:13:46,217 --> 00:13:48,152 RELATIONSHIP, SO THE PEOPLE HAD 428 00:13:48,152 --> 00:13:49,220 GOOD STRONG SOCIAL SUPPORT 429 00:13:49,220 --> 00:13:51,856 ACTUALLY DID BETTER AND THE 430 00:13:51,856 --> 00:13:53,858 SOCIAL COHESION, NEIGHBORHOOD 431 00:13:53,858 --> 00:13:54,892 COHESION ALSO MADE IT DIFFERENT. 432 00:13:54,892 --> 00:13:57,928 SO TRESES WAS 1 OF THE PATHWAYS, 433 00:13:57,928 --> 00:13:59,463 WAS STRESS ALSO HARD, WITH 2 434 00:13:59,463 --> 00:14:01,298 PATHWAYS 1 THROUGH SELF-CARE AND 435 00:14:01,298 --> 00:14:03,134 THE OTHER DIRECTLY ON GLYCEMIC 436 00:14:03,134 --> 00:14:03,467 CONTROL. 437 00:14:03,467 --> 00:14:04,735 SO AGAIN, RACING QUESTIONS ABOUT 438 00:14:04,735 --> 00:14:08,539 HOW DO WE BEGIN TO FACTOR--HOW 439 00:14:08,539 --> 00:14:09,540 DOES DISCRIMINATION LEAD TO POOR 440 00:14:09,540 --> 00:14:11,375 OUTCOMES AND SOME OF THESE 441 00:14:11,375 --> 00:14:14,812 PATHWAYS WE WILL ACTUALLY STUDY 442 00:14:14,812 --> 00:14:17,148 AND THEN I HAD A STUDENT NOW 443 00:14:17,148 --> 00:14:18,215 WHO'S IN MEDICAL SCHOOL NOW WHO 444 00:14:18,215 --> 00:14:20,117 WAS LOOKING AT THIS AND THE NEXT 445 00:14:20,117 --> 00:14:21,452 QUESTION WAS LET'S LOOK AT 446 00:14:21,452 --> 00:14:23,821 MENTAL HEALTH AND AGAIN VERY 447 00:14:23,821 --> 00:14:25,823 SIMILAR PATHWAY, AND WHAT WE 448 00:14:25,823 --> 00:14:27,158 FOUND WAS THAT STRESS ACTUALLY 449 00:14:27,158 --> 00:14:30,294 LED TO POOR MENTAL HEALTH, SO 450 00:14:30,294 --> 00:14:31,896 NOT JUST POOR PHYSICAL HEALTH 451 00:14:31,896 --> 00:14:34,365 BUT POOR MENTAL HEALTH BUT 452 00:14:34,365 --> 00:14:35,900 SOCIAL SUPPORT, MITIGATED THAT 453 00:14:35,900 --> 00:14:36,934 EFFECT AND ACTUALLY BUFFERED 454 00:14:36,934 --> 00:14:38,202 SOME OF THAT EFFECT, SO AGAIN, 455 00:14:38,202 --> 00:14:41,005 SHOWING THAT YOU IN PEOPLE WITH 456 00:14:41,005 --> 00:14:42,573 DIABETES, SOME OF THESE FACTORS 457 00:14:42,573 --> 00:14:45,109 ACTUALLY PLAYED A ROLE. 458 00:14:45,109 --> 00:14:47,178 AND THEN NEXT, WE BEGUN TO LOOK 459 00:14:47,178 --> 00:14:49,613 AT WAS LOOKING AT FOOD 460 00:14:49,613 --> 00:14:52,016 INSECURITY ANSWERS SO DR. WALKER 461 00:14:52,016 --> 00:14:53,684 IS AN ASSOCIATE PROFESSOR, HE 462 00:14:53,684 --> 00:14:55,553 HAS AN RO-1 LOOKING AT SOME OF 463 00:14:55,553 --> 00:14:58,522 THESE AREAS BUT AT THAT TIME, 464 00:14:58,522 --> 00:15:02,059 SHE IS A DOCTORATE STUDENT AND 465 00:15:02,059 --> 00:15:04,295 ASKED THE QUESTION HOW DOES FOOD 466 00:15:04,295 --> 00:15:05,296 INSECURITY AFFECT DIABETES 467 00:15:05,296 --> 00:15:05,563 CONTROL. 468 00:15:05,563 --> 00:15:07,765 IN THAT ERA EVERYTHING WAS ABOUT 469 00:15:07,765 --> 00:15:09,300 SELF-CARE AND WHAT THIS STUDY 470 00:15:09,300 --> 00:15:13,938 ACTUALLY SHOWED WAS THAT FOOD 471 00:15:13,938 --> 00:15:17,208 INSECURITY WAS ASSOCIATE WIDE 472 00:15:17,208 --> 00:15:17,975 FATALISM, SUICIDE, DEPRESSION, 473 00:15:17,975 --> 00:15:19,476 STREASES, AND HAD AN IPT GREATER 474 00:15:19,476 --> 00:15:21,779 PACT ON A1C, AND SOME OF THOSE 475 00:15:21,779 --> 00:15:22,846 WERE DIRECT PATHWAY ANDS OTHERS 476 00:15:22,846 --> 00:15:24,848 WERE INDREK THROUGH SELF-CARE, 477 00:15:24,848 --> 00:15:26,150 SO THIS WAS 1 OF THE FIRST 478 00:15:26,150 --> 00:15:30,087 TODAYS TO DEMON TRAIT THE FOOD 479 00:15:30,087 --> 00:15:31,455 INSECURITY HAD DIRECT CONTROL 480 00:15:31,455 --> 00:15:33,290 THAT WAS INDEPENDENT OF 481 00:15:33,290 --> 00:15:34,391 SELF-CARE AND AGAIN RAISING THE 482 00:15:34,391 --> 00:15:35,793 QUESTION, WHAT DO WE ACTUALLY DO 483 00:15:35,793 --> 00:15:41,098 IN AND THEN THE LAST STUDY, 484 00:15:41,098 --> 00:15:42,499 TURNS OUT SON WAS DOING A SUMMER 485 00:15:42,499 --> 00:15:44,802 PROGRAM WITH US SO HE PICKED UP 486 00:15:44,802 --> 00:15:46,870 THIS PROGEC, IT WAS SOMETHING OF 487 00:15:46,870 --> 00:15:47,504 INTEREST TO HIM, NEIGHBORHOOD 488 00:15:47,504 --> 00:15:51,141 FACTORS AND THE QUESTION WAS HOW 489 00:15:51,141 --> 00:15:52,243 DO NEIGHBORHOOD FACTORS REALLY 490 00:15:52,243 --> 00:15:53,611 IMPACT GLYCEMIC CONTROL IN 491 00:15:53,611 --> 00:15:54,144 INDIVIDUALS WITH DIABETES. 492 00:15:54,144 --> 00:15:56,413 AS YOU CAN SEE, WE HYPOTHESIZED 493 00:15:56,413 --> 00:15:58,849 AT THAT TIME THAT VIOLENCE, 494 00:15:58,849 --> 00:16:00,084 DISCRIMINATION AND CRIME IN THE 495 00:16:00,084 --> 00:16:03,387 NEIGHBORHOOD WOULD LEAD TO 496 00:16:03,387 --> 00:16:08,859 STRESS AND STRESS WAS AFFECT THE 497 00:16:08,859 --> 00:16:09,727 SELF-EFFICACY, [INDISCERNIBLE] 498 00:16:09,727 --> 00:16:10,427 SELF-MANAGEMENT AND GLYCEMIC 499 00:16:10,427 --> 00:16:12,329 CONTROL AND ALL THOSE PATHWAYS 500 00:16:12,329 --> 00:16:12,896 ARE ACTUALLY VALIDATED. 501 00:16:12,896 --> 00:16:15,366 SO YOU CAN SEE, WE HAVE VIOLENCE 502 00:16:15,366 --> 00:16:18,335 IN THE COMMUNITY, STRESS LEVELS 503 00:16:18,335 --> 00:16:19,203 ARE VERY HIGH, DISCRIMINATION 504 00:16:19,203 --> 00:16:22,039 LEVELS ARE VERY HIGH, CRIME, 505 00:16:22,039 --> 00:16:25,109 TRESES IS HIGH, STRESS LEAVES TO 506 00:16:25,109 --> 00:16:26,477 POOR SELF-EFFICACY AND POOR 507 00:16:26,477 --> 00:16:28,112 SELF-CARE AND POOR SELF-CARE TO 508 00:16:28,112 --> 00:16:29,747 GLYCEMIC CONTROL BUT THEN HAVE 509 00:16:29,747 --> 00:16:32,182 YOU ALL OF THIS INDIRECT 510 00:16:32,182 --> 00:16:36,754 PATHWAYS FROM CRIME TO 511 00:16:36,754 --> 00:16:38,122 SELF-EFFICACY, SO AGAIN, RAISING 512 00:16:38,122 --> 00:16:39,823 THE IDEA THAT WE NEED TO START 513 00:16:39,823 --> 00:16:41,158 THINKING ABOUT NEIGHBORHOODS AND 514 00:16:41,158 --> 00:16:42,159 THE NEIGHBORHOODS ACTUALLY 515 00:16:42,159 --> 00:16:44,028 MATTER AND IF WE WANT TO GET 516 00:16:44,028 --> 00:16:45,629 GOOD CONTROL, WE NEED TO PAY 517 00:16:45,629 --> 00:16:46,864 ATTENTION TO WHAT THOSE THINGS 518 00:16:46,864 --> 00:16:47,264 ARE. 519 00:16:47,264 --> 00:16:49,166 SO WE DID ALL THIS STUDIES VERY 520 00:16:49,166 --> 00:16:51,168 EARLY ON FOR THE FIRST COUPLE OF 521 00:16:51,168 --> 00:16:53,570 YEARS, AND THEN WE REALIZE, WELL 522 00:16:53,570 --> 00:16:55,406 YOU, NOW WE HAVE THESE PATHWAYS, 523 00:16:55,406 --> 00:16:56,540 WHAT DO WEB CONNECTED DO, HOW DO 524 00:16:56,540 --> 00:17:01,045 YOU ADDRESS THIS ISSUE, SO THIS 525 00:17:01,045 --> 00:17:01,879 COINCIDED ABOUT THE TIME ALL 526 00:17:01,879 --> 00:17:05,249 THIS WORK WAS DONE WHEN I WAS IN 527 00:17:05,249 --> 00:17:05,983 CHARLESTON, THE MEDICAL 528 00:17:05,983 --> 00:17:07,351 UNIVERSITY OF SOUTH CAROLINA ASK 529 00:17:07,351 --> 00:17:08,552 WE MOVED TO MILWAUKEE AND WE'RE 530 00:17:08,552 --> 00:17:10,287 FACE WIDE A PROBLEM, ALL THE 531 00:17:10,287 --> 00:17:11,221 TIME WE'RE IN SOUTH CAROLINA, 532 00:17:11,221 --> 00:17:13,757 MOST OF THE WORK WAS ABOUT RURAL 533 00:17:13,757 --> 00:17:15,025 MINORITIES AND THEN WE CAME TO 534 00:17:15,025 --> 00:17:19,229 MILWAUKEE AND IT WAS ABOUT OTHER 535 00:17:19,229 --> 00:17:19,697 CHALLENGES. 536 00:17:19,697 --> 00:17:21,632 SO WE SPENT THE FIRST 2 YEARS 537 00:17:21,632 --> 00:17:23,934 DOING A LOT OF DEEP WORK IN THE 538 00:17:23,934 --> 00:17:26,236 COMMUNITY, WE DID ABOUT 350 539 00:17:26,236 --> 00:17:27,738 FOCUS GROUPS, WE STICK WITH THE 540 00:17:27,738 --> 00:17:28,939 INTERVIEWS, WE'RE ASKING 541 00:17:28,939 --> 00:17:30,207 QUESTIONS ABOUT AND THE GOAL WAS 542 00:17:30,207 --> 00:17:31,709 TO ASK THE QUESTION, GIVEN WHAT 543 00:17:31,709 --> 00:17:33,610 WE KNOW, WHAT TYPES OF 544 00:17:33,610 --> 00:17:34,511 INTERVENTIONS WOULD ACTUALLY 545 00:17:34,511 --> 00:17:37,815 WORK IN THIS ENVIRONMENT, I SAID 546 00:17:37,815 --> 00:17:39,249 THE VERY FIRST STUDY GOT FUNDED 547 00:17:39,249 --> 00:17:41,185 CAME OUT OF CONVERSATIONS WITH 548 00:17:41,185 --> 00:17:42,252 COMMUNITY MEMBERS AND WE'RE 549 00:17:42,252 --> 00:17:44,321 ASKING A QUESTION, WE ACTUALLY 550 00:17:44,321 --> 00:17:46,323 AT THE SENIOR CENTER AND THE 551 00:17:46,323 --> 00:17:48,058 WOMEN SAID, YOU KNOW OUR REAL 552 00:17:48,058 --> 00:17:49,159 PROBLEM IS SOCIAL ISOLATION AND 553 00:17:49,159 --> 00:17:50,994 WE DON'T HAVE, YOU 554 00:17:50,994 --> 00:17:52,629 KNOW--WOULDN'T IT BE NICE IF 555 00:17:52,629 --> 00:17:53,597 SOMEONE COULD COME FROM YOUR 556 00:17:53,597 --> 00:17:54,631 TEAM AND EDUCATE US ABOUT 557 00:17:54,631 --> 00:17:55,399 DIABETES SO WE DON'T HAVE TO 558 00:17:55,399 --> 00:17:56,667 COME TO THE HOSPITAL AND THEN WE 559 00:17:56,667 --> 00:17:57,901 COULD GET A TEAM TOGETHER AND 560 00:17:57,901 --> 00:18:00,204 THAT WOULD REALLY ALLOW US TO 561 00:18:00,204 --> 00:18:01,071 HIT THE COMMUNITY. 562 00:18:01,071 --> 00:18:05,109 SO WE KIND OF THOUGHT IT 563 00:18:05,109 --> 00:18:06,143 THROUGH, DID THE STUDY, WROTE 564 00:18:06,143 --> 00:18:08,178 THE GRAND TO NIDDK AND GOT IT 565 00:18:08,178 --> 00:18:09,913 FUNDED AND THIS STUDY IS JUST 566 00:18:09,913 --> 00:18:11,382 FINISHING UP NOW, WE RANDOMIZED 567 00:18:11,382 --> 00:18:14,184 ABOUT 2 HELPED INDIVIDUALS, 568 00:18:14,184 --> 00:18:15,786 ORIGINALLY THE PLAN WAS TO 569 00:18:15,786 --> 00:18:17,521 RANDOMIZE A DISCIPLINARY SIGN, 570 00:18:17,521 --> 00:18:19,790 AND TAKING 30 SENIOR CENTERS AND 571 00:18:19,790 --> 00:18:21,258 RANDOMIZING PEOPLE BY TRUSTEESS 572 00:18:21,258 --> 00:18:22,960 BUT WHEN THE PANDEMIC HIT WE HAD 573 00:18:22,960 --> 00:18:28,065 TO CONVERT THIS TO ONE-ON-ONE 574 00:18:28,065 --> 00:18:28,866 INTERVENTIONS AND CHANGES, SO 575 00:18:28,866 --> 00:18:30,534 WE'RE AT THE POINT WHERE WE'RE 576 00:18:30,534 --> 00:18:33,670 DOING THE INITIAL ANALYSIS TO 577 00:18:33,670 --> 00:18:35,005 SEE--THE IDEA WAS IF WE COULD 578 00:18:35,005 --> 00:18:36,673 TAKE PEOPLE AND PROVIDE THEM 579 00:18:36,673 --> 00:18:37,941 WITH NOT JUST DIABETES 580 00:18:37,941 --> 00:18:40,911 EDUCATION, BUT SOCIAL NEEDS, YOU 581 00:18:40,911 --> 00:18:42,880 KNOW, HOUSING, TRANSPORTATION, 582 00:18:42,880 --> 00:18:43,947 AND ASSESSING WHAT COULD WE DO 583 00:18:43,947 --> 00:18:45,315 TO HELP YOU, THE GOAL OF THIS 584 00:18:45,315 --> 00:18:47,684 WAS NOT TO FIX THE SOCIAL NEEDS, 585 00:18:47,684 --> 00:18:50,053 IT WAS TO HELP THEM FIND 586 00:18:50,053 --> 00:18:51,522 RESOURCES, WHAT'S OUT IN THE 587 00:18:51,522 --> 00:18:52,055 COMMUNITY, WHAT BEING YOU 588 00:18:52,055 --> 00:18:53,724 ACTUALLY DO AND DOING THAT 589 00:18:53,724 --> 00:18:54,591 TOGETHER WITH DIABETES 590 00:18:54,591 --> 00:18:57,261 MEDICATION TO SEE IF IT HAD AN 591 00:18:57,261 --> 00:18:57,961 IMPACT ON CLINICAL OUTCOMES. 592 00:18:57,961 --> 00:18:59,696 AND WE USE SOMETHING CALLED 593 00:18:59,696 --> 00:19:02,199 BEHAVIOR ACTIVATION WHICH IS A 594 00:19:02,199 --> 00:19:02,933 PSYCHOSOCIAL APPROACH THAT 595 00:19:02,933 --> 00:19:06,837 ALLOWS YOU TO INCREASE ACTIVITY, 596 00:19:06,837 --> 00:19:08,172 REALLY HELP PEOPLE VIEW 597 00:19:08,172 --> 00:19:09,606 RESILIENCE AS A WAY TO USE HAD 598 00:19:09,606 --> 00:19:11,909 AS AN ISHT VENTION AND THIS 599 00:19:11,909 --> 00:19:13,043 PEPPING SOME RESULTS NOW. 600 00:19:13,043 --> 00:19:15,679 THE NEXT 1 THAT CAME ABOUT WAS 601 00:19:15,679 --> 00:19:16,980 WE WERE DOING SOME OF THIS 602 00:19:16,980 --> 00:19:18,382 AGAIN, WE WENT TO THE FOOD 603 00:19:18,382 --> 00:19:19,416 PANTRY AND HAVING THIS 604 00:19:19,416 --> 00:19:21,351 CONVERSATION ABOUT HOW DO YOU 605 00:19:21,351 --> 00:19:22,453 DEAL WITH FOOD, AND THE PEOPLE 606 00:19:22,453 --> 00:19:23,921 SAID, WELL, YOU KNOW, PEOPLE 607 00:19:23,921 --> 00:19:27,524 COME IN AND ASK US TO GO TO YOU 608 00:19:27,524 --> 00:19:28,459 KNOW FARMER'S MARKET, PEOPLE 609 00:19:28,459 --> 00:19:30,627 LIKE US DON'T ANY TO FARMER'S 610 00:19:30,627 --> 00:19:32,629 MARKET, IT DOESN'T REALLY WORK 611 00:19:32,629 --> 00:19:34,298 FOR US EMPLOY WELL WHAT WOULD 612 00:19:34,298 --> 00:19:37,901 WORK FOR YOU EMPLOY WOULDN'T IT 613 00:19:37,901 --> 00:19:40,637 BE NICE IF SOMEONE COULD DELIVER 614 00:19:40,637 --> 00:19:41,839 STOP CONTROLLER OF BANKS, AND 615 00:19:41,839 --> 00:19:42,573 SOMEONE SAID STOP CONTROLLER OF 616 00:19:42,573 --> 00:19:44,341 BANKS MAY NOT BE ENOUGH, WHAT 617 00:19:44,341 --> 00:19:45,209 ABOUT VOUCHERS. 618 00:19:45,209 --> 00:19:46,977 AND SOMEONE SAID WHAT IF YOU DID 619 00:19:46,977 --> 00:19:47,811 BOTH, CAN YOU DO BOTH? 620 00:19:47,811 --> 00:19:49,079 I SAID WE CAN DO ANYTHING YOU 621 00:19:49,079 --> 00:19:51,515 WANT US TO DO, JUST TELL US WHAT 622 00:19:51,515 --> 00:19:52,649 YOU THINK WILL WORK, WE WILL 623 00:19:52,649 --> 00:19:54,017 FEBRUARY OUT THE SCIENCE. 624 00:19:54,017 --> 00:19:57,521 SO WE SAT DOWN AND CAME DOWN 625 00:19:57,521 --> 00:20:00,891 WITH THE 2 BY 2 DESIGN WHERE WE 626 00:20:00,891 --> 00:20:02,292 QUOM PAIRED 1 GROUP GOT 627 00:20:02,292 --> 00:20:04,294 DIABETES, EVERYBODY GOT DIABETES 628 00:20:04,294 --> 00:20:05,929 MEDICATION, THE 1 GROUP GOT THE 629 00:20:05,929 --> 00:20:08,599 BOXES MAILED TO THEM, THE THIRD 630 00:20:08,599 --> 00:20:10,467 GROUP GOT VOUCHERS AND THE 631 00:20:10,467 --> 00:20:13,437 FOURTH GROUP GOT BOTH, ABOUT 632 00:20:13,437 --> 00:20:13,837 HALF OF EACH. 633 00:20:13,837 --> 00:20:16,673 AND WE ACTUALLY DID THIS AND WE 634 00:20:16,673 --> 00:20:17,474 RANDOMIZED PEOPLE AND WE 635 00:20:17,474 --> 00:20:19,176 PARTNERED WITH THE HUNGER TASK 636 00:20:19,176 --> 00:20:20,477 FORCE TO PROVIDE THE STOCK BOXES 637 00:20:20,477 --> 00:20:22,045 SO WE DIDN'T HAVE TO PAY FOR 638 00:20:22,045 --> 00:20:22,980 THEM BECAUSE THIS IS SOMETHING 639 00:20:22,980 --> 00:20:24,648 THAT THE GOVERNMENT PROVIDES AS 640 00:20:24,648 --> 00:20:28,218 PART OF USDA SUPPORT FOR FOOD. 641 00:20:28,218 --> 00:20:29,419 AND WE RANDOMIZE THIS 642 00:20:29,419 --> 00:20:30,787 INDIVIDUALS AND THE FIRST THING 643 00:20:30,787 --> 00:20:32,322 WE REALIZE, HALFWAY INTO THE 644 00:20:32,322 --> 00:20:34,291 STUDY WAS THE PEOPLE, COMMUNITY 645 00:20:34,291 --> 00:20:37,127 MEMBERS BEGAN TO SAY, YOU KNOW, 646 00:20:37,127 --> 00:20:38,962 THESE BOXES ARE TOO HEAVY, IT'S 647 00:20:38,962 --> 00:20:40,163 NOT CONVENIENT, AND I DON'T 648 00:20:40,163 --> 00:20:42,666 REALLY LIKE WHAT'S IN THE BOX. 649 00:20:42,666 --> 00:20:44,301 BECAUSE 1 OF THE THINGS I 650 00:20:44,301 --> 00:20:45,402 BELIEVE IN BEFORE I ASK PEOPLE 651 00:20:45,402 --> 00:20:47,304 TO DO SOMETHING, I WANT TO MAKE 652 00:20:47,304 --> 00:20:48,472 SURE I'M COMFORTABLE, SO I TOOK 653 00:20:48,472 --> 00:20:50,040 THE TOCK BOX HOME AT THE VERY 654 00:20:50,040 --> 00:20:51,041 BEGINNING OF THE STUDY AND I 655 00:20:51,041 --> 00:20:52,943 TRIED TO EAT WHAT WAS IN THE BOX 656 00:20:52,943 --> 00:20:59,416 AND NO 1 IN MY HOUSE WOULD EAT 657 00:20:59,416 --> 00:20:59,917 IT. 658 00:20:59,917 --> 00:21:00,651 [LAUGHTER] 659 00:21:00,651 --> 00:21:03,186 THE CEREAL WASN'T REALLY GOOD, 660 00:21:03,186 --> 00:21:03,921 THE CHEESE WASN'T--THEN I 661 00:21:03,921 --> 00:21:05,322 REALIZED WHAT WAS GOING IN THE 662 00:21:05,322 --> 00:21:10,160 BOXES WAS REALLY NOT IERK DEAL 663 00:21:10,160 --> 00:21:12,262 SO THEN I SAID DO PEOPLE, WE 664 00:21:12,262 --> 00:21:13,697 WILL FINISH THIS STUDY AND LEARN 665 00:21:13,697 --> 00:21:15,132 FROM THIS FEEDBACK AND 666 00:21:15,132 --> 00:21:17,467 INCORPORATE IT INTO THE NEXT 667 00:21:17,467 --> 00:21:19,169 STUDIES THAT WE DID EMPLOY SO 668 00:21:19,169 --> 00:21:21,672 THIS IS FINISHING UP AND 669 00:21:21,672 --> 00:21:23,340 [INDISCERNIBLE] IS ADA GRANT, WE 670 00:21:23,340 --> 00:21:26,143 USED THAT TO DO AN INTERVENTION 671 00:21:26,143 --> 00:21:27,945 WHERE SHE'S TESTING DIFFERENT 672 00:21:27,945 --> 00:21:29,780 APPROACH, SO WE NOW HAVE A 673 00:21:29,780 --> 00:21:30,981 BETTER SENSE THAT THIS BOX 674 00:21:30,981 --> 00:21:32,049 DOESN'T WORK AND PEOPLE TELLING 675 00:21:32,049 --> 00:21:33,450 US WHAT WE WANT BECAUSE I DON'T 676 00:21:33,450 --> 00:21:37,554 WANT THE STIGMA OF SHOWING UP 677 00:21:37,554 --> 00:21:39,089 WITH A VOUCHER, WHY CAN'T I GET 678 00:21:39,089 --> 00:21:40,290 A CARD AND NOBODY CAN TELL 679 00:21:40,290 --> 00:21:41,692 WHAT'S IN IT SO WE'RE FOURTH 680 00:21:41,692 --> 00:21:43,393 APPEARANCE GIVING PEOPLE CARDS 681 00:21:43,393 --> 00:21:45,495 AND SO NOW THEY GO TO THE 682 00:21:45,495 --> 00:21:46,697 GROCERY TORE AND SHOP WITHOUT 683 00:21:46,697 --> 00:21:48,398 HAVING TO FEEL LIKE EVERYBODY 684 00:21:48,398 --> 00:21:50,601 KNOWS THAT YOU ARE FOOD INSECURE 685 00:21:50,601 --> 00:21:52,202 OR GETTING A WIC CARD OR THINGS 686 00:21:52,202 --> 00:21:52,769 LIKE THAT. 687 00:21:52,769 --> 00:21:54,438 SO THIS STUDY IS NOW, JUST 688 00:21:54,438 --> 00:21:57,741 FINISHED UP IN THAT ANALYSIS SO 689 00:21:57,741 --> 00:21:58,809 THIS IS ALL WRAPPING UP YOU KNOW 690 00:21:58,809 --> 00:22:03,780 5 YEAR STUDIES THAT ARE JUST 691 00:22:03,780 --> 00:22:06,249 WRAPPING UP, THE FED STUDY WAS 692 00:22:06,249 --> 00:22:07,217 INTERESTING BECAUSE THIS 693 00:22:07,217 --> 00:22:09,052 WAS--WITH WHEN WE WERE IN CHARLS 694 00:22:09,052 --> 00:22:10,187 TON, WE WERE TRYING TO FIGURE 695 00:22:10,187 --> 00:22:12,556 OUT HOW TO MOTIVATE PEOPLE TO 696 00:22:12,556 --> 00:22:13,123 GET BEHAVIOR CHANGE. 697 00:22:13,123 --> 00:22:18,328 AND WE HAD DONE A COUPLE OF 698 00:22:18,328 --> 00:22:20,163 STUDIES, IS AS YOU REALIZE WHEN 699 00:22:20,163 --> 00:22:21,331 YOU LEARN MORE FROM FIELD 700 00:22:21,331 --> 00:22:22,733 STUDIES, DIFFERENT STUDIES THAT 701 00:22:22,733 --> 00:22:24,201 SUCCEED, SO THEN WE COME UP TO 702 00:22:24,201 --> 00:22:26,269 RO-1S AND WE GOT RESULTS THAT 703 00:22:26,269 --> 00:22:27,504 WERE NOT INCONCLUSIVE ABOUT 704 00:22:27,504 --> 00:22:29,573 EDUCATION AND SO, IN DISCUSSING, 705 00:22:29,573 --> 00:22:31,308 I SAID, YOU KNOW, THAT WAS ABOUT 706 00:22:31,308 --> 00:22:32,776 THE TIME WHEN BEHAVIORIAL 707 00:22:32,776 --> 00:22:34,611 ECONOMICS WAS COMING UP, SO I 708 00:22:34,611 --> 00:22:37,080 SAID LET'S DO PILOTS TOEE IF 709 00:22:37,080 --> 00:22:38,081 GIVING PEOPLE FINANCIAL 710 00:22:38,081 --> 00:22:41,652 INCENTIVES CAN MAKE A DIFFERENCE 711 00:22:41,652 --> 00:22:47,691 WE DID A PILOT AND IT DROPPED 712 00:22:47,691 --> 00:22:53,997 ALMOST 3%. 713 00:22:53,997 --> 00:23:03,707 AND IRB THOUGHT HOW AND 714 00:23:03,707 --> 00:23:04,741 EEIVETTUALRY TRANSITION TO 715 00:23:04,741 --> 00:23:05,909 MOTIVATION SO WE RAPPED ORDER OF 716 00:23:05,909 --> 00:23:06,476 MICRONSIZE PEOPLE TO THIS 717 00:23:06,476 --> 00:23:08,545 DESIGN, AND I WANTED TO TEST, WE 718 00:23:08,545 --> 00:23:10,213 HAD ALREADY TESTED THE HOME 719 00:23:10,213 --> 00:23:10,847 MONITORING INTERVENTION AND THE 720 00:23:10,847 --> 00:23:12,582 GOAL WAS TO LAYER THIS INCENTIVE 721 00:23:12,582 --> 00:23:23,126 ON TOP OF THE HOME INTERVENTION, 722 00:23:28,999 --> 00:23:30,701 SO PLUS STRUCTURAL INCENTIVE AND 723 00:23:30,701 --> 00:23:31,735 AS WAY QUESTION WAS STRATIFIED 724 00:23:31,735 --> 00:23:34,204 BY RISK BECAUSE THE QUESTION WAS 725 00:23:34,204 --> 00:23:35,272 IT APPEARS FINANCIAL INCENTIVES 726 00:23:35,272 --> 00:23:37,007 MAY ACTUALLY FUNCTION 727 00:23:37,007 --> 00:23:37,941 DIFFERENTLY BY RACIAL GROUP AND 728 00:23:37,941 --> 00:23:39,676 WE DIDN'T HAVE THAT INFORMATION 729 00:23:39,676 --> 00:23:44,281 SO WE STRATIFIED BY RACE AND SO 730 00:23:44,281 --> 00:23:46,917 WE HAD WHITE, BLACK AND 731 00:23:46,917 --> 00:23:48,552 HISPANIC, THE OTHER THING WE 732 00:23:48,552 --> 00:23:50,787 SAID IS WHAT WOULD HAPPEN IF WE 733 00:23:50,787 --> 00:23:52,956 STUDY INTERVENTION, DO WE REALLY 734 00:23:52,956 --> 00:23:56,259 HAVE PEOPLE CONVERTING FROM 735 00:23:56,259 --> 00:23:58,729 INTRINSIC TO EXTRINSIC SO WE 736 00:23:58,729 --> 00:24:00,864 FOLLOWED THEM FOR 6 MONTHS, SO 737 00:24:00,864 --> 00:24:03,834 THAT STUDY IS PROBABLY THE LONG 738 00:24:03,834 --> 00:24:05,068 OAST RANDOMIZED PROGRAM AND 739 00:24:05,068 --> 00:24:07,003 LARGEST WE'VE DONE TO DATE AND 740 00:24:07,003 --> 00:24:09,606 WE JUST FINISHED THE 18 MONTH 741 00:24:09,606 --> 00:24:11,575 PHASE RIGHT NOW AND SOME OF THE 742 00:24:11,575 --> 00:24:13,210 STUDIES SUGGEST THAT THE 743 00:24:13,210 --> 00:24:14,978 INCENTIVES ACTUALLY WORK AND TRY 744 00:24:14,978 --> 00:24:17,647 TO SEE WHAT ARE THE RISKS 745 00:24:17,647 --> 00:24:18,348 ASSOCIATED RESPOND DIFFERENTLY 746 00:24:18,348 --> 00:24:19,382 TO INCENTIVES IN EMERGING ITS OF 747 00:24:19,382 --> 00:24:20,450 HOW THIS IS ACTUALLY DONE. 748 00:24:20,450 --> 00:24:22,552 SO THIS IS SPENDING RESULTS 749 00:24:22,552 --> 00:24:25,055 RIGHT NOW, BUT WE'RE ALMOST 750 00:24:25,055 --> 00:24:28,291 READY TO DO ANALYSIS. 751 00:24:28,291 --> 00:24:37,467 AND THEN, OR AT THE END WHEN WE 752 00:24:37,467 --> 00:24:38,368 FINISHING THIS, GEORGE FLOYD, 753 00:24:38,368 --> 00:24:40,036 THE DEATH OF GEORGE FLOYD, THE 754 00:24:40,036 --> 00:24:40,771 CONVERSATION ABOUT THIS AND WE 755 00:24:40,771 --> 00:24:42,239 GET TO THE POINT WHERE WE SAID 756 00:24:42,239 --> 00:24:44,174 THIS LEVEL OF INTERVENTIONS ARE 757 00:24:44,174 --> 00:24:46,042 NOT ADDRESSING THIS UPSTREAM 758 00:24:46,042 --> 00:24:47,310 FACTORS, AND SO, WE ACTUALLY 759 00:24:47,310 --> 00:24:49,713 BEGUN TO LOOK AT THIS W. H. O. 760 00:24:49,713 --> 00:24:51,782 FRAMEWORK AND WE SAID OKAY, 761 00:24:51,782 --> 00:24:53,216 THERE'S THIS WHOLE SOCIALIO 762 00:24:53,216 --> 00:24:54,651 ECONOMIC AND POLITICAL CONTEXT 763 00:24:54,651 --> 00:24:56,720 THAT IS TYPICALLY NOT TALKED 764 00:24:56,720 --> 00:24:57,020 ABOUT. 765 00:24:57,020 --> 00:24:58,522 HOW DO WE ADDRESS THIS? 766 00:24:58,522 --> 00:25:00,657 AND SO I WANT TO WALK YOU 767 00:25:00,657 --> 00:25:03,460 THROUGH THE CONCEPT OF 768 00:25:03,460 --> 00:25:04,294 STRUCTURAL RACISM, STRUCTURAL 769 00:25:04,294 --> 00:25:05,162 INEQUALITIES AND SOME OF THE 770 00:25:05,162 --> 00:25:06,763 WORK WE'VE DONE THERE AND WHAT 771 00:25:06,763 --> 00:25:09,533 WE'VE ACTUALLY FOUND IN OUR 772 00:25:09,533 --> 00:25:10,367 RESEARCH. 773 00:25:10,367 --> 00:25:13,637 SO THESE ARE 2 DEFINITIONS THAT 774 00:25:13,637 --> 00:25:14,938 MOST PEOPLE WIDELY ACCEPTED 775 00:25:14,938 --> 00:25:17,574 RIGHT NOW IN TERMS OF DEFINITION 776 00:25:17,574 --> 00:25:18,475 STRUCTURAL RACISM, 1 IS TO TURN 777 00:25:18,475 --> 00:25:22,979 IT TO WAYS IN WHICH SOCIETIES 778 00:25:22,979 --> 00:25:24,915 FOSTER DISCRIMINATION THROUGH 779 00:25:24,915 --> 00:25:26,116 MUTUAL REINFORCING EQUITY 780 00:25:26,116 --> 00:25:29,853 SYSTEMS THAT IN TURN ENFORCE 781 00:25:29,853 --> 00:25:30,687 DISCRIMINATORY PLEEFS AND 782 00:25:30,687 --> 00:25:32,222 RESOURCES AND THE SECOND IS 783 00:25:32,222 --> 00:25:34,391 ORGANIZE SYSTEMS THAT CAUSE 784 00:25:34,391 --> 00:25:35,358 AVOIDABLE AND UNFAIR 785 00:25:35,358 --> 00:25:36,927 INEQUALITIES IN POWER, 786 00:25:36,927 --> 00:25:38,628 RESOURCES, CAPACITIES AND 787 00:25:38,628 --> 00:25:39,796 OPPORTUNITIES ACROSS RACIAL OR 788 00:25:39,796 --> 00:25:42,365 ETHNIC GROUPS. 789 00:25:42,365 --> 00:25:44,668 NOW, WE USE STRUCTURAL 790 00:25:44,668 --> 00:25:46,870 INEQUALITIES AS THE OVERALL 791 00:25:46,870 --> 00:25:48,338 FRAMEWORK, AND THE INEQUALITIES 792 00:25:48,338 --> 00:25:54,477 ARE ARE TIED TIED--ARE TIED TOE 793 00:25:54,477 --> 00:26:04,855 AND STRUCTURAL RACE. 794 00:26:07,524 --> 00:26:09,125 BUT THERE ARE 2 CONCEPTS, THIS 795 00:26:09,125 --> 00:26:15,899 IS FROM THE WORK OF RICHARD 796 00:26:15,899 --> 00:26:20,804 ROSTIN, THE THIS IS NOT 797 00:26:20,804 --> 00:26:21,504 OFFICIALLY SAIRCHGZED, THE 798 00:26:21,504 --> 00:26:22,806 RESULT OF PRIVATE PREVENTIVE 799 00:26:22,806 --> 00:26:23,473 FERENCE OR INDIVIDUAL CHOICE, 800 00:26:23,473 --> 00:26:25,809 NOT A RESULT OF LAW OR 801 00:26:25,809 --> 00:26:27,911 GOVERNMENT POLICY, WHEREAS THE 802 00:26:27,911 --> 00:26:33,250 YOURY IS SANKED BY A LAW OF 803 00:26:33,250 --> 00:26:34,150 PUBLIC POLICY, PRIVATE-PREJUDICE 804 00:26:34,150 --> 00:26:36,653 [INDISCERNIBLE] AND IT'S NOT 805 00:26:36,653 --> 00:26:38,655 REINFORCED THROUGH JUDICIAL 806 00:26:38,655 --> 00:26:39,256 DECISIONS [INDISCERNIBLE] SO 807 00:26:39,256 --> 00:26:42,058 THIS IS THE CONCEPT OF YOU CALL 808 00:26:42,058 --> 00:26:43,560 IT TRUCTURE, THESE ARE THINGS 809 00:26:43,560 --> 00:26:48,932 THAT ARE EMBEDDED IN OUR SOCIETY 810 00:26:48,932 --> 00:26:50,300 IN SYSTEMS AND THE SYSTEMS HAVE 811 00:26:50,300 --> 00:26:51,968 THE WAY OF ACTUALLY PERPETRATING 812 00:26:51,968 --> 00:26:52,369 THEMSELVES. 813 00:26:52,369 --> 00:26:54,070 SO WHEN PEOPLE SAY, WELL, LET 814 00:26:54,070 --> 00:26:55,238 THE PAST BE THE PAST. 815 00:26:55,238 --> 00:26:57,374 IT'S REALLY NOT TRUE BECAUSE THE 816 00:26:57,374 --> 00:26:58,441 PAST INFLUENCES THE PRESENT. 817 00:26:58,441 --> 00:27:01,912 IF YOU UNDERSTAND LAW, THAT ALL 818 00:27:01,912 --> 00:27:04,648 THESE DECISIONS ARE BASED ON 819 00:27:04,648 --> 00:27:08,652 PROUD DECISIONS, SO IF YOU DON'T 820 00:27:08,652 --> 00:27:09,552 INVEST IN THESE DECISIONS, THEN 821 00:27:09,552 --> 00:27:11,488 YOU WILL CONTINUE FORWARD THE 822 00:27:11,488 --> 00:27:11,855 INYESTERDAYS. 823 00:27:11,855 --> 00:27:22,365 SO HERE ARE EXAMPLES OF SOCIAL 824 00:27:23,733 --> 00:27:26,269 INJUSTICES, HOUSING AND 825 00:27:26,269 --> 00:27:29,773 RESIDENTIAL SEGREGATION, AND 826 00:27:29,773 --> 00:27:30,941 EDUCATION, RICH SYSTEMS ARE 827 00:27:30,941 --> 00:27:34,077 BETTER THAN POOR NEIGHBORHOODS, 828 00:27:34,077 --> 00:27:36,012 OR VALUES, WHERE PEOPLE WERE 829 00:27:36,012 --> 00:27:37,080 KILLED OR POLICE KILLINGS HAPPEN 830 00:27:37,080 --> 00:27:38,181 AND WHEN NOTHING IS ACTUALLY 831 00:27:38,181 --> 00:27:41,484 DONE AS PART OF TRYING TO BRING 832 00:27:41,484 --> 00:27:42,152 ABOUT CHANGE, MASS INCARCERATION 833 00:27:42,152 --> 00:27:43,553 THIS, IS GETTING BETTER NOW BUT 834 00:27:43,553 --> 00:27:47,057 WE HAD A TIME WHEN ABOUT 37% OF 835 00:27:47,057 --> 00:27:49,359 AFRICAN-AMERICAN MEN WITHOUT A 836 00:27:49,359 --> 00:27:53,096 HIGH SCHOOL DIPLOMA WERE 837 00:27:53,096 --> 00:27:54,264 INCARCERATED. 838 00:27:54,264 --> 00:27:55,665 THEN THE JUDICIAL SYSTEM, 839 00:27:55,665 --> 00:27:56,933 DEPENDING HOW RICH OR WEALTHY 840 00:27:56,933 --> 00:27:59,235 YOU ARE, YOU CAN EXPUNGE YOUR 841 00:27:59,235 --> 00:28:03,640 RECORDINGS IF YOU ARE NOT THAT 842 00:28:03,640 --> 00:28:04,107 WEALTHY, YOU CAN'T. 843 00:28:04,107 --> 00:28:13,383 BUT ALSO IN TERMS OF 844 00:28:13,383 --> 00:28:16,353 DIFFERENTIAL RACE, AND THEN ALSO 845 00:28:16,353 --> 00:28:18,655 ACCUMULATION OF WEALTH, WHEN YOU 846 00:28:18,655 --> 00:28:20,056 HAVE GENERATIONS WHO OWN HOMES 847 00:28:20,056 --> 00:28:21,391 YOU CREATE A WEALTH GAP THAT IS 848 00:28:21,391 --> 00:28:22,792 PRESENT TO THIS DAY, IF YOU LOOK 849 00:28:22,792 --> 00:28:24,661 AT SOCIETY TODAY ABOUT 85% OF 850 00:28:24,661 --> 00:28:27,731 THE WEALTH, IS IN WHITE HOUSE 851 00:28:27,731 --> 00:28:30,033 HOLDS AND ABOUT 4.2% IN AFRICAN 852 00:28:30,033 --> 00:28:31,668 AMERICAN HOUSEHOLDS AND 3% IN 853 00:28:31,668 --> 00:28:34,304 LATIN O OR HISPANIC HOUSEHOLDS 854 00:28:34,304 --> 00:28:35,505 SO YOU SEE DIFFERENTIAL WEALTH 855 00:28:35,505 --> 00:28:36,573 AND WEALTH IS VERY DIFFERENT 856 00:28:36,573 --> 00:28:37,707 FROM INCOME BECAUSE INCOME IS 857 00:28:37,707 --> 00:28:39,476 ESSENTIAL TO WHAT YOU MAKE NOW 858 00:28:39,476 --> 00:28:40,443 EMPLOY WEGHT IS CUMULATIVE AND 859 00:28:40,443 --> 00:28:42,412 IT IS WHAT IS IN YOUR FAMILY AND 860 00:28:42,412 --> 00:28:47,050 WHAT YOU HAVE OVER TIME. 861 00:28:47,050 --> 00:28:48,251 SO NOW I WANT TO SWITCH GEARS 862 00:28:48,251 --> 00:28:53,590 AND TALK ABOUT SOME OF OUR WORK. 863 00:28:53,590 --> 00:28:55,458 SO WHEN WE GOT ON THIS PATH, WE 864 00:28:55,458 --> 00:28:58,261 SAID OKAY, WHAT DO WE DO TO 865 00:28:58,261 --> 00:28:59,929 CREATE MEANINGFUL RESEARCH THAT 866 00:28:59,929 --> 00:29:02,165 WOULD HELP US UNDERSTAND ISSUES, 867 00:29:02,165 --> 00:29:06,302 BUT ALSO THAT WILL ACTUALLY GET 868 00:29:06,302 --> 00:29:07,871 PEOPLE, ISHT VENTION JUST AS WE 869 00:29:07,871 --> 00:29:09,406 DID WITH SOCIAL DETERMINANTS, WE 870 00:29:09,406 --> 00:29:11,141 DID THE INSHALL PATHWAYS AND WE 871 00:29:11,141 --> 00:29:12,342 SAID HERE ARE THE TARGETS SO 872 00:29:12,342 --> 00:29:14,144 HERE WE ARE DOING WORK NOW, THE 873 00:29:14,144 --> 00:29:16,079 VERY FIRST STUDY WE DID WAS 874 00:29:16,079 --> 00:29:19,249 PUBLISHED IN DIABETES IN 2022 875 00:29:19,249 --> 00:29:20,850 WITH MY--3 OF MENTEES AND THE 876 00:29:20,850 --> 00:29:25,989 IDEA WAS TO LOOK AT RED LINING 877 00:29:25,989 --> 00:29:27,590 AND PRESENTING DIABETES 878 00:29:27,590 --> 00:29:29,092 MORTALITY IN YEARS OF LIFE LOST. 879 00:29:29,092 --> 00:29:30,293 WHAT WAS FASCINATING ABOUT THIS 880 00:29:30,293 --> 00:29:32,862 IS THAT MANY PEOPLE MAY NOT BE 881 00:29:32,862 --> 00:29:35,231 FAMILIAR WITH, BUT RED LINING IS 882 00:29:35,231 --> 00:29:39,335 THE PREVIOUS LEGAL PRACTICE OF 883 00:29:39,335 --> 00:29:42,739 SYSTEMATICALLY DENYING CREDIT 884 00:29:42,739 --> 00:29:44,908 ACCESS TO THOSE IN CERTAIN 885 00:29:44,908 --> 00:29:45,942 NEIGHBORHOODS. 886 00:29:45,942 --> 00:29:47,277 IT WAS LATER PROHIB THORS 887 00:29:47,277 --> 00:29:51,881 EDUCATIONALLED BY THE FEDERAL 888 00:29:51,881 --> 00:29:53,116 HOUSING IN 1968, IT'S ILLEGAL 889 00:29:53,116 --> 00:29:54,717 TODAY, SO WHAT DID THE RED 890 00:29:54,717 --> 00:29:57,253 LINING DID, THEY HAD WHAT 891 00:29:57,253 --> 00:29:58,822 HOMEOWNERS LONE CORPORATION AND 892 00:29:58,822 --> 00:29:59,989 THEY GRADED NEIGHBORHOODS BASED 893 00:29:59,989 --> 00:30:02,725 ON WHAT THEY THOUGHT ABOUT 894 00:30:02,725 --> 00:30:04,894 VIABILITY, SO A WAS CONSIDERED 895 00:30:04,894 --> 00:30:05,695 BEST, COLORED GREEN. 896 00:30:05,695 --> 00:30:08,498 B, WAS STILL DESIRABLE, COLORED 897 00:30:08,498 --> 00:30:11,668 BLUE, C, WAS DECLINING COLORED 898 00:30:11,668 --> 00:30:13,269 YELLOW AND DWAS HAZARDOUS, IT 899 00:30:13,269 --> 00:30:13,703 WAS COLORED RED. 900 00:30:13,703 --> 00:30:16,005 IF YOU WERE RED, YOU DIDN'T GET 901 00:30:16,005 --> 00:30:17,907 RESOURCES, YOU COULDN'T BUILD, 902 00:30:17,907 --> 00:30:19,309 BUY, INVEST IN THOSE 903 00:30:19,309 --> 00:30:19,642 NEIGHBORHOODS. 904 00:30:19,642 --> 00:30:24,581 SO, THIS IS THE CONCEPT OF RED 905 00:30:24,581 --> 00:30:25,882 LINING, AND SO, CITIES THAT HAVE 906 00:30:25,882 --> 00:30:29,352 THOSE RED LINING MAPS, ACTUALLY 907 00:30:29,352 --> 00:30:31,488 SEE THAT MOST OF THE 908 00:30:31,488 --> 00:30:32,288 MARGINALIZED NEIGHBORHOODS ARE 909 00:30:32,288 --> 00:30:34,390 IN THOSE RED ZONES TODAY, NOW 910 00:30:34,390 --> 00:30:35,325 THERE'S OVERLAP BUT TILL ABOUT 911 00:30:35,325 --> 00:30:35,592 THE SAME. 912 00:30:35,592 --> 00:30:38,895 SO WHAT WE WANTED TO DO WAS ASK 913 00:30:38,895 --> 00:30:40,163 THE QUESTION, WAS THE 914 00:30:40,163 --> 00:30:43,533 RELATIONSHIP BETWEEN RED LINING 915 00:30:43,533 --> 00:30:44,134 AND [INDISCERNIBLE] MORTALITY 916 00:30:44,134 --> 00:30:45,635 AND YEARS OF LIFE LOST FOR 917 00:30:45,635 --> 00:30:47,237 PEOPLE WITH DIABETES AND WE USE 918 00:30:47,237 --> 00:30:48,471 MULTIPLE DATA SETS AND 1 OF THE 919 00:30:48,471 --> 00:30:50,773 THINGS BECAUSE OF MY BACKGROUND 920 00:30:50,773 --> 00:30:52,375 IN TRAINING HEALTH SERVICES, WE 921 00:30:52,375 --> 00:30:56,112 WERE ABLE TO WORK WITH NATIONAL 922 00:30:56,112 --> 00:30:59,315 DATA, LIKE DATA, SMALL DATA, 923 00:30:59,315 --> 00:31:00,450 THIS WAS DATA FROM--AT THE TIME 924 00:31:00,450 --> 00:31:03,019 WHEN WE DID THIS WORK, THERE WAS 925 00:31:03,019 --> 00:31:05,755 ONLY 1 COUNTY IN WASHINGTON THAT 926 00:31:05,755 --> 00:31:07,690 HAD ENOUGH DATA TO ALLOW US TO 927 00:31:07,690 --> 00:31:11,694 DO THIS ANALYSIS AND THAT WAS 928 00:31:11,694 --> 00:31:12,061 FROM SEATTLE. 929 00:31:12,061 --> 00:31:13,730 SOPHISTICATEDY WE TOOK THE HOT 930 00:31:13,730 --> 00:31:18,101 MAP FROM THE CITY OF SEATTLE AND 931 00:31:18,101 --> 00:31:19,435 WE USED INFORMATION FROM THE 932 00:31:19,435 --> 00:31:22,772 CENSUS BURRO AND WE CAME UP WITH 933 00:31:22,772 --> 00:31:24,207 109 CENSUS TRACKS AND FOLLOW 934 00:31:24,207 --> 00:31:24,574 OUTCOMES. 935 00:31:24,574 --> 00:31:26,776 WE WANTED TO FOLLOW THEM FROM 936 00:31:26,776 --> 00:31:27,277 1990 TO 2014. 937 00:31:27,277 --> 00:31:29,112 SO THIS IS WHAT WE FOUND. 938 00:31:29,112 --> 00:31:34,317 SOT THE FIRST PANEL IS 1990, THE 939 00:31:34,317 --> 00:31:37,187 SECOND PANEL IS 2014, THE TOP IS 940 00:31:37,187 --> 00:31:39,289 DEATH AND THE OTHER IS YEARS OF 941 00:31:39,289 --> 00:31:39,556 LIFE LOST. 942 00:31:39,556 --> 00:31:43,326 AND WHAT YOU SEE IT'S ALMOST A 943 00:31:43,326 --> 00:31:44,827 LINEAR RELATIONSHIP BETWEEN 944 00:31:44,827 --> 00:31:47,330 [INDISCERNIBLE] GREEN, SO 1 IS 945 00:31:47,330 --> 00:31:48,698 GREEN AND 4 IS [INDISCERNIBLE]. 946 00:31:48,698 --> 00:31:49,966 BUT WHAT WAS MORE CONCERNING FOR 947 00:31:49,966 --> 00:31:52,802 US WAS NOT JUST THE FACT WE 948 00:31:52,802 --> 00:31:54,037 ARE--WE KNEW THIS IS WHAT WE 949 00:31:54,037 --> 00:31:55,004 WERE GOING TO FIND IN EMERGING 950 00:31:55,004 --> 00:31:56,773 ITS OF THIS SPECIFICATION, IT 951 00:31:56,773 --> 00:31:58,875 WAS PERSISTENCE, SO YOU LOOK AT 952 00:31:58,875 --> 00:32:00,910 1990 AND 2014, THE EFFECTS ARE 953 00:32:00,910 --> 00:32:02,212 STILL VERY SIMILAR, WHAT THIS IS 954 00:32:02,212 --> 00:32:03,046 SAYING IS THAT WHAT ALL OF THOSE 955 00:32:03,046 --> 00:32:04,247 CENTER FOR EXCELLENCE ON AGINGS 956 00:32:04,247 --> 00:32:07,550 THAT WE HAD IN 1960S ARE STILL 957 00:32:07,550 --> 00:32:08,618 CARRYING FORWARD TODAY AND WE'RE 958 00:32:08,618 --> 00:32:10,620 HAVING SOME OF THOSE EEIVETS SO 959 00:32:10,620 --> 00:32:12,121 AGAIN, THIS IS SOMETHING THAT 960 00:32:12,121 --> 00:32:13,356 REALLY GOT US THINKING ABOUT, 961 00:32:13,356 --> 00:32:15,124 OKAY, NOW, IF THIS IS TRUE, THEN 962 00:32:15,124 --> 00:32:17,327 WHAT ELSE DO WE NEED TO ACTUALLY 963 00:32:17,327 --> 00:32:17,927 PAY ATTENTION TO. 964 00:32:17,927 --> 00:32:21,531 SO THE NEXT STUDY WE DID, WAS A 965 00:32:21,531 --> 00:32:23,600 STUDY WHERE WE WERE TRYING TO 966 00:32:23,600 --> 00:32:25,802 UNDERSTAND WHAT'S BEEN DONE IN 967 00:32:25,802 --> 00:32:28,171 THE LITERATURE AND SO WE DID THE 968 00:32:28,171 --> 00:32:30,073 SCOPING REVIEW, LOOKING AT 969 00:32:30,073 --> 00:32:31,374 STRUCTURAL RACISM AS AN UPSTREAM 970 00:32:31,374 --> 00:32:32,408 SOCIAL DETERMINANT OF HEALTH AND 971 00:32:32,408 --> 00:32:34,043 I'M NOT GOING TO GO INTO THIS, 972 00:32:34,043 --> 00:32:35,411 THIS IS THE ABSTRACT BOOK, WHAT 973 00:32:35,411 --> 00:32:37,347 WE WANTED TO ACTUALLY DO WAS TO 974 00:32:37,347 --> 00:32:39,449 ACTUALLY TAKE THE LITERATURE 975 00:32:39,449 --> 00:32:43,086 USING THE W. H. O. MODEL AND ASK 976 00:32:43,086 --> 00:32:44,187 THE QUESTION, THOSE UPTREME 977 00:32:44,187 --> 00:32:45,622 FACTORS WHAT'S BEEN DONE IN THE 978 00:32:45,622 --> 00:32:47,390 LITERATURE, HOW MANY STUDIES, SO 979 00:32:47,390 --> 00:32:50,593 WE DID RESEARCH OF MED LINE, AND 980 00:32:50,593 --> 00:32:51,828 WE ACTUALLY LOOKED AT ALL 981 00:32:51,828 --> 00:32:52,996 ARTICLES PUBLISHED FROM THE 982 00:32:52,996 --> 00:32:55,031 BEGINNING OF THE DATABASE TO 983 00:32:55,031 --> 00:32:56,799 JULY OF 2022, AND WE USE THIS 984 00:32:56,799 --> 00:32:59,102 FRAMEWORK, THE W. H. O. 985 00:32:59,102 --> 00:32:59,636 FRAMEWORK THAT CLASSIFIES 986 00:32:59,636 --> 00:33:01,271 STUDIES AND THEN WE HAVE--WE 987 00:33:01,271 --> 00:33:03,673 FOUND A TOTAL FOR THE STUDIES 988 00:33:03,673 --> 00:33:05,942 THAT WE ACTUALLY IDENTIFIED AND 989 00:33:05,942 --> 00:33:07,443 AND THAT WE REALLY NAARE O DOWN 990 00:33:07,443 --> 00:33:10,313 TO 54, WE HAD THAT INFORMATION 991 00:33:10,313 --> 00:33:12,015 AND ULTIMATELY WE'RE DOWN TO 10 992 00:33:12,015 --> 00:33:15,518 STUDIES TO ACTUALLY HAVE ANY 993 00:33:15,518 --> 00:33:17,086 KIND OF MEASURABLE RELATIONSHIP. 994 00:33:17,086 --> 00:33:19,255 AND WHAT CAN WE FIND, 1 POSITIVE 995 00:33:19,255 --> 00:33:20,757 WORK IN THAT SPACE BUT 2 FOR 996 00:33:20,757 --> 00:33:22,225 THOSE STUDIES THAT ACTUALLY HAD 997 00:33:22,225 --> 00:33:24,260 DATA THERE WAS A VERY STRONG 998 00:33:24,260 --> 00:33:25,595 RELATIONSHIP BETWEEN STRUCTURAL 999 00:33:25,595 --> 00:33:27,430 RACISM, AND POOR DIABETES 1000 00:33:27,430 --> 00:33:28,865 OUTCOMES AND MORTALITY, SO, 1001 00:33:28,865 --> 00:33:31,401 AGAIN, SUGGESTING THAT THERE WAS 1002 00:33:31,401 --> 00:33:35,138 SOMETHING GOING ON, SO, IT WAS 1003 00:33:35,138 --> 00:33:36,839 POOR CLINICAL OUTCOMES, MORE 1004 00:33:36,839 --> 00:33:37,907 [INDISCERNIBLE] BEHAVIORS, LOWER 1005 00:33:37,907 --> 00:33:39,142 STANDARDS OF CARE, HIGHER 1006 00:33:39,142 --> 00:33:40,576 MORTALITY AND MORE YEARS OF LIFE 1007 00:33:40,576 --> 00:33:40,910 LOST. 1008 00:33:40,910 --> 00:33:42,078 BUT THE MAIN ISSUE TO DATE IS 1009 00:33:42,078 --> 00:33:44,147 THERE ARE NO PATHWAYS. 1010 00:33:44,147 --> 00:33:46,049 WE CAN'T CREATE INTERVENTIONS 1011 00:33:46,049 --> 00:33:46,749 WITHOUT UNDERSTANDING THE 1012 00:33:46,749 --> 00:33:48,051 MECHANISM AND THE PATHWAYS, AND 1013 00:33:48,051 --> 00:33:54,090 SO WE THEN STARTED AND THIS WAS 1014 00:33:54,090 --> 00:33:55,658 2023, WE SAT DOWN AND WE SAID 1015 00:33:55,658 --> 00:33:58,394 HOW DO WE ANSWER THIS QUESTION? 1016 00:33:58,394 --> 00:33:59,829 AT THIS LEVEL, YOU NEED DATA, 1017 00:33:59,829 --> 00:34:02,165 NOT AT THE INDIVIDUAL LEVEL, 1018 00:34:02,165 --> 00:34:03,700 MORE ABOUT CENSUS TRACK, SO WE 1019 00:34:03,700 --> 00:34:05,201 DECIDED TO DO THIS LAST STUDY 1020 00:34:05,201 --> 00:34:06,536 THAT JUST GOT PUBLISHED THIS 1021 00:34:06,536 --> 00:34:08,438 YEAR, AND LOOKING AT HISTORIC 1022 00:34:08,438 --> 00:34:11,607 LIKE IMPACT OF STRUCTURAL RACISM 1023 00:34:11,607 --> 00:34:12,608 AND DIABETES, PREVALENCE OR 1024 00:34:12,608 --> 00:34:14,944 NATIONAL [INDISCERNIBLE] OF U.S. 1025 00:34:14,944 --> 00:34:15,311 ADULTS. 1026 00:34:15,311 --> 00:34:16,312 SO WHAT DID WE DO? 1027 00:34:16,312 --> 00:34:18,848 WE USE RED LINE AS A SURROGATE 1028 00:34:18,848 --> 00:34:23,453 AND RED LINING IS NOT STRUCTURAL 1029 00:34:23,453 --> 00:34:25,154 RACISM, IT'S AN EXPRESSION OF 1030 00:34:25,154 --> 00:34:26,389 STRUCTURAL RACISM. 1031 00:34:26,389 --> 00:34:27,423 SO IT'S NOT--IT'S 1 OF THE 1032 00:34:27,423 --> 00:34:28,725 MEASURES WE HAVE, IT'S NOT THE 1033 00:34:28,725 --> 00:34:30,159 BEST MEASURE BUT IT GIVES US 1034 00:34:30,159 --> 00:34:31,627 SOME SENSE OF WHAT'S GOING ON, 1035 00:34:31,627 --> 00:34:33,730 AND I WANTED TO INVESTIGATE THE 1036 00:34:33,730 --> 00:34:35,431 DIRECT OR INDIRECT RELATIONSHIPS 1037 00:34:35,431 --> 00:34:37,834 BETWEEN RED LINING AND 1038 00:34:37,834 --> 00:34:40,069 PREVALENCE OF DIABETES. 1039 00:34:40,069 --> 00:34:41,738 FOR THOSE OF COURSE WE DO 1040 00:34:41,738 --> 00:34:42,772 INTERVENTIONS, WE'RE NOT 1041 00:34:42,772 --> 00:34:44,574 SATISFIED WITH FINDING RESULTS, 1042 00:34:44,574 --> 00:34:46,609 WE WANT TO FIND THE PLANETARY 1043 00:34:46,609 --> 00:34:48,378 MODELS, HOW DO WE FIX THIS, SO 1044 00:34:48,378 --> 00:34:49,045 WE'RE CONDITIONALLINGA THE THIS 1045 00:34:49,045 --> 00:34:51,114 WITH THE MIND SET OF WHAT 1046 00:34:51,114 --> 00:34:52,648 UNMUTABLE FACTORS, WHAT ARE 1047 00:34:52,648 --> 00:34:53,716 POLICIES THAT COULD ACTUALLY BE 1048 00:34:53,716 --> 00:34:55,351 CHANGED AND WHAT WOULD THAT LOOK 1049 00:34:55,351 --> 00:34:55,685 LIKE? 1050 00:34:55,685 --> 00:34:56,953 SO WE TOOK DATA FROM VERY 1051 00:34:56,953 --> 00:34:59,422 SIMILAR TO WHAT WE DID, CDC 1052 00:34:59,422 --> 00:35:02,859 PLACES DATA FOR PREVALENCE, 1053 00:35:02,859 --> 00:35:03,693 [INDISCERNIBLE] MAPPING 1054 00:35:03,693 --> 00:35:05,194 INEQUALITY PROJECT AND THEN WE 1055 00:35:05,194 --> 00:35:06,396 ACTUALLY USED A REALLY NICE WORK 1056 00:35:06,396 --> 00:35:09,832 THAT HAS BEEN PUT TOGETHER 1057 00:35:09,832 --> 00:35:10,900 LOOKING AT CONCEPTUAL FRAMEWORK 1058 00:35:10,900 --> 00:35:12,268 AND WE HAVE DONE THAT WORK IN 1059 00:35:12,268 --> 00:35:14,370 EMERGING ITS OF CONCEPTUAL 1060 00:35:14,370 --> 00:35:16,072 FRAMEWORK AND THEN ADJUSTED FOR 1061 00:35:16,072 --> 00:35:18,241 THE CENSUS POPULATION BASED ON 1062 00:35:18,241 --> 00:35:19,108 CENSUS DATA. 1063 00:35:19,108 --> 00:35:21,811 SO WE'RE AT ABOUT ALMOST 9600 1064 00:35:21,811 --> 00:35:22,712 TRACKS ACROSS THE UNITED STATES 1065 00:35:22,712 --> 00:35:24,480 AND WE USE THIS WHOLE 1066 00:35:24,480 --> 00:35:25,181 METHODOLOGY FOR USING WHOLE 1067 00:35:25,181 --> 00:35:27,650 GRADE BECAUSE WHEN YOU HAVE 1068 00:35:27,650 --> 00:35:30,386 OVERLAP, OF HISTORIC GRADE 1069 00:35:30,386 --> 00:35:33,356 VERSUS NEW DATA, WE ACTUALLY 1070 00:35:33,356 --> 00:35:35,091 SIGN AGGREGATE SCORE, SO IF YOU 1071 00:35:35,091 --> 00:35:37,427 ARE 1 PLUS 2, WE TAKE EVERY DAY, 1072 00:35:37,427 --> 00:35:38,961 BECAUSE 1 PBT 5 SO THAT ALLOWS 1073 00:35:38,961 --> 00:35:40,496 US TO ACCOUNT FOR OVERLAP, YOU 1074 00:35:40,496 --> 00:35:42,165 KNOW IF YOU ARE RED, BEFORE NOW, 1075 00:35:42,165 --> 00:35:44,200 YOU ARE KIND OF GREEN, WHAT DOES 1076 00:35:44,200 --> 00:35:45,401 THAT REALLY MEAN AND WE'RE ABLE 1077 00:35:45,401 --> 00:35:47,503 TO DO THAT CONFIDENT. 1078 00:35:47,503 --> 00:35:48,838 AND WE USEDDED MODELING AS A 1079 00:35:48,838 --> 00:35:49,939 METHODOLOGY FOR DOING THIS, BUT 1080 00:35:49,939 --> 00:35:53,009 I WANT TO TALK TO YOU ABOUT HOW 1081 00:35:53,009 --> 00:35:55,244 WE GOT TO THE FRAMEWORK, SO WHEN 1082 00:35:55,244 --> 00:36:00,116 WE'RE IN WISCONSIN, I GOT SOME 1083 00:36:00,116 --> 00:36:01,350 FUNDING FROM ADVANCED HELGTD 1084 00:36:01,350 --> 00:36:02,351 CARE WISCONSIN FOUNDATION AND 1085 00:36:02,351 --> 00:36:04,053 THEY GAVE US ALMOST $3 MILLION 1086 00:36:04,053 --> 00:36:07,557 TO LOOK AT DATA IN THE INNER 1087 00:36:07,557 --> 00:36:08,357 CITY OF MILWAUKEE, 10 ZIP CODES 1088 00:36:08,357 --> 00:36:11,627 SO WE DID A DEEP DIVE INTO THE 1089 00:36:11,627 --> 00:36:14,897 ZIP CODES, WE DID 30 FOCUS 1090 00:36:14,897 --> 00:36:16,732 GROUPS, 60 INTERVIEWS, 1091 00:36:16,732 --> 00:36:18,234 INTERVIEWED ABOUT 50 COMMUNITY 1092 00:36:18,234 --> 00:36:21,471 MEMBERS AND LEADERS AND DID A 1093 00:36:21,471 --> 00:36:24,640 BREW OF INDIVIDUALS, VERY DEEP 1094 00:36:24,640 --> 00:36:25,975 STUDY OF CLINICAL RISKS AND 1095 00:36:25,975 --> 00:36:27,677 OUTCOMES ACROSS THE BOARD AND 1096 00:36:27,677 --> 00:36:29,745 WHEN WE GOT DONE, IT WAS A MIXED 1097 00:36:29,745 --> 00:36:30,913 METHOD, WE WERE TRYING TO 1098 00:36:30,913 --> 00:36:31,614 UNDERSTAND WHAT DRIVES THESE 1099 00:36:31,614 --> 00:36:33,082 DIFFERENCES FROM THE COMMUNITY 1100 00:36:33,082 --> 00:36:34,150 PERSPECTIVE, PLUS WHAT WE HAVE 1101 00:36:34,150 --> 00:36:35,418 ACTUALLY FOUND AND THIS IS A 1102 00:36:35,418 --> 00:36:37,053 PAPER WE PUBLISHED ABOUT THE 1103 00:36:37,053 --> 00:36:38,688 CONCEPTUAL FRAMEWORK AND WE 1104 00:36:38,688 --> 00:36:40,323 ACTUAL LYE ARGUED THAT 1105 00:36:40,323 --> 00:36:42,258 STRUCTURAL RACISM EXPRESSED AS 1106 00:36:42,258 --> 00:36:45,294 RED LINING LED TO 1107 00:36:45,294 --> 00:36:47,663 DISCRIMINATION, HIGH 1108 00:36:47,663 --> 00:36:49,198 INCARCERATION RATE, POVERTY, 1109 00:36:49,198 --> 00:36:50,967 RESIDENTIAL SEGREGATION, HOUSING 1110 00:36:50,967 --> 00:36:51,934 INSTABILITY, FOOD INSECURITY, 1111 00:36:51,934 --> 00:36:53,736 LOWER EICATIONAL ACTIVITY 1112 00:36:53,736 --> 00:36:54,837 APPROXIMATE UNEMPLOYMENT AND 1113 00:36:54,837 --> 00:36:56,205 THIS LED TO POOR HEALTH AND THIS 1114 00:36:56,205 --> 00:36:57,974 ABILITY AND WE INTRODUCED THE 1115 00:36:57,974 --> 00:36:59,509 CONCEPT OF HUMAN CAPITAL, 1116 00:36:59,509 --> 00:37:02,011 BECAUSE SICK PEOPLE DO NOT 1117 00:37:02,011 --> 00:37:02,812 CONTRIBUTE TO SOCIETY. 1118 00:37:02,812 --> 00:37:04,747 SO YOU ACTUALLY HAVE A 1119 00:37:04,747 --> 00:37:05,381 [INDISCERNIBLE] WHEN PEOPLE ARE 1120 00:37:05,381 --> 00:37:07,083 SICK AND WHEN PEOPLE ARE NOT 1121 00:37:07,083 --> 00:37:10,520 DOING VERY WELL, SO WE PUBLISHED 1122 00:37:10,520 --> 00:37:12,154 THIS IN 2021 AS A FRAME WOR WORK 1123 00:37:12,154 --> 00:37:13,890 FOR HOW TO ADDRESS THIS SO WE 1124 00:37:13,890 --> 00:37:15,958 USE THAT SAME FRAMEWORK NOW FOR 1125 00:37:15,958 --> 00:37:16,859 THIS PARTICULAR PAPER, I SAID 1126 00:37:16,859 --> 00:37:19,495 WHAT WE DID WAS WE ACTUALLY 1127 00:37:19,495 --> 00:37:21,097 ASKED THE QUESTION, I DON'T 1128 00:37:21,097 --> 00:37:22,465 DIRECT AND INDIRECT REP 1129 00:37:22,465 --> 00:37:24,634 RELATIONSHIPS BETWEEN RED LINES 1130 00:37:24,634 --> 00:37:26,736 AND SOME OF THESE FACTORS. 1131 00:37:26,736 --> 00:37:28,371 AND WHAT YOU CAN SEE IS THAT ALL 1132 00:37:28,371 --> 00:37:33,876 OF THEM, RED LINING WAS HIGH 1133 00:37:33,876 --> 00:37:35,912 ENCORSERATION, HIGH POVERTY, 1134 00:37:35,912 --> 00:37:38,848 HIGH DISCRIMINATION, SUBSTANCE 1135 00:37:38,848 --> 00:37:40,716 USE DISORDER, HOUSING, 1136 00:37:40,716 --> 00:37:41,484 UNEMPLOYMENT, FOOD ACCESS, AND 1137 00:37:41,484 --> 00:37:43,686 THOSE FACTORS LED TO INCREASED 1138 00:37:43,686 --> 00:37:45,922 DIABETES PREVALENCE AND THERE 1139 00:37:45,922 --> 00:37:47,256 WAS A [INDISCERNIBLE] TO RED 1140 00:37:47,256 --> 00:37:48,291 LINING TO DIABETES PREVALENCE. 1141 00:37:48,291 --> 00:37:52,828 SO WHY IS THIS IMPORTANT? 1142 00:37:52,828 --> 00:37:54,730 THIS GIVES US ACTIONABLE 1143 00:37:54,730 --> 00:37:54,964 TARGETS. 1144 00:37:54,964 --> 00:37:58,000 YOU CAN SEE IF YOU WANT TO DO 1145 00:37:58,000 --> 00:37:59,702 SOMETHING HERE YOU CAN FOCUS ON 1146 00:37:59,702 --> 00:38:01,037 THE STRESS OF THE ASSOCIATION, 1147 00:38:01,037 --> 00:38:04,540 AND BASED ON WHAT CAN BE MUTABLE 1148 00:38:04,540 --> 00:38:05,441 AT THE POPULATION LEVEL BECAUSE 1149 00:38:05,441 --> 00:38:06,475 THIS IS NOT INDIVIDUAL LEVEL, 1150 00:38:06,475 --> 00:38:08,344 THIS IS REALLY IF YOU TOOK YOUR 1151 00:38:08,344 --> 00:38:11,647 ZIP CODE WHAT COULD YOU DO WITH 1152 00:38:11,647 --> 00:38:13,616 YOUR ZIP CODE LEVEL. 1153 00:38:13,616 --> 00:38:15,251 SO WHAT ARE WE DOING NOW? 1154 00:38:15,251 --> 00:38:16,886 WE'RE NOW AT A POINT WHERE WE'RE 1155 00:38:16,886 --> 00:38:18,220 ASKING OURSELVES, OKAY, WE HAVE 1156 00:38:18,220 --> 00:38:19,989 SOME OF THIS GENERAL SENSE, BUT 1157 00:38:19,989 --> 00:38:23,526 WHAT WE REALLY DO AND WHAT IS 1158 00:38:23,526 --> 00:38:25,962 THE NEXT--SO WE HAVE 2 RO-1S 1159 00:38:25,962 --> 00:38:27,563 RIGHT NOW, THE MULTIPLE PI 1160 00:38:27,563 --> 00:38:28,664 WHICHON OF MY MENTEES AND THE 1161 00:38:28,664 --> 00:38:33,469 FIRST 1 IS LOOKING AT STRUCTURAL 1162 00:38:33,469 --> 00:38:35,805 RACISM AND DISPARITIES IN SOCIAL 1163 00:38:35,805 --> 00:38:37,306 RISK, HUMAN CAPITAL, HEGHT CARE 1164 00:38:37,306 --> 00:38:39,108 RESOURCES AND OUTCOMES, I WILL 1165 00:38:39,108 --> 00:38:40,643 CALL IT MULTILEVEL ANALYSIS OF 1166 00:38:40,643 --> 00:38:41,844 PATHWAYS AND POLICY LEVELS, 1167 00:38:41,844 --> 00:38:44,280 WE'RE PARTICULAR ABOUT NOT JUST 1168 00:38:44,280 --> 00:38:44,847 SHOWING RELATIONSHIPS, WE'RE 1169 00:38:44,847 --> 00:38:46,382 ASKING OURSELVES THE QUESTION, 1170 00:38:46,382 --> 00:38:50,753 SO THIS IS THE 5 YEAR RO-1 1171 00:38:50,753 --> 00:38:52,555 FUNDED BY NIMHD, TO LOOK AT 1172 00:38:52,555 --> 00:38:53,356 USING NATIONAL DATA, AND 1173 00:38:53,356 --> 00:38:57,326 TRACKING ALL OF THIS MEASURES, 1174 00:38:57,326 --> 00:38:58,761 AND LOOK AT THE RELATIONSHIP, 1175 00:38:58,761 --> 00:39:00,096 SOME OF WHICH WE ALREADY KNOW 1176 00:39:00,096 --> 00:39:01,964 AND SOME IS LOOK AT DIRECT AND 1177 00:39:01,964 --> 00:39:03,032 INDIRECT EFFECTS AND THEN THE 1178 00:39:03,032 --> 00:39:04,467 THIRD IS TO LOOK AT POLICIES, 1179 00:39:04,467 --> 00:39:07,937 WHAT ARE THE POLICIES THAT ARE 1180 00:39:07,937 --> 00:39:09,805 ACTUALLY ABLE, AT THE FEDERAL, 1181 00:39:09,805 --> 00:39:10,606 STATE AND REGIONAL GOVERNMENTS 1182 00:39:10,606 --> 00:39:12,975 THAT CAN BE USED TO REDUCE 1183 00:39:12,975 --> 00:39:15,044 VULNERABLES AND FINALLY TO 1184 00:39:15,044 --> 00:39:16,212 ENGAGE STAKEHOLDERS, I WANT TO 1185 00:39:16,212 --> 00:39:17,780 BE ABLE TO GET PEOPLE TO 1186 00:39:17,780 --> 00:39:18,881 PRIORITIZE THIS ON THE DATA AND 1187 00:39:18,881 --> 00:39:21,350 SAY WHAT ARE THE TOP 3-5 1188 00:39:21,350 --> 00:39:22,685 INTERVENTIONS THAT REALLY MAKE A 1189 00:39:22,685 --> 00:39:25,721 DIFFERENCE FROM THE RIGHT KEY 1190 00:39:25,721 --> 00:39:28,424 STAKEHOLDER SO WE CAN HAVE A 1191 00:39:28,424 --> 00:39:29,325 BLUEPRINT FOR PEOPLE GOING 1192 00:39:29,325 --> 00:39:29,558 FORWARD. 1193 00:39:29,558 --> 00:39:30,760 SO THIS STUDY IS ONGOING, WE'RE 1194 00:39:30,760 --> 00:39:32,361 IN THE SECOND YEAR OF THIS. 1195 00:39:32,361 --> 00:39:35,765 WE'RE ECTOMYOSIN KLF-TWOING DATA 1196 00:39:35,765 --> 00:39:37,199 NOW. 1197 00:39:37,199 --> 00:39:39,268 THE DATA IS HUMONGOUS AND AND 1198 00:39:39,268 --> 00:39:40,636 WE'RE TRYING TO PUT IT TOGETHER. 1199 00:39:40,636 --> 00:39:43,939 BUT THE SECOND IS A GRANT, A 1200 00:39:43,939 --> 00:39:45,007 GRANT WITH INDIVIDUALS, WHERE 1201 00:39:45,007 --> 00:39:47,043 WE'RE LOOKING AT STRUCTURAL 1202 00:39:47,043 --> 00:39:48,511 RACISM AND CLINICAL CLOSURES AND 1203 00:39:48,511 --> 00:39:50,246 COMMUNITY ACCESS AND HEALTH 1204 00:39:50,246 --> 00:39:52,281 OUTCOMES, AGAIN THIS IS A VERY 1205 00:39:52,281 --> 00:39:53,582 DIFFERENT PERSPECTIVE AND SAYING 1206 00:39:53,582 --> 00:39:54,884 WE'RE LOOKINGA THE THESE FACTORS 1207 00:39:54,884 --> 00:40:00,356 CAN AND HOW IF YOU LOOK AT MOST 1208 00:40:00,356 --> 00:40:02,024 VIERPTS YOU HAVE ABSENCE OF 1209 00:40:02,024 --> 00:40:03,059 HEALTHCARE AND THE PANDEMIC MADE 1210 00:40:03,059 --> 00:40:05,361 IT WORSE SO OUR GOAL IS TO LOOK 1211 00:40:05,361 --> 00:40:07,663 AT THE STRUCTURAL RACISM AND 1212 00:40:07,663 --> 00:40:09,165 PROPENSITY FOR HOSPITAL CLINIC 1213 00:40:09,165 --> 00:40:10,966 CLOSURES, SO ARE WE DISINVESTING 1214 00:40:10,966 --> 00:40:13,602 IN COMMUNITIES THAT ACTUALLY 1215 00:40:13,602 --> 00:40:17,573 HAVE YOU KNOW THAT ARE FORMALLY 1216 00:40:17,573 --> 00:40:23,079 RED LINE AND WHAT DOES THAT DO 1217 00:40:23,079 --> 00:40:25,081 WHEN ENVIRONMENT, MOST OF THOSE 1218 00:40:25,081 --> 00:40:27,850 ARE THE HIGHEST IN THE RARE, YOU 1219 00:40:27,850 --> 00:40:30,720 TAKE ARK WAY YOB CORPSS, FROM 1220 00:40:30,720 --> 00:40:32,421 OPPORTUNITIES SO ALL OF THIS 1221 00:40:32,421 --> 00:40:34,256 CREATES A CASCADING EFFECT IN 1222 00:40:34,256 --> 00:40:34,757 E-PRESCRIBING ITS OF 1223 00:40:34,757 --> 00:40:36,258 NEIGHBORHOOD AND WE WANT TO LOOK 1224 00:40:36,258 --> 00:40:38,327 AT THE ABILITY OF THE RISK OF 1225 00:40:38,327 --> 00:40:39,495 CLOSURE SO CAN WE ANTICIPATE 1226 00:40:39,495 --> 00:40:41,597 HOSPITALS THAT ARE ABOUT TO 1227 00:40:41,597 --> 00:40:43,466 CLOSE CLINIC, CLOSE THAT 1228 00:40:43,466 --> 00:40:44,900 ENVIRONMENTS AND MITIGATE THOSE 1229 00:40:44,900 --> 00:40:49,538 CLOSURES BEFORE THEY ACTUALLY 1230 00:40:49,538 --> 00:40:49,839 HAPPEN. 1231 00:40:49,839 --> 00:40:51,507 AND FEIGNALLY AGAINST THE 1232 00:40:51,507 --> 00:40:54,510 ENIMAIJMENT, WE CAN USE, YOU 1233 00:40:54,510 --> 00:40:56,545 KNOW POLICIES IDENTIFIED TO 1234 00:40:56,545 --> 00:40:57,646 IDENTIFY STRATEGIES TO REALLY 1235 00:40:57,646 --> 00:40:59,081 HELP US ADDRESS FUTURE IMPACT 1236 00:40:59,081 --> 00:41:05,755 AND FOR MOST OF MY RESEARCH, AND 1237 00:41:05,755 --> 00:41:07,923 WE CAN'T DO SOMETHING ABOUT, IT 1238 00:41:07,923 --> 00:41:11,961 NOT ENOUGH TO TELL SOMEONE YOUR 1239 00:41:11,961 --> 00:41:13,429 PROBLEM, YOU NEED TO GIVE 1240 00:41:13,429 --> 00:41:16,932 SOLUTIONS GOING FORWARD. 1241 00:41:16,932 --> 00:41:18,467 SO IN CONCLUSION I THINK I AM 1242 00:41:18,467 --> 00:41:20,236 DOING WELL IN TERMS OF TIME. 1243 00:41:20,236 --> 00:41:21,570 SO IN CONCLUSION, SOCIAL 1244 00:41:21,570 --> 00:41:22,872 DETERMINANTS OF HEALTH ARE KEY 1245 00:41:22,872 --> 00:41:24,240 DRIVERS OF POOR DIABETES 1246 00:41:24,240 --> 00:41:26,075 OUTCOMES, THIS IS PRETTY MUCH 1247 00:41:26,075 --> 00:41:31,680 CONCLUSIVE THAT WE KNOW AND IT'S 1248 00:41:31,680 --> 00:41:33,749 BEEN WELL DOCUMENTED AND IT'S A 1249 00:41:33,749 --> 00:41:35,017 STRONG DRIVER OF POOR DIABETES 1250 00:41:35,017 --> 00:41:35,451 OUTCOMES. 1251 00:41:35,451 --> 00:41:36,952 I THINK THIS IS THE PART THAT 1252 00:41:36,952 --> 00:41:38,287 SOMETIME SYSTEM MISSING WHERE 1253 00:41:38,287 --> 00:41:39,522 SOCIAL DETERMINE NABTS AND WE 1254 00:41:39,522 --> 00:41:40,589 DON'T PAY ATTENTION TO THE 1255 00:41:40,589 --> 00:41:41,557 UPSTREAM FACTORS AND WE ARE 1256 00:41:41,557 --> 00:41:44,727 TRYING TO MAKE PEOPLE AWARE THAT 1257 00:41:44,727 --> 00:41:47,062 THE UPSTREAM FACTORS AND THAT 1258 00:41:47,062 --> 00:41:49,064 RED LINING HAS A DREK AND 1259 00:41:49,064 --> 00:41:49,965 INDIRECT RELATIONSHIP WITH 1260 00:41:49,965 --> 00:41:51,767 DIABETES PREVALENCE AND THE KEY 1261 00:41:51,767 --> 00:41:53,302 OF THIS FOR RESEARCH SHOULD BE 1262 00:41:53,302 --> 00:41:57,106 TO IDENTIFY DIRECT AND INDIRECT 1263 00:41:57,106 --> 00:41:58,007 PATHWAYS AND IDENTIFY 1264 00:41:58,007 --> 00:42:00,142 INTERVENTIONS, WHAT CAN BE DONE 1265 00:42:00,142 --> 00:42:01,410 AND WE BELIEVE TAKEN--THEY 1266 00:42:01,410 --> 00:42:04,146 POLICY INTERVENTIONS ARE NEEDED 1267 00:42:04,146 --> 00:42:06,682 TO ADDRESS UPSTREAM STRUCTURAL 1268 00:42:06,682 --> 00:42:08,050 RACISM TO IMPROVE DIABETES 1269 00:42:08,050 --> 00:42:10,753 OUTCOMES. 1270 00:42:10,753 --> 00:42:13,556 THANK YOU. 1271 00:42:13,556 --> 00:42:14,723 [ APPLAUSE ] 1272 00:42:14,723 --> 00:42:15,090 >> THANK YOU. 1273 00:42:15,090 --> 00:42:18,294 WE HAVE 2 MICROPHONES IN THE 1274 00:42:18,294 --> 00:42:19,728 AISLES, SO I WOULD ENCOURAGE 1275 00:42:19,728 --> 00:42:21,063 MEMBERS OF THE AUDIENCE TO STEP 1276 00:42:21,063 --> 00:42:22,731 UP TO A MICROPHONE IF YOU HAVE A 1277 00:42:22,731 --> 00:42:22,998 QUESTION. 1278 00:42:22,998 --> 00:42:24,166 BE HAPPY TO LET YOU ASK YOUR 1279 00:42:24,166 --> 00:42:26,602 QUESTION AND GET AN ANSWER. 1280 00:42:26,602 --> 00:42:27,770 SO PLEASE. 1281 00:42:27,770 --> 00:42:29,805 >> HELLO, MY NAME'S REBECCA 1282 00:42:29,805 --> 00:42:32,374 [INDISCERNIBLE] I'M AT NIAID. 1283 00:42:32,374 --> 00:42:34,376 THANK YOU SO MUCH FOR WILL 1284 00:42:34,376 --> 00:42:35,878 EXCELLENT TALKOT OVERRUE OF THE 1285 00:42:35,878 --> 00:42:38,714 HISTORY OF CURRENT EFFECT OF 1286 00:42:38,714 --> 00:42:39,682 STRUCTURAL RACISM. 1287 00:42:39,682 --> 00:42:43,185 IN TERMS OF INTERVENTIONS, YOU 1288 00:42:43,185 --> 00:42:45,187 MENTIONED THAT AN INTERVENTION 1289 00:42:45,187 --> 00:42:46,956 COULD BE STAKEHOLDERS TRYING TO 1290 00:42:46,956 --> 00:42:47,990 PREVENTION THE CLOSURE OF 1291 00:42:47,990 --> 00:42:50,526 COMMUNITY HOSPITALS AND AREAS, I 1292 00:42:50,526 --> 00:42:51,827 AM CURIOUS WHETHER YOU'VE HAD 1293 00:42:51,827 --> 00:42:53,596 SUCCESS WITH THAT, OR KNOW OF 1294 00:42:53,596 --> 00:42:54,763 SUCCESS WITH THAT, EITHER IN 1295 00:42:54,763 --> 00:42:56,665 WHERE YOU WERE BEFORE, I THINK 1296 00:42:56,665 --> 00:42:58,934 YOU SAID SOUTH CAROLINA OR WE'RE 1297 00:42:58,934 --> 00:43:02,938 IN WISCONSIN, AND I HAD A SECOND 1298 00:43:02,938 --> 00:43:03,706 QUESTION. 1299 00:43:03,706 --> 00:43:04,840 >> OKAY, SO, THE STRATEGIES NOW 1300 00:43:04,840 --> 00:43:06,442 WE ACTUALLY HAD A SIMILAR 1301 00:43:06,442 --> 00:43:07,843 SITUATION THAT JUST HAPPEN 1302 00:43:07,843 --> 00:43:09,044 INDEED WISCONSIN WHERE 1 OF THE 1303 00:43:09,044 --> 00:43:10,312 INNER CITY HOSPITALS WAS ABOUT 1304 00:43:10,312 --> 00:43:13,282 TO BE CLOSED AND FROM A BUSINESS 1305 00:43:13,282 --> 00:43:14,950 STAND POINT IT MADE SENSE FOR 1306 00:43:14,950 --> 00:43:16,919 THE HEALTH SYSTEM, THAT 1307 00:43:16,919 --> 00:43:17,753 PARTICULAR HEALTH SYSTEM TO 1308 00:43:17,753 --> 00:43:18,821 CLOSE DOWN BUT THE COMMUNITY 1309 00:43:18,821 --> 00:43:20,723 ROSE UP AND SAID THIS IS ABOUT 1310 00:43:20,723 --> 00:43:21,924 THE ONLY HOSPITAL WE HAVE, IF 1311 00:43:21,924 --> 00:43:23,492 YOU CLOSE IT DOWN, PEOPLE WILL 1312 00:43:23,492 --> 00:43:26,595 NOT HAVE ACCESS BECAUSE OF 1313 00:43:26,595 --> 00:43:27,630 COMMUNITY ACTIVISM, THE HOSPITAL 1314 00:43:27,630 --> 00:43:28,931 IS STILL OPEN SO PEOPLE CAME 1315 00:43:28,931 --> 00:43:31,333 TOGETHER AND IT BECAME VERY 1316 00:43:31,333 --> 00:43:34,203 CLEAR THAT BECAUSE SOMETIMES, WE 1317 00:43:34,203 --> 00:43:36,939 MAKING THESE DECISIONS, PEOPLE 1318 00:43:36,939 --> 00:43:38,540 ARE NOT MAKING DECISIONS BASED 1319 00:43:38,540 --> 00:43:40,276 ON WHAT IS THE IMPACT TO THE 1320 00:43:40,276 --> 00:43:42,044 COMMUNITY AND THIS GROUP GOT 1321 00:43:42,044 --> 00:43:44,213 TOGETHER AND PROVIDED EVIDENT 1322 00:43:44,213 --> 00:43:45,414 ISSUES THE COMPROMISE WAS WE 1323 00:43:45,414 --> 00:43:46,615 WILL MOVE PROGRAMS THAT ARE NOT 1324 00:43:46,615 --> 00:43:47,917 VIABLE AND WE WILL KEEP OTHERS 1325 00:43:47,917 --> 00:43:50,619 AND THAT ALLOWED THEM TO KEEP 1326 00:43:50,619 --> 00:43:51,954 THAT HOSPITAL OPEN. 1327 00:43:51,954 --> 00:43:52,354 NTHAT WAS GREAT. 1328 00:43:52,354 --> 00:43:55,991 THAT WAS IN WISCONSIN IN. 1329 00:43:55,991 --> 00:43:56,392 >> YES. 1330 00:43:56,392 --> 00:43:57,559 >> OKAY, SECOND QUESTION RELATES 1331 00:43:57,559 --> 00:43:59,261 TO FOOD DESERT ANDS YOUR FIRST 1332 00:43:59,261 --> 00:44:01,997 STUDY, WE WERE LOOKING AT 1333 00:44:01,997 --> 00:44:02,831 INTERVENTIONS RELATED TO SENDING 1334 00:44:02,831 --> 00:44:04,433 BOXES OF FOOD OR GIVING 1335 00:44:04,433 --> 00:44:07,036 VOUCHERS, I KNOW IN THE SOCIAL 1336 00:44:07,036 --> 00:44:08,904 EPILITERATURE THERE'S A LOT OF 1337 00:44:08,904 --> 00:44:10,739 DISCUSSION OF A FOOD DESSERS, 1338 00:44:10,739 --> 00:44:13,943 I'M CURIOUS IN THOSE 1339 00:44:13,943 --> 00:44:16,145 NEIGHBORHOODS ARE THEY FOOD--ARE 1340 00:44:16,145 --> 00:44:17,413 YOU SENDING BOXES OF FOOD 1341 00:44:17,413 --> 00:44:18,881 BECAUSE OF SENIOR CITIZEN CAN'T 1342 00:44:18,881 --> 00:44:22,184 GET OUT TO THE GROCERY STORE, 1343 00:44:22,184 --> 00:44:24,620 WHATEVER OR ARE THEY IN FOOD 1344 00:44:24,620 --> 00:44:26,288 DESERTS OR IS IT A LITTLE BIT OF 1345 00:44:26,288 --> 00:44:27,656 BOTH NIT'S A LITTLE BIT OF BOTH. 1346 00:44:27,656 --> 00:44:29,258 SO HAVE YOU THE SITUATION WHERE 1347 00:44:29,258 --> 00:44:30,626 SOME NEIGHBOR HOODS IT WOULD 1348 00:44:30,626 --> 00:44:32,294 TAKE YOU A BUS ROUTE ALMOST 2 1349 00:44:32,294 --> 00:44:34,897 HOURS TO GET TO THE NEAREST 1350 00:44:34,897 --> 00:44:36,832 GROCERY STORE, AND THEN IN OTHER 1351 00:44:36,832 --> 00:44:37,933 AREAS, THESE ARE OTHER 1352 00:44:37,933 --> 00:44:39,468 INDIVIDUALS AS WELL, THEY DON'T 1353 00:44:39,468 --> 00:44:40,636 FEEL SAFE GOING AROUND AND THEN 1354 00:44:40,636 --> 00:44:42,071 MANY OF THEM ACTUALLY DO NOT 1355 00:44:42,071 --> 00:44:43,572 HAVE TRANSPORTATION SO GETTING 1356 00:44:43,572 --> 00:44:46,108 ARK ROUND BECOMES CHALLENGING TO 1357 00:44:46,108 --> 00:44:47,176 DO THAT BUT WHAT'S ALSO 1358 00:44:47,176 --> 00:44:48,377 IMPORTANT IS THAT IF YOU LOOK AT 1359 00:44:48,377 --> 00:44:50,579 MOST OF THESE NEIGHBORHOODS, 1360 00:44:50,579 --> 00:44:52,247 RIGHT, YOU HAVE CORNER STORES, 1361 00:44:52,247 --> 00:44:54,817 WHERE THE FOOD IS NOT FRESH, 1362 00:44:54,817 --> 00:44:56,385 IT'S REALLY NOT, SO THEY REALLY 1363 00:44:56,385 --> 00:44:58,053 DON'T, YOU MAY HAVE MANAGE IN 1364 00:44:58,053 --> 00:45:01,790 YOUR NAIB HERE HOOD, BUT MOSTLY 1365 00:45:01,790 --> 00:45:02,591 SHOPPING AND SO COMMUNITY 1366 00:45:02,591 --> 00:45:04,026 MEMBERS ARE SAYING IS THIS IS 1367 00:45:04,026 --> 00:45:06,762 FOCUS ON THE HEALTHY AND WE 1368 00:45:06,762 --> 00:45:07,997 ACTUALLY--THE MORE WE EDUCATE 1369 00:45:07,997 --> 00:45:09,164 IT, THE MORE WE REALIZE THIS IS 1370 00:45:09,164 --> 00:45:11,300 NO GOOD FOR US, SO HOW DO WE GET 1371 00:45:11,300 --> 00:45:13,602 TO HEALTHY FOOD OR HOW DO WE GET 1372 00:45:13,602 --> 00:45:14,903 ACCESS TO THOSE HEALTHY OPTIONS 1373 00:45:14,903 --> 00:45:15,304 NGREAT. 1374 00:45:15,304 --> 00:45:18,107 I WISH YOU SUCCESS IN THESE 1375 00:45:18,107 --> 00:45:21,377 STUDIES AND INTERVENTIONS. 1376 00:45:21,377 --> 00:45:27,883 >> THANK YOU. 1377 00:45:27,883 --> 00:45:30,285 >> HI, ROLAND'S OFFICE OF 1378 00:45:30,285 --> 00:45:31,520 INTRAMURAL RESEARCH. 1379 00:45:31,520 --> 00:45:35,057 SO BOTH LOW SOCIOECONOMIC STATUS 1380 00:45:35,057 --> 00:45:37,359 OR NUMERACY WERE ASSOCIATE WIDE 1381 00:45:37,359 --> 00:45:40,496 POOR GLYCEMIC CONTROL, HAVE YOU 1382 00:45:40,496 --> 00:45:43,098 LOOKED AT FINANCIAL LITERACY AS 1383 00:45:43,098 --> 00:45:44,400 AN EDUCATION TO INTERVENTION? 1384 00:45:44,400 --> 00:45:45,901 >> YOU ARE RIGHT ON TARGET. 1385 00:45:45,901 --> 00:45:47,569 SO 1 OF THE THINGS WE DO AFTER 1386 00:45:47,569 --> 00:45:49,838 EVERY STUDY WE DO, WE DO FOCUS 1387 00:45:49,838 --> 00:45:51,306 GROUPS AT THE END OF THE STUDY 1388 00:45:51,306 --> 00:45:53,809 REALLY TO UNDERSTAND WHAT WORK 1389 00:45:53,809 --> 00:45:57,112 OR DIDN'T WORK AND WHAT COULD WE 1390 00:45:57,112 --> 00:45:58,447 LEARN FROM IT BEYOND THE 1391 00:45:58,447 --> 00:45:59,548 COMPONENT AND 1 THING IS COMING 1392 00:45:59,548 --> 00:46:02,584 UP NOW IS THE DESIRE TO HAVE A 1393 00:46:02,584 --> 00:46:03,185 LITERACY EDUCATION EMPLOY NOW 1394 00:46:03,185 --> 00:46:05,587 WHAT WE ARE REALIZING IS, WHEN 1395 00:46:05,587 --> 00:46:10,125 YOU CALL IT FINANCIAL LITERACY, 1396 00:46:10,125 --> 00:46:12,895 COMMUNITY MEMBERS THINK YOU'RE 1397 00:46:12,895 --> 00:46:14,263 TRYING TO MANAGE THEIR FINANCES 1398 00:46:14,263 --> 00:46:15,831 SO YOU HAVE TO CREATE A 1399 00:46:15,831 --> 00:46:17,833 TERMINOLOGY THAT ALLOWS THEM TO 1400 00:46:17,833 --> 00:46:18,667 FEEL COMFORTABLE, WITH MANY OF 1401 00:46:18,667 --> 00:46:20,402 THEM ASKING AND SOME OF OUR 1402 00:46:20,402 --> 00:46:21,970 FOCUS GROUPS A WOMAN SAID NO 1 1403 00:46:21,970 --> 00:46:23,672 TOLL ME ABOUT CREDIT. 1404 00:46:23,672 --> 00:46:24,306 YOU KNOW? 1405 00:46:24,306 --> 00:46:26,875 THEY KEEP OFFERING YOU THESE 1406 00:46:26,875 --> 00:46:29,978 CREDIT CARDS AND THEN YOU SEE 1407 00:46:29,978 --> 00:46:32,247 YOUR CREDIT SCORES GO DOWN, SO 1408 00:46:32,247 --> 00:46:34,583 WHY OFFER THEM IF IT'S GOING TO 1409 00:46:34,583 --> 00:46:35,084 DING YOUR CREDIT. 1410 00:46:35,084 --> 00:46:37,319 SO GOING THROUGH THE EXPLANATION 1411 00:46:37,319 --> 00:46:38,587 OF UNDERSTANDING, WHAT DOES IT 1412 00:46:38,587 --> 00:46:41,957 EVEN MEAN TO HAVE, WHAT IS 1413 00:46:41,957 --> 00:46:45,060 CREDIT, WHAT DO CREDIT CARDS DO, 1414 00:46:45,060 --> 00:46:46,628 THEN ISSUES AROUND THIS AS 1415 00:46:46,628 --> 00:46:48,197 SIMPLE AS BUDGETING IN HOW MUCH 1416 00:46:48,197 --> 00:46:49,832 DO YOU ACTUALLY SPEND, SO 1417 00:46:49,832 --> 00:46:52,034 PARTICIPANTS SAID, I DIDN'T 1418 00:46:52,034 --> 00:46:55,070 REALIZE YOU KNOW HOW MUCH THESE 1419 00:46:55,070 --> 00:46:57,339 THINGS ACTUALLY COST UNTIL I 1420 00:46:57,339 --> 00:46:58,273 REALLY GOT HERE BECAUSE THE 1421 00:46:58,273 --> 00:46:59,575 QUESTION WE WERE CATEGORY WAS, 1422 00:46:59,575 --> 00:47:02,578 SO HOW DO YOU KNOW AND WHO 1423 00:47:02,578 --> 00:47:04,413 EDUCATES YOU, AND THAT'S PART OF 1424 00:47:04,413 --> 00:47:06,181 WHAT WE NEED TO ACTUALLY BEGIN 1425 00:47:06,181 --> 00:47:08,851 TO DOE, SO IT'S REALLY VERY 1426 00:47:08,851 --> 00:47:09,952 CUSTOMIZED SO PEOPLE IT WOULD 1427 00:47:09,952 --> 00:47:12,054 VARY, WE WILL HAVE TO CREATE 1428 00:47:12,054 --> 00:47:13,255 MENUS SO PEOPLE CAN PICK AND 1429 00:47:13,255 --> 00:47:15,190 CHOOSE WHAT THEY NEED TO KNOW IN 1430 00:47:15,190 --> 00:47:20,796 TERMS OF FINANCIAL LITERACY. 1431 00:47:20,796 --> 00:47:21,363 >> THANK YOU. 1432 00:47:21,363 --> 00:47:25,100 NOTHER QUESTIONS IN THE ROOM? 1433 00:47:25,100 --> 00:47:26,568 NJANE [INDISCERNIBLE] DIRECTOR 1434 00:47:26,568 --> 00:47:28,770 OF OBSSR HERE AT NIH. 1435 00:47:28,770 --> 00:47:31,473 GREAT TALK, I LOVE LOOKING AT 1436 00:47:31,473 --> 00:47:33,208 WIDER BROADER STRUCTURAL FACTORS 1437 00:47:33,208 --> 00:47:34,309 AS THE CLINICAL PSYCHEICOLOGYIST 1438 00:47:34,309 --> 00:47:35,744 TO LOOK AT THE INDIVIDUAL 1439 00:47:35,744 --> 00:47:37,346 FACTORS BUT IT'S HARDER WHEN YOU 1440 00:47:37,346 --> 00:47:39,515 LOOK AT THESE BIGGER PROBLEMS TO 1441 00:47:39,515 --> 00:47:41,316 ADDRESS, AND YOU SAID, I THINK 1442 00:47:41,316 --> 00:47:43,352 CORRECTLY THAT THE NEXT STEP IS 1443 00:47:43,352 --> 00:47:45,087 KIND OF POLICY CHANGES TO LOOK 1444 00:47:45,087 --> 00:47:46,989 AT THESE THINGS, THERE'S NO 1445 00:47:46,989 --> 00:47:47,723 INDIVIDUAL COUNSELING, AND TALK 1446 00:47:47,723 --> 00:47:50,058 TO A PERSON AND SOLVE RACISM, 1447 00:47:50,058 --> 00:47:52,027 ANY WHYEDS FROM ALL THIS GREAT 1448 00:47:52,027 --> 00:47:53,862 WORK YOU'VE DONE SO FAR ON WHERE 1449 00:47:53,862 --> 00:47:55,531 THESE POLICY CHANGES MIGHT BE 1450 00:47:55,531 --> 00:47:56,298 THE MOST EFFECTIVE? 1451 00:47:56,298 --> 00:47:58,300 >> YES, SO WE HAVE ACTUALLY 1452 00:47:58,300 --> 00:48:01,570 PLAYED AROUND WITH USING DATA, 1453 00:48:01,570 --> 00:48:03,539 RIGHT, TO DO--SO IN 1 OF MY 1454 00:48:03,539 --> 00:48:06,141 MENTEES IS OUR COLLABORATOR NOW 1455 00:48:06,141 --> 00:48:07,509 IS THE HEALTHY [INDISCERNIBLE] 1456 00:48:07,509 --> 00:48:09,344 WHO IS VERY WELL TRAINED IN 1457 00:48:09,344 --> 00:48:10,279 THIS, DIFFERENCE IN DIFFERENCE 1458 00:48:10,279 --> 00:48:11,713 WHEN YOU LOOK AT POLICY 1459 00:48:11,713 --> 00:48:13,782 INTERVENTION AND YOU CHOOSE 1460 00:48:13,782 --> 00:48:17,486 CONTROLS, SO 1 EXAMPLE IS 1461 00:48:17,486 --> 00:48:20,255 MEDICAID ADOPG SO IF YOU THINK 1462 00:48:20,255 --> 00:48:21,256 ABOUT THE LOW HANGING FRUIT. 1463 00:48:21,256 --> 00:48:22,958 WE KNOW THAT ACCESS IS A BIG 1464 00:48:22,958 --> 00:48:25,961 DRIVER, IT DOESN'T MATTER WHAT 1465 00:48:25,961 --> 00:48:27,062 [INDISCERNIBLE] ON THE SPECTRUM 1466 00:48:27,062 --> 00:48:28,530 YOU ARE, RIGHT OR LEFT, IT 1467 00:48:28,530 --> 00:48:29,464 DOESN'T REALLY MATTER, PEOPLE 1468 00:48:29,464 --> 00:48:32,401 ARE PEOPLE, THEY NEED ACCESS TO 1469 00:48:32,401 --> 00:48:34,736 HEALTHCARE, HOW WE GET IT IS A 1470 00:48:34,736 --> 00:48:36,038 POLITICAL DEBATE BUT THE KEY 1471 00:48:36,038 --> 00:48:38,440 ISSUES WE KNOW ARE ACCESS 1472 00:48:38,440 --> 00:48:38,840 IMPROVES OUTCOMES. 1473 00:48:38,840 --> 00:48:41,777 SO WE ACTUALLY TESTED, SO 1 OF 1474 00:48:41,777 --> 00:48:48,016 THE GREATEST DRIVERS OF 1475 00:48:48,016 --> 00:48:49,418 BANKRUPTY IS HEALTHCARE, SO IF 1476 00:48:49,418 --> 00:48:50,319 YOU DON'T HAVE INSURANCE, MANY 1477 00:48:50,319 --> 00:48:52,321 OF YOU MAY NOT KNOW THIS, WHEN 1478 00:48:52,321 --> 00:48:53,956 YOU HAVE INSURANCE, THERE'S 1479 00:48:53,956 --> 00:48:55,123 WHAT'S CALLED THE PRENEGOTIATED 1480 00:48:55,123 --> 00:48:55,324 RATE. 1481 00:48:55,324 --> 00:48:56,792 SO IF YOU GO TO THE HOSPITAL FOR 1482 00:48:56,792 --> 00:48:59,728 2 DAYS, 3 DAYS AND CHAI CHARGE 1483 00:48:59,728 --> 00:49:01,463 YOU 50,000, YOUR INSURANCE 1484 00:49:01,463 --> 00:49:03,532 NEGOTIATES THAT RATE DOWN AND 1485 00:49:03,532 --> 00:49:06,501 MAYBE YOU PAY 20,000, OF THAT 1486 00:49:06,501 --> 00:49:08,537 20,000 YOUR COPAYMENT MAY HAVE 1487 00:49:08,537 --> 00:49:10,205 500, WHEN YOU DON'T HAVE 1488 00:49:10,205 --> 00:49:12,441 INSURANCE YOU PAY THE FULL 1489 00:49:12,441 --> 00:49:14,810 PRICE, SO THEY CHARGE YOU 50,000 1490 00:49:14,810 --> 00:49:17,279 AND HAY CHARGE IT YOU. 1491 00:49:17,279 --> 00:49:17,846 YOU CAN'T PRENEGOTIATE. 1492 00:49:17,846 --> 00:49:19,915 SO THOSE ARE HIT WITH A BILL FOR 1493 00:49:19,915 --> 00:49:20,782 50,000, IT'S PROBABLY BECAUSE 1494 00:49:20,782 --> 00:49:23,285 YOU DON'T HAVE THE RESOURCES TO 1495 00:49:23,285 --> 00:49:24,386 HAVE THAT SO THOSE INDIVIDUALS 1496 00:49:24,386 --> 00:49:27,522 ARE HIT AND WE'VE SHOWN THAT 1497 00:49:27,522 --> 00:49:28,690 THOSE CATASTROPHIC EXPENDITURES 1498 00:49:28,690 --> 00:49:29,858 ARE HIGHER IN MINORITY 1499 00:49:29,858 --> 00:49:31,126 COMMUNITIES AND INSURANCE OF 1 1500 00:49:31,126 --> 00:49:34,096 OF THOSE RATES, AND WE'VE ALSO 1501 00:49:34,096 --> 00:49:34,763 SHOWN THAT MEDICAID ADOPTION IF 1502 00:49:34,763 --> 00:49:39,701 YOU LOOK AT COMMUNITIES ARE 1503 00:49:39,701 --> 00:49:41,370 MEDICAID EVIKS RATES, AND 1504 00:49:41,370 --> 00:49:42,437 JUDGMENTS ARE LOWER AND WHAT DID 1505 00:49:42,437 --> 00:49:43,839 THAT MEAN, PEOPLE ARE 1506 00:49:43,839 --> 00:49:44,906 PRIORITIZING WHAT TO SPEND MONEY 1507 00:49:44,906 --> 00:49:45,307 ON. 1508 00:49:45,307 --> 00:49:49,845 SO IF I HAVE A CHOICE, BECAUSE 1509 00:49:49,845 --> 00:49:51,046 HEALTHCARE YOU CAN'T CHOOSE, IF 1510 00:49:51,046 --> 00:49:51,947 YOU'RE SICK, YOU ARE SICK. 1511 00:49:51,947 --> 00:49:53,615 SO PEOPLE ARE USING THEIR 1512 00:49:53,615 --> 00:49:56,852 RESOURCES TO PAY FOR HEALTHCARE 1513 00:49:56,852 --> 00:49:58,086 AND AS A RESULT YOU CAN'T PAY 1514 00:49:58,086 --> 00:49:58,453 FOR HOUSING. 1515 00:49:58,453 --> 00:50:00,355 SO IF YOU HAVE TO CREATE ACCESS 1516 00:50:00,355 --> 00:50:02,257 TO HEGHT CARE, YOU DECREASE 1517 00:50:02,257 --> 00:50:03,692 THOSE, WE DEMON TRAITED THIS IN 1518 00:50:03,692 --> 00:50:03,925 STUDIES. 1519 00:50:03,925 --> 00:50:05,260 SO THESE ARE EXAMPLES OF THINGS 1520 00:50:05,260 --> 00:50:06,628 THAT ACTUALLY MAKE SENSE IN 1521 00:50:06,628 --> 00:50:10,032 TERPS OF VERY LOGICAL 1522 00:50:10,032 --> 00:50:12,334 [INDISCERNIBLE] WITH THESE 1523 00:50:12,334 --> 00:50:12,567 ISSUES. 1524 00:50:12,567 --> 00:50:14,036 >> ONE OF THE DIFFICULTIES OF 1525 00:50:14,036 --> 00:50:16,405 COURSE IS THAT'S A VERY RATIONAL 1526 00:50:16,405 --> 00:50:18,507 ARGUMENT AND THE WORLD ISN'T 1527 00:50:18,507 --> 00:50:20,142 ALWAYS VERY RATIONAL. 1528 00:50:20,142 --> 00:50:20,475 >> POLITICS. 1529 00:50:20,475 --> 00:50:23,011 >> THE QUESTION WE GOT FROM 1530 00:50:23,011 --> 00:50:24,579 DR. [INDISCERNIBLE] ABOUT POLICY 1531 00:50:24,579 --> 00:50:25,047 INTERVENTIONS, POLICY 1532 00:50:25,047 --> 00:50:27,182 INTERVENTIONS ARE TOUGH FOR NIH 1533 00:50:27,182 --> 00:50:28,617 TO SUPPORT AS AN INTERVENTION 1534 00:50:28,617 --> 00:50:31,019 APPROACH TO TRY TO IMPROVE SOME 1535 00:50:31,019 --> 00:50:34,323 HEALTH CONDITION, THOSE ARE 1536 00:50:34,323 --> 00:50:35,724 POLITICAL PROCESSES AND IT CAN 1537 00:50:35,724 --> 00:50:37,159 BE CHALLENGING TO GET A GRANT 1538 00:50:37,159 --> 00:50:38,260 FUNDED IF YOU ARE GOING TO GO 1539 00:50:38,260 --> 00:50:40,662 OUT AND TRY TO DO POLITICAL WORK 1540 00:50:40,662 --> 00:50:45,167 NYEAH, SO I THINK THAT'S THE 1541 00:50:45,167 --> 00:50:45,934 VERY, VERY IMPORTANT POINT. 1542 00:50:45,934 --> 00:50:48,670 SO WHAT WE TRY TO FOCUS ON IS 1543 00:50:48,670 --> 00:50:50,572 NOT THE POLITICS, IT IS THE 1544 00:50:50,572 --> 00:50:51,907 HEALTH OUTCOME. 1545 00:50:51,907 --> 00:50:54,242 NIH FUNDS RESEARCH THAT IMPROVES 1546 00:50:54,242 --> 00:50:56,445 HEALTH, AND SO WE HAVE FOCUSED 1547 00:50:56,445 --> 00:50:58,380 ON ON--EVEN WHEN WE DO FINANCIAL 1548 00:50:58,380 --> 00:51:00,115 INCENTIVES, WE'RE NOT GIVING 1549 00:51:00,115 --> 00:51:01,516 PEOPLE PEOPLE MONEY FOR THE SAKE 1550 00:51:01,516 --> 00:51:03,885 OF GIVING THEM MONEY, WE'RE 1551 00:51:03,885 --> 00:51:05,821 ACTUALLY ASKING MOW DO WE CHANGE 1552 00:51:05,821 --> 00:51:07,055 BEHAVIOR TO IMPROVE SCIENTIFIC 1553 00:51:07,055 --> 00:51:07,322 OUTCOME. 1554 00:51:07,322 --> 00:51:09,591 SO THAT'S THE QUESTION, BUT IF 1555 00:51:09,591 --> 00:51:11,326 WE ARE SAYING COME OUT AND 1556 00:51:11,326 --> 00:51:12,728 GIVING PEOPLE MONEY TO FEEL 1557 00:51:12,728 --> 00:51:14,296 BETTER, THAT'S NOT A SCIENTIFIC 1558 00:51:14,296 --> 00:51:14,563 QUESTION. 1559 00:51:14,563 --> 00:51:16,732 SO HOW THESE STUDIES ARE FRAMED, 1560 00:51:16,732 --> 00:51:17,966 THE NCTS FRONTIER IS HOW DO WE 1561 00:51:17,966 --> 00:51:19,334 FRAME TODAYS THAT GET RESULTS 1562 00:51:19,334 --> 00:51:21,603 THAT IMPROVE HELT AND NOW WITHIN 1563 00:51:21,603 --> 00:51:26,708 THIS PERVIEW OF SCIENTIFIC 1564 00:51:26,708 --> 00:51:26,975 INQUIRY. 1565 00:51:26,975 --> 00:51:28,310 NEVEN THAT KIND OF INTERVENTION 1566 00:51:28,310 --> 00:51:30,011 IS A HOT POTATO, WE HAVE SEVERAL 1567 00:51:30,011 --> 00:51:32,180 STATES NOW THAT ARE PASSING LAWS 1568 00:51:32,180 --> 00:51:33,448 THAT FORGID COMMUNITIES FROM 1569 00:51:33,448 --> 00:51:35,217 PASSING OUT MONEY, WITHOUT A 1570 00:51:35,217 --> 00:51:36,351 WORK REQUIREMENT NBUT I THINK 1571 00:51:36,351 --> 00:51:39,554 THAT IS IMPORTANT TO RECOGNIZE 1572 00:51:39,554 --> 00:51:40,222 THAT PHILOSOPHICALLY, DEPENDING 1573 00:51:40,222 --> 00:51:42,624 ON WHERE YOU STAND, I THINK 1574 00:51:42,624 --> 00:51:43,892 GIVING MONEY WITHOUT--WE USE 1575 00:51:43,892 --> 00:51:46,294 WHAT WE CALL CONDITIONAL CASH 1576 00:51:46,294 --> 00:51:48,029 TRANSFER, THE CONDITION IS THAT 1577 00:51:48,029 --> 00:51:50,165 IT'S A HEALTH COMPONENT TO IT, 1578 00:51:50,165 --> 00:51:53,602 SO IT'S CONDITIONAL ON YOU 1579 00:51:53,602 --> 00:51:54,669 ATTENDING CLASSES, CONDITIONAL 1580 00:51:54,669 --> 00:51:56,405 ON YOU IMPROVING OUTCOMES, 1581 00:51:56,405 --> 00:51:57,906 EATING BETTER, THOSE CONDITIONAL 1582 00:51:57,906 --> 00:51:58,907 TRANSFERS ARE LOGICAL AND 1583 00:51:58,907 --> 00:52:00,175 THEY'RE TIED TO HEALTH OUTCOME, 1584 00:52:00,175 --> 00:52:02,611 WHERE YOU MEASURE, I THINK WHERE 1585 00:52:02,611 --> 00:52:05,247 POLITICIAN ANDS THE COMMUNITY OF 1586 00:52:05,247 --> 00:52:07,048 THOSE INDIVIDUALS, IT GIVES 1587 00:52:07,048 --> 00:52:08,517 PEOPLE, FROM ECONOMIC THEORY, IF 1588 00:52:08,517 --> 00:52:11,520 YOU FLOOD THE MARKET WITH MONEY, 1589 00:52:11,520 --> 00:52:13,188 YOU WILL CAUSE INFLATION, IT'S A 1590 00:52:13,188 --> 00:52:14,322 PROCESS, RIGHT? 1591 00:52:14,322 --> 00:52:15,690 SO I THINK WHAT PEOPLE ARE 1592 00:52:15,690 --> 00:52:19,027 WORRIED ABOUT IS HOW DO YOU DO 1593 00:52:19,027 --> 00:52:20,662 THIS WITHOUT IT FEELING LIKE 1594 00:52:20,662 --> 00:52:21,730 YOU'RE JUST GIVING PEOPLE MONEY 1595 00:52:21,730 --> 00:52:22,964 AND THAT'S WHERE THAT TENSION 1596 00:52:22,964 --> 00:52:24,099 COMING IN. 1597 00:52:24,099 --> 00:52:26,501 BECAUSE NO 1 IS ARGUING ABOUT SO 1598 00:52:26,501 --> 00:52:29,704 IF YOU GIVE PEOPLE MONEY TO BUY 1599 00:52:29,704 --> 00:52:31,606 STRIPS SO THEY CAN CHECK THEIR 1600 00:52:31,606 --> 00:52:32,874 DIABETES, IT'S LOGICAL, IT'S 1601 00:52:32,874 --> 00:52:33,775 TIED TO AN END POINT. 1602 00:52:33,775 --> 00:52:35,644 IT'S WHEN YOU GIVE MONEY AND SAY 1603 00:52:35,644 --> 00:52:36,678 NO 1 DITION, DO WHATEVER YOU 1604 00:52:36,678 --> 00:52:40,115 WANT WITH IT AND YOU KNOW THAT 1605 00:52:40,115 --> 00:52:41,616 IS--THAT'S VIABLE, BUT WE THINK 1606 00:52:41,616 --> 00:52:43,685 IT'S A VIABLE OPTION BUT WE 1607 00:52:43,685 --> 00:52:45,754 THINK FROM FUNDING NIH FUNDED, I 1608 00:52:45,754 --> 00:52:47,956 THINK THOSE ARE ISSUES MAY NOT 1609 00:52:47,956 --> 00:52:51,460 BE EASY FOR NIERK H. 1610 00:52:51,460 --> 00:52:51,827 NNEXT QUESTION. 1611 00:52:51,827 --> 00:52:56,198 NHI, I'M RENE AND I'M A POST DOC 1612 00:52:56,198 --> 00:52:57,032 IN THE NEUROLOGICAL DISORDERS 1613 00:52:57,032 --> 00:52:58,733 AND STROKE BRANCH AND MY 1614 00:52:58,733 --> 00:53:01,837 RESEARCH HAS BEEN FOCUSAD I LOT 1615 00:53:01,837 --> 00:53:02,737 ON EPIDEMIOLOGY RELATING TO 1616 00:53:02,737 --> 00:53:04,206 STROKE AND SOCIAL DETERMINANTS 1617 00:53:04,206 --> 00:53:04,473 OF HEALTH. 1618 00:53:04,473 --> 00:53:06,475 SO I REALLY ENJOYED THIS, MY 1619 00:53:06,475 --> 00:53:08,343 QUESTION OVERLAPS WITH A LOT OF 1620 00:53:08,343 --> 00:53:09,478 OTHER QUESTIONS TO THE POLICY 1621 00:53:09,478 --> 00:53:10,812 INTERVENTIONS BUT ALSO I'M 1622 00:53:10,812 --> 00:53:13,482 CURIOUS ABOUT IN TERMS OF 1623 00:53:13,482 --> 00:53:14,416 INTRINSIC MOTIVATION IN THESE 1624 00:53:14,416 --> 00:53:16,151 FOCUS GROUPS WHEN YOU'RE SEEING 1625 00:53:16,151 --> 00:53:17,118 PEOPLE GIVING DIFFERENT OPTIONS 1626 00:53:17,118 --> 00:53:18,053 WHETHER IT'S FOOD OR EDUCATION 1627 00:53:18,053 --> 00:53:20,021 AND THINGS THAT WILL HELP THEM 1628 00:53:20,021 --> 00:53:21,623 CHANGE THEIR HEALTH, DO YOU 1629 00:53:21,623 --> 00:53:23,525 NOTICE THAT PEOPLE TEND TO 1630 00:53:23,525 --> 00:53:24,659 GRAVITATE TOWARDS 1 OR THE 1631 00:53:24,659 --> 00:53:27,162 RECOLLECT IN LIKE I'M WONDERING 1632 00:53:27,162 --> 00:53:28,930 WHAT KIND OF INTERVENTIONS WOULD 1633 00:53:28,930 --> 00:53:30,499 HAVE THE MOST SUCCESS IN TERMS 1634 00:53:30,499 --> 00:53:33,001 OF GIVING PEOPLE RESOURCES OR 1635 00:53:33,001 --> 00:53:34,803 EDUCATING THEM TO MAKE BETTER 1636 00:53:34,803 --> 00:53:37,038 CHOICES IN TERMS OF THE 1637 00:53:37,038 --> 00:53:38,607 LONGEVITY OF THE SITUATION. 1638 00:53:38,607 --> 00:53:41,309 >> YEAH, SO WE HAVE THE MENTEE 1639 00:53:41,309 --> 00:53:46,448 RIGHT NOW WHO HAS A FRANT 1640 00:53:46,448 --> 00:53:50,752 LOOKING AT BASIC INCOME 1641 00:53:50,752 --> 00:53:51,253 SUPPLEMENTATION, RIGHT? 1642 00:53:51,253 --> 00:53:55,657 AND SO THE WHYED WHYED--IDEA FT 1643 00:53:55,657 --> 00:53:57,859 STUDY AND FUNDS FOR NIDDK, WHAT 1644 00:53:57,859 --> 00:53:59,794 THEY SAID WAS FOR THAT 1645 00:53:59,794 --> 00:54:00,996 PARTICULAR K-GRANT WE WILL FUND 1646 00:54:00,996 --> 00:54:02,831 THE SCIENCE AND YOU FIND OTHER 1647 00:54:02,831 --> 00:54:04,399 RESOURCES FOR THE INCOME 1648 00:54:04,399 --> 00:54:04,666 COMPONENT. 1649 00:54:04,666 --> 00:54:07,269 SO WE ACTUALLY USED, WE KIND OF 1650 00:54:07,269 --> 00:54:08,670 PUT OUR RESOURCES TOGETHER AND 1651 00:54:08,670 --> 00:54:11,740 WE TESTED IN THAT STUDY WAS WE 1652 00:54:11,740 --> 00:54:13,909 LOOKED AT CONDITIONAL AND 1653 00:54:13,909 --> 00:54:15,944 UNCONDITIONAL CASH TRANSFER AND 1654 00:54:15,944 --> 00:54:17,145 WHAT WOULD HAPPEN WITH 1655 00:54:17,145 --> 00:54:18,380 RANDOMIZED PEOPLE AND WE 1656 00:54:18,380 --> 00:54:19,614 FOLLOWED THEM AND EACH PERSON 1657 00:54:19,614 --> 00:54:21,316 GOT EDUCATION, WHAT WE FOUND FOR 1658 00:54:21,316 --> 00:54:23,018 A LOT OF--NOW FOCUS GROUP, THE 1659 00:54:23,018 --> 00:54:24,052 STUDY JUST FINISHING UP RIGHT 1660 00:54:24,052 --> 00:54:26,254 NOW, THE FOCUS GROUPS, THE 1661 00:54:26,254 --> 00:54:28,123 PARTICIPANT SAID THE EDUCATIONAL 1662 00:54:28,123 --> 00:54:29,190 WAS VERY HELPFUL, THAT YOU KNOW 1663 00:54:29,190 --> 00:54:31,526 I KNOW THE MONEY IS HELPFUL BUT 1664 00:54:31,526 --> 00:54:33,495 THE MOST IMPORTANT FROM THEN WAS 1665 00:54:33,495 --> 00:54:34,396 EDUCATION, SO WE BELIEVE THAT 1666 00:54:34,396 --> 00:54:37,132 AND WHEN WE ACTUALLY LOOKEDDA AT 1667 00:54:37,132 --> 00:54:39,100 THAT, WE WERE GIVING OUT THE 1668 00:54:39,100 --> 00:54:42,170 CONDITION WAS, WE'VE GOT ACCESS 1669 00:54:42,170 --> 00:54:43,405 TO THE GIVING BANK CARDS BUT 1670 00:54:43,405 --> 00:54:44,839 ACCESS TO THE STATEMENT, WE WENT 1671 00:54:44,839 --> 00:54:46,007 IN AND ANALYZED WHAT ARE THEY 1672 00:54:46,007 --> 00:54:47,542 DOING WITH THE MONEY. 1673 00:54:47,542 --> 00:54:48,577 RIGHT? 1674 00:54:48,577 --> 00:54:52,814 PEOPLE ARE PAYING RENT. 1675 00:54:52,814 --> 00:54:53,582 TRANSPORTATION. 1676 00:54:53,582 --> 00:54:55,083 THEY'RE BEING MEDICATION, 1677 00:54:55,083 --> 00:54:56,284 THEY'RE BUYING STRIPS SORE 1678 00:54:56,284 --> 00:54:57,686 THEY'RE USING THEIR FUNDS FOR 1679 00:54:57,686 --> 00:55:00,555 THE THINGS THAT THEY COULD BT DO 1680 00:55:00,555 --> 00:55:01,856 OTHERWISE THAT'S TIED TO HEALTH. 1681 00:55:01,856 --> 00:55:03,124 BUT WHAT MANY OF THEM ACTUALLY 1682 00:55:03,124 --> 00:55:06,361 SAID TO US WAS THEY SAID, 1683 00:55:06,361 --> 00:55:08,296 BECAUSE OF THE INCENTIVE, I CAME 1684 00:55:08,296 --> 00:55:10,298 IN, BUT THE EDUCATIONALLY, 1685 00:55:10,298 --> 00:55:11,499 REALLY, REALLY HELPED ME SO I 1686 00:55:11,499 --> 00:55:13,702 THINK IT'S REALLY ABOUT, SO WE 1687 00:55:13,702 --> 00:55:15,136 THEN HAVE SOME OTHER MENTEES WHO 1688 00:55:15,136 --> 00:55:17,172 ARE WORKING ON SOCIAL NEEDS, SO 1689 00:55:17,172 --> 00:55:18,940 HAVE YOU SOCIAL NEEDS 1690 00:55:18,940 --> 00:55:21,810 NAVIGATION, YOU HAVE SOCIAL 1691 00:55:21,810 --> 00:55:22,777 NEEDS EDUCATION, AND THEN HAVE 1692 00:55:22,777 --> 00:55:27,015 YOU SOCIAL NEEDS INTERVENTION O 1693 00:55:27,015 --> 00:55:28,617 PROVIDE SPECIAL NEEDS AND ALL OF 1694 00:55:28,617 --> 00:55:29,684 THEM HAVE RESULTS, IT JUST 1695 00:55:29,684 --> 00:55:31,219 DEPENDS ON WHAT YOU ARE 1696 00:55:31,219 --> 00:55:32,087 COMPORTABLE WITH, WHAT RESOURCES 1697 00:55:32,087 --> 00:55:33,221 HAVE YOU AND OW MUCH. 1698 00:55:33,221 --> 00:55:34,856 SO FOR EXAMPLE, WE KNOW THAT 1699 00:55:34,856 --> 00:55:36,391 TELLING PEOPLE ABOUT SOCIAL 1700 00:55:36,391 --> 00:55:38,693 NEEDS IS NOT ENOUGH, RIGHT? 1701 00:55:38,693 --> 00:55:39,761 SO JUST SAYING, HERE. 1702 00:55:39,761 --> 00:55:42,497 BUT WHAT HELPS A SOCIAL NEEDS 1703 00:55:42,497 --> 00:55:43,598 RESOLUTION, HOW CAN RESOLUTION 1704 00:55:43,598 --> 00:55:47,402 HAPPEN, 1 IS TO SEND THEM TO 1705 00:55:47,402 --> 00:55:48,036 EXISTING RESOURCES. 1706 00:55:48,036 --> 00:55:49,704 WE HAVE ALL THESE GOVERNMENTAL 1707 00:55:49,704 --> 00:55:50,639 PROGRAMS THAT ALREADY EXIST, CAN 1708 00:55:50,639 --> 00:55:51,573 YOU HELP PEOPLE WITH THAT BUT 1709 00:55:51,573 --> 00:55:52,807 YOU'RE NOT PART OF THAT, THEN 1710 00:55:52,807 --> 00:55:55,510 YOU CAN ALSO HAVE PEOPLE WHO 1711 00:55:55,510 --> 00:55:57,545 HELP THEM SO FOR XCH, INSURANCE, 1712 00:55:57,545 --> 00:56:01,916 HELPING THEM ARK PLIE FOR AID AS 1713 00:56:01,916 --> 00:56:03,218 IS A HUGE DIFFERENCE. 1714 00:56:03,218 --> 00:56:05,253 SO JUST THINKING ABOUT HEALTH 1715 00:56:05,253 --> 00:56:07,756 RESEARCH FROM THE STANDPOINT OF 1716 00:56:07,756 --> 00:56:09,791 HOW DO WE CREATE A REALISTIC 1717 00:56:09,791 --> 00:56:11,393 APPROACH TO SOME OF THESE 1718 00:56:11,393 --> 00:56:12,827 PROGRAMS, AS OPPOSE TO THESE 1719 00:56:12,827 --> 00:56:15,597 SILOS, WHERE WE DO THIS AND SO 1720 00:56:15,597 --> 00:56:17,632 WE HAVE YOU, IT WAS HOUSING 1721 00:56:17,632 --> 00:56:19,768 INSECURE, PROBABLY ANYTHING TO 1722 00:56:19,768 --> 00:56:21,469 HAVE TRANSPORTATION PROBLEMS, SO 1723 00:56:21,469 --> 00:56:23,638 RATHER THAN JUST SAYING HEY, I 1724 00:56:23,638 --> 00:56:27,008 ONLY DO HOUSING, CAN WE CREATE A 1725 00:56:27,008 --> 00:56:28,343 WHOLISTIC PROGRAM THAT THEN 1726 00:56:28,343 --> 00:56:30,278 PLOTS PEOPLE TO WHAT THEY NEED. 1727 00:56:30,278 --> 00:56:30,779 >> GREAT. 1728 00:56:30,779 --> 00:56:35,316 THANK YOU NHI, GREAT TALK. 1729 00:56:35,316 --> 00:56:39,888 I'M SOFY DRAW, I'M VISITING NIH, 1730 00:56:39,888 --> 00:56:41,189 I'M A RESEARCHER FROM BAYLOR 1731 00:56:41,189 --> 00:56:43,591 COLLEGE OF MEDICINE DOWN IN 1732 00:56:43,591 --> 00:56:47,062 HOUSTON, I LOVE WHAT YOU SAID IN 1733 00:56:47,062 --> 00:56:48,963 THE STUDY, YOU DID, TELL US WHAT 1734 00:56:48,963 --> 00:56:51,466 WORKS ABOUT WE WILL FIGURE OUT 1735 00:56:51,466 --> 00:56:53,101 THE SCIENCE AND YOU TALKED ABOUT 1736 00:56:53,101 --> 00:56:54,269 RACE BEING A BIOLOGICAL 1737 00:56:54,269 --> 00:56:56,137 CONSTRUCK, AND FROM THE WORK 1738 00:56:56,137 --> 00:56:57,472 NOW, YOU NO LONG BELIEVE THAT 1739 00:56:57,472 --> 00:56:58,973 AND DOING ALL THIS FANTASTIC 1740 00:56:58,973 --> 00:57:01,843 EFFORT TO REDUCE THE BURDENS OF 1741 00:57:01,843 --> 00:57:02,944 STRUCTURAL RACISM, I'M WONDERING 1742 00:57:02,944 --> 00:57:04,279 WHAT THE PIVOT POINT WAS FOR YOU 1743 00:57:04,279 --> 00:57:06,247 AND WHAT DROVE YOU INTO THIS 1744 00:57:06,247 --> 00:57:07,682 LINE OF WORK ESPECIALLY COMING 1745 00:57:07,682 --> 00:57:09,484 FROM MY POSITIONALLITY OF TEXAS 1746 00:57:09,484 --> 00:57:12,821 WHERE OUR LEGISLATORS ARE TRYING 1747 00:57:12,821 --> 00:57:14,522 TO MAKE SURE THAT IS NOT TAUGHT 1748 00:57:14,522 --> 00:57:16,524 IN COOLS NOW, I WOULD LOVE TO 1749 00:57:16,524 --> 00:57:17,959 HEAR YOUR YOWRN TOW GIVE THIS 1750 00:57:17,959 --> 00:57:20,195 TALK TODAY, IT'S A LONG 1751 00:57:20,195 --> 00:57:20,462 QUESTION. 1752 00:57:20,462 --> 00:57:22,464 GIVE ME THE SHORT VERSION. 1753 00:57:22,464 --> 00:57:23,698 >> YES, I WILL GIVE YOU VERY, 1754 00:57:23,698 --> 00:57:24,199 VERY SHORT. 1755 00:57:24,199 --> 00:57:29,604 SO I THINK COMING FROM NIGERIA 1756 00:57:29,604 --> 00:57:31,139 MY FIRST STOP WAS IN BALTIMORE, 1757 00:57:31,139 --> 00:57:33,141 I WAS A RESIDENT IN BALTIMORE 1758 00:57:33,141 --> 00:57:36,711 AND I WAS WALK WORKING THE 1759 00:57:36,711 --> 00:57:38,379 CLINIC IN DOWN TOWN BALTIMORE 1760 00:57:38,379 --> 00:57:39,814 AND I WAS SURPRISED. 1761 00:57:39,814 --> 00:57:42,050 I DID NOT EXPECT TO SEE, I COULD 1762 00:57:42,050 --> 00:57:43,184 UNDERSTAND A DEVELOPING COUNTRY 1763 00:57:43,184 --> 00:57:44,519 HAVING DIFFICULTY BUT THIS I SAW 1764 00:57:44,519 --> 00:57:45,854 IN BALTIMORE, I SAID TO MYSELF, 1765 00:57:45,854 --> 00:57:47,255 I CAN'T BELIEVE THIS IS 1766 00:57:47,255 --> 00:57:48,256 HAPPENING IN AMERICA. 1767 00:57:48,256 --> 00:57:50,024 IT WAS SHOCKING TO ME, SO, AND 1768 00:57:50,024 --> 00:57:51,793 THEN AT THAT TIME, DIABETES OR 1769 00:57:51,793 --> 00:57:53,895 SOMETHING ELSE, I WAS KIND OF 1770 00:57:53,895 --> 00:57:55,330 REALLY FASCINATED BY, SO IT WAS 1771 00:57:55,330 --> 00:57:59,000 FOR ME, THE COMBINATION OF THE 1772 00:57:59,000 --> 00:58:00,468 EXPERIENCE AND THE DIABETES, SO 1773 00:58:00,468 --> 00:58:02,804 FOR ME WAS A NATURAL AND THEN I 1774 00:58:02,804 --> 00:58:04,606 HAVE SOMEONE WHO INVESTED IN ME, 1775 00:58:04,606 --> 00:58:06,441 YOU KNOW, A DIVISION CHIEF WHO 1776 00:58:06,441 --> 00:58:07,942 SAID, MY FIRST JOB SAID WE WILL 1777 00:58:07,942 --> 00:58:09,344 GIVE YOU FACULTY POSITION AND WE 1778 00:58:09,344 --> 00:58:12,647 WILL ALLOW YOU TO DO MASTERS OF 1779 00:58:12,647 --> 00:58:14,115 CLINICAL RESEARCH AND GET YOUR 1780 00:58:14,115 --> 00:58:15,383 FELLOWSHIP TRAINING SO I DID 1781 00:58:15,383 --> 00:58:17,152 THAT AND THAT JUST CHANGED MY 1782 00:58:17,152 --> 00:58:17,752 TRANSLATIONAL RESEARCH YECTRY 1783 00:58:17,752 --> 00:58:19,154 BUT I THINK IT'S REALLY A 1784 00:58:19,154 --> 00:58:22,023 FUNCTION OF THAT EXPOSURE AND I 1785 00:58:22,023 --> 00:58:23,224 REALIZE AND SO FOR MY 1786 00:58:23,224 --> 00:58:25,193 [INDISCERNIBLE] I WAS FUNDED BY 1787 00:58:25,193 --> 00:58:27,328 HRQ TO GIVE KUDOS TO HRQ FOR 1788 00:58:27,328 --> 00:58:29,097 FUNDING ME AT THE TIME WHEN 1789 00:58:29,097 --> 00:58:30,565 HEALTH SERVICES WAS PRETTY MUCH 1790 00:58:30,565 --> 00:58:32,934 UNKNOWN BUT 1 MIGHT HAVE MENTORS 1791 00:58:32,934 --> 00:58:35,703 WAS A SOCIOLOGIST, AND THE OTHER 1792 00:58:35,703 --> 00:58:37,572 WAS A PSYCHEICOLOGYIST SO I HAD 1793 00:58:37,572 --> 00:58:40,074 PEOPLE FROM NONMEDICAL AND I HAD 1794 00:58:40,074 --> 00:58:40,975 AN ENDOCRINOLOGIST THAT WAS MY 1795 00:58:40,975 --> 00:58:42,010 DIABETES PERSON BUT THAT 1796 00:58:42,010 --> 00:58:43,478 EXPOSURE GOT ME THINKING ABOUT 1797 00:58:43,478 --> 00:58:45,180 SO MANY ASPECTS THAT ARE NOT 1798 00:58:45,180 --> 00:58:46,714 TAUGHT IN MEDICAL SCHOOL AND I 1799 00:58:46,714 --> 00:58:50,718 THOUGHT--1 OF THEM WAS A 1800 00:58:50,718 --> 00:58:52,620 STATISTICIAN, SO I MET MENTORS 1801 00:58:52,620 --> 00:58:57,225 AND THAT CHANGED MY 1802 00:58:57,225 --> 00:58:58,193 TRAJECTORY. 1803 00:58:58,193 --> 00:58:59,060 >> WE HAVE ALMOST 400 PEOPLE 1804 00:58:59,060 --> 00:59:00,228 ONLINE, WE SHOULD GIVE THEM A 1805 00:59:00,228 --> 00:59:07,635 CHANCE TO ASK A QUESTION. 1806 00:59:07,635 --> 00:59:09,337 NOKAY, WHAT SUGGESTIONS DO YOU 1807 00:59:09,337 --> 00:59:11,005 HAVE FOR RESEARCHERS LOOKING AT 1808 00:59:11,005 --> 00:59:11,906 FEMALE DIABETES, ALREADY 1809 00:59:11,906 --> 00:59:13,775 SCREENING FOR DIABETES IN 1810 00:59:13,775 --> 00:59:15,877 PREGNANCY BUT LOOKING AT BLOOD 1811 00:59:15,877 --> 00:59:17,412 SUGAR ISSUES IN POLYCYSTIC 1812 00:59:17,412 --> 00:59:18,446 OVARIAN DISEASE AND CONDITIONS 1813 00:59:18,446 --> 00:59:22,350 THAT LOOK LIKE PC O S. 1814 00:59:22,350 --> 00:59:22,684 >> YES. 1815 00:59:22,684 --> 00:59:27,188 SO A BIG ISSUE RIGHT NOW IS 1816 00:59:27,188 --> 00:59:27,655 GUESTATIONAL DIABETES. 1817 00:59:27,655 --> 00:59:35,763 THIS IS MORE PROBLEMATIC BECAUSE 1818 00:59:35,763 --> 00:59:37,966 AS WE HAVE--HIGHLY PREVALENT IN 1819 00:59:37,966 --> 00:59:39,200 THE MINORITY COMMUNITIES AND 1820 00:59:39,200 --> 00:59:40,702 THEY HAVE LONG-TERM IMPACT WITH 1821 00:59:40,702 --> 00:59:42,136 THE RISK OF DEVELOPING TYPE 2 1822 00:59:42,136 --> 00:59:43,671 DIABETES AND ALSO IMPACT ON 1823 00:59:43,671 --> 00:59:43,905 INFANT. 1824 00:59:43,905 --> 00:59:45,840 SO THERE ARE GROUPS OF 1825 00:59:45,840 --> 00:59:46,975 INDIVIDUAL WHO IS--I DON'T DO 1826 00:59:46,975 --> 00:59:48,443 WORK IN THAT SPACE BUT I KNOW 1827 00:59:48,443 --> 00:59:49,711 THERE'S A LOT OF ADADVANCEMENT 1828 00:59:49,711 --> 00:59:51,613 IN SCIENCE IN TERMS OF SCREENING 1829 00:59:51,613 --> 00:59:53,982 AND DETECTION AND IN TREATMENT, 1830 00:59:53,982 --> 00:59:55,917 SO MOST PROGRAMS ACTUALLY USED 1831 00:59:55,917 --> 00:59:58,386 FOR DPUNISHING P DIABETES 1832 00:59:58,386 --> 01:00:00,889 PREVENTION, WORK IN WOMEN WITH 1833 01:00:00,889 --> 01:00:01,789 GUESTATIONAL DIABETES, SO THIS 1834 01:00:01,789 --> 01:00:03,358 WOULD BE DIET AND PHYSICAL 1835 01:00:03,358 --> 01:00:07,228 ACTIVITY AND HELPING PEOPLE GET 1836 01:00:07,228 --> 01:00:07,462 SCREENS. 1837 01:00:07,462 --> 01:00:08,263 >> THANK YOU. 1838 01:00:08,263 --> 01:00:12,467 I WANT TO THANK DR. EGEDE, FOR A 1839 01:00:12,467 --> 01:00:13,601 TERRIFIC PRESENTATION, I WANT TO 1840 01:00:13,601 --> 01:00:15,136 THANK THE AUDIENCE FOR GOOD 1841 01:00:15,136 --> 01:00:17,071 QUESTIONS, A LIVELY DISCUSSION. 1842 01:00:17,071 --> 01:00:19,240 AS I MENTIONED EARLIER, WE WILL 1843 01:00:19,240 --> 01:00:21,542 BE POSTING THE RECORDING OF 1844 01:00:21,542 --> 01:00:24,445 TODAY'S PRESENTATION ON OUR 1845 01:00:24,445 --> 01:00:25,980 WEBSITE PREVENTION.NIH .GOV IN 1846 01:00:25,980 --> 01:00:27,582 THE NEXT FEW WEEKS AND IT WILL 1847 01:00:27,582 --> 01:00:28,883 BE AVAILABLE ON THE NIH 1848 01:00:28,883 --> 01:00:29,684 VIDEOCAST SITE. 1849 01:00:29,684 --> 01:00:31,653 I WANT TO THANK EVERYONE FOR 1850 01:00:31,653 --> 01:00:32,320 JOINING TODAY'S LECTURE, FOR 1851 01:00:32,320 --> 01:00:35,590 THOSE WHO ARE HERE IN LIP SET, 1852 01:00:35,590 --> 01:00:37,859 PLEASE JOIN US OUTSIDE THE 1853 01:00:37,859 --> 01:00:39,694 AUDITORIUM FOR A BRIEF RECEPTION 1854 01:00:39,694 --> 01:00:41,629 AND TO THOSE ONLINE, IF YOU WERE 1855 01:00:41,629 --> 01:00:43,264 HERE, YOU COULD BE PART OF THE 1856 01:00:43,264 --> 01:00:46,067 RECEPTION AND HANG OUT WITH OUR 1857 01:00:46,067 --> 01:00:46,301 SPEAKER. 1858 01:00:46,301 --> 01:00:48,236 SO I WOULD ENCOURAGE YOU TO COME 1859 01:00:48,236 --> 01:00:50,805 IN PERSON NEXT TIME, HELP US 1860 01:00:50,805 --> 01:00:51,139 FILL THE ROOM. 1861 01:00:51,139 --> 01:00:52,473 YOU ALSO HAVE A BETTER CRACK AT 1862 01:00:52,473 --> 01:00:55,176 ASKING QUESTIONS IF YOU ARE IN 1863 01:00:55,176 --> 01:00:55,877 THE ROOM. 1864 01:00:55,877 --> 01:00:59,213 FINALLY, THE CME CODE, I'VE BEEN 1865 01:00:59,213 --> 01:01:00,214 ASKED TO REPEAT, 50125. 1866 01:01:00,214 --> 01:01:01,649 THANK YOU VERY MUCH. 1867 01:01:01,649 --> 01:01:11,859 [ APPLAUSE ]