Blog,  Health

Berkeley Conversations – Straight Talk: A Conversation about Racism, Health Inequities and COVID-19

– Hello.

I'm Denise Herd.

I'm a professor in theSchool pf Public Health and the associate director of the Othering and Belonging Institute, the two organizations thatare co-sponsoring this event.

It's my pleasure towelcome you to our session, Straight Talk, aconversation about racism, health inequities and COVID-19.

Before we begin, I'd liketo acknowledge and thank the Ohlone people for allowingus to shelter in place and work at UC Berkeleyon their beautiful land.

The theme of today's session was selected to help us think more deeplyabout the racial inequities that have emerged in the cases and deaths from COVID-19 in the US.

Statistics from all over the country show that African Americansare getting infected and dying at much higherrates of the disease than their proportion in the population.

And these high rates aren't confined just to African Americans.

Native Americans, Latinos insome states and neighborhoods, even right here and in ourSan Francisco Bay Area, are also experiencing extremely high rates of sickness and deaths from COVID.

These figures are tragicand disturbing evidence of the deep racialdifferences in the country at a time when the media keeps telling us we're all in this together.

The focus of today'ssession is not to dwell on more facts and figuresabout these disparities, but to start a conversationabout structural racism as a paradigm shifting focus.

We want to foster more understanding of the structural causesof these problems, and also to think more creatively about our path forward tostop the sickness and dying, promote recovery and preventfuture disasters like this.

Our speakers will highlight how racism shapes the social conditionsthat create more risk among vulnerable populations.

And of equal importance, they will discuss how we need to have an anti-racist lens to design effectiveinterventions against COVID-19 and its fundamental causes.

I'm joined by an extraordinarypanel of experts, all professors from theSchool of Public Health, and all of whom are members of the Health Disparities cluster at the Othering and Belonging Institute who will focus on this issue.

First, we have with us Amani Allen.

Amani is an associate professor in the School of Public Health, where she also serves as theExecutive Associate Dean.

Jason Corburn is a professorin the School of Public Health and in the Department ofCity and Regional Planning.

Cassie Marshall is an assistant professor in the School of Public Health.

Mahasin Mujahid is an AssociateProfessor of Public Health and the Chancellor'sProfessor of Public Health.

Osagie Obasogie is aprofessor of bioethics in the School of Public Health and Joint Medical Program with UCSF and the Haas DistinguishedChair in health disparities.

Today's format will includeconversation by our panelists, followed by a Q&A withour audience on Facebook.

And so now, I'm very pleasedto turn the conversation over to several of ourpanelists, Mahasin Mujahid, Amani Allen and OsagieObasogie, who will talk with us about how they enter this conversation and what perspectivesthey bring to the problem that we're here to discuss today.

So thank you, Mahasin.

– Great.

Thank you, Denise, andthank you to the organizers of this important and timely panel.

So I'm gonna enter the conversation as a social epidemiologistwho really genuinely believes in the power of data.

Data can be a powerful tool when collected rigorously and inclusively.

It can be undeniable, and it can really highlightimportant inequities in health, and it can also lead to orpinpoint potential solutions.

So one example of this is from the Heckler Reportof 1985, and this was out of the Department of Healthand Human Services.

And it really raised nationalattention about the status of minoritized populationsin the United States.

And because the data were undeniable, it led to the creations of the Office of Minority Health for the Centers of Disease Control and the National Institutes of Health.

And it also led to, aspart of our report card on how we're doing, whether or not we are working to eliminatehealth disparities as a part of that report card, and that's, again, becausethe data were undeniable.

So it was in this vein thatmany began to call for data based on race and ethnicity in response to this COVID-19 pandemic.

So we heard fromrepresentative Ayanna Pressley.

We heard from senators ElizabethWarren and Cory Booker, as well as Kamala Harris.

And we really neededto have data to back up what people in the trenches were seeing, and that's the piling upof black and brown bodies across the country in hotspotslike Detroit, Michigan, in Chicago, Illinois, as wellas New Orleans, Louisiana.

And what we got was aconfirmation of our worst fears.

It was data that started being reported in the beginning of April that said things like in the state of Michigan, where blacks make up14% of the population, they made up 41% of COVID-19 deaths.

Similarly, in the state of Louisiana, blacks made up 32% of the population but 70% of deaths due to COVID.

And so I mentioned thatthese data are alarming, but they're certainly not surprising.

And we have other examplesof this throughout history, and we'll unpack that morethroughout this panel.

But equally unsurprisingare the explanations that followed the results of this data.

So we heard from prominentofficials that the reasons why blacks are morelikely to die is because they're more likely tohave underlying conditions.

And indeed, there's data that comes out of the Centers for Disease Control that highlights that 90%of hospitalized patients have one or more underlying conditions.

And these are conditionslike hypertension, which leads the pack, aswell as obesity, diabetes, chronic lung disease andcardiovascular disease.

So it's easy to understandthe basic logic.

If A equals B and Bequals C, then A equals C.

The reason why African Americans are dying is because they're more likelyto have these conditions.

Quite frankly, it helps usto sleep at night, right? It alleviates the burdenand the responsibility that institutions and systems play in shaping the opportunityand resources risks across the social hierarchies that exist in the United States.

So we have to do better.

We have to really acknowledge the role of social determinants in shaping the distribution ofresources and opportunities.

But more importantly, we haveto highlight the critical role that structural racism is playing, not only in this COVID-19 pandemic, but why black and brown and other other marginalizedpopulations live sicker and die younger in the United States.

So I'm gonna turn the conversationover now to Amani Allen to continue to unpack these things.

– Thank you, Mahasin.

And again, thank you to theorganizers of this panel.

It's really a pleasure to be on a panel with my friends and colleagues to talk about this very important issue.

So I'm entering the conversation also as a social epidemiologistwho studies, specifically, why black people live sickerand die sooner than others and how racism becomes embodied.

And as Mahasin said, this virus is playing out along racial lines, and this is because race is a major source ofsocial division in this country.

And it's not just about someone being mistreated in a restaurant or acting as if they're surprised at your level of intelligence, which we've all experiencedtime and time again.

It's really about beingdenied the opportunity to thrive in this country, socially, economically and politically.

It's about who holds voice and power in this country to decide, for example, the number of liquor storesversus grocery stores that will be allowedin certain communities, where funding for our schools comes from.

It's about where toxic wastefacilities will be located, who will be stopped and frisked.

It's about race-based consumer marketing.

So sure, people shouldexercise good health behaviors, but the longstanding patterns of race-based health disparitiesthat we see in this country is not about health behaviors.

Racial differences in health behaviors are simply just not big enough to account for the stark disparities that we see in health by race.

In fact, for almost anyoutcome that we look at, we see blacks doing worse, worse than other groups, with Native Americans as a close second.

And so the bottom line is that as horrible as the coronavirusis, what we are seeing in terms of the racialdistribution of this virus is actually not about the virus at all.

It's about racism.

We saw it with Katrina.

We saw it with H1N1, the Flint water crisis, and we're seeing it playing out right now with climate change in termsof who's most vulnerable.

And every time we have acatastrophe and see these patterns, everyone gets upset and asks why, but to many of us, thisdoesn't come as a surprise.

It doesn't come as a shock at all.

The racial distribution of this virus is actually very predictableand is what we will likely see a year from now when welook at the residual impacts of the virus on communities of color, and not just black communities, Latinos, Asian Americans, et cetera.

We're talking about jobs, access to healthcare and the residual stress, among other challenges.

Now, I was reading a, Iwas looking at a piece written by Soraya McDonald from The Undefeated a few weeks ago.

And I really think shehad it right when she said the most prominent preexisting condition is race.

And I would actuallyargue that it's racism, and that's because racismdetermines exposure to a lifetime of risks thatresult in poor health overall and poor access to a host ofhealth-promoting resources.

And this dates back tothe history of slavery, to black codes during Reconstruction, Jim Crow, redlining, massincarceration, stop and frisk.

All of these experienceswhich have truly characterized the lives of blacks in thiscountry with almost no relief have created a situationthat has made it impossible for blacks to have the sameopportunities as others.

So it's opportunity.

It's stress.

It's socioeconomic mobility.

My mother had to drink out ofcolored only water fountains.

And so that's only one generation removed, at least from where I sit.

And so, until we recognizeand institute policies to correct these wrongsand even the playing field, we will continue to seethese racial patterns emerge with every passing epidemic.

And when we think aboutchronic experiences of racism over one's lifetime, we haveto also talk about stress and what it does to our bodies.

Stress on our bodies islike a continual fire that eventually just erodes our ability, our body's ability to operate.

And eventually our bodiesor the systems in our bodies give out and they're no longer able to carry out their functions properly, leaving us more susceptibleto disease and death.

So for example, chronic stress, including chronic experiences of racism, can erode our immune systems and our ability to fight infection.

It can cause heightenedinflammation in our bodies, which impacts cardiovascularhealth and has been associated with aa number of other chronic diseases.

And so at the end of the day, yes, there are pre-existing conditions, but the question is what isthe pre-existing condition that we see over and over again, regardless of what catastrophe we might happen to bedealing with at the time.

So I'll stop there andturn it over to Osagie who I'm sure will have a lot more to say.

Osagie? – Great.

Thank you, Amani.

So I'm entering this conversation as a legal scholar and a social scientist who studies history, theory and bioethics.

And I'm interested inhow racial disparities that we see in the COVID-19 case are tied to the long legacies of previous forms of racial exclusion, such as slavery, eugenics, Jim Crow, and other forms of legal andextra-legal subordination.

So we have to understandhow these linkages are tied together inorder to truly understand what's going on and how to fix it.

So we, I think one of the questions we'll talk about todayduring our conversation is how does acknowledging this history help us broaden ourunderstanding of this problem.

And so we really have to think about this as not only a pandemic around COVID-19 but also understand thatracism itself is a pandemic.

What we're seeing is, what we're seeing now is the symptom of existingstructural inequities, not something that is new or unexpected.

So indeed, this outcomewas entirely predictable.

So an inability toacknowledge this dark history and to speak truth actuallymakes public health as a field part of the problem.

And as public health practitioners, we really have to approach this tragedy and this ongoing problemwith a deep understanding of history theory, in orderto make the connections that are necessary toimprove people's lives.

– Okay, thank you so much, Amani, Osagie and Mahasin.

I now wanna turn toour other two panelists to talk to us a little bit more about what's the aftermath of the kind of disparate rates we're seeing with COVID in African American and othermarginalized communities.

– Thanks, Denise, and like everyone else, I'm so thrilled to be here.

I enter this conversationas someone who thinks a lot about reproductive justiceand healthcare delivery, specifically interventions that happen in the healthcaresetting to promote equity in the space of reproductivehealth and maternal health.

And so I became increasinglyalarmed at what was happening when I started to think of thelong-term impacts of COVID-19 on the populations thatI care about and study.

And so one example of this really has to do with maternal health.

And so due to all the thingsthat have been said before, we're already battling acrisis in maternal health in this country, andthis is particularly true among black women and populations.

You often hear the statistic that black women are three to four times more likely to die ofpregnancy-related causes than white women in America.

And this was alreadygoing on before COVID-19 and has everything to dowith what was just discussed, specifically around the chronic stress that comes with living with racism and sexism in the United States.

When I began to think aboutwhat COVID-19 might mean for birthing people, people currently pregnant and having to go tohospitals to give birth, I was increasingly alarmed.

In New York City where, wasan epidemic of COVID-19, very strict policies were put into place to deal with the epidemic and to protect healthcareworkers, of course.

But what ended up happening is that the policies that were beingenacted were thought to, what I anticipated were goingto impact the populations that we were already concerned about.

So one example of this was the limitation ofvisitors in birthing suites.

So in some cases, no visitor is allowed, so not a support person, nota husband, not a partner, and certainly not interventionsthat we already know can be beneficial for black woman.

In some of my research in thework that I'm doing right now, we focus on the role of community doulas as interventions to providesupport for black women, to help them advocate fortheir needs and desires in what's often a racisthealthcare setting.

And at this point, that wasno longer being allowed.

And so increasingly, it became clear that what was happening with COVID was not just going to impact COVID.

It had these long-term impacts.

And so many have already predicted that COVID-19 may increasethe inequities and disparities we already see around maternal health due to the stress, fear andanxiety that people feel.

You know, you can imagine being a pregnant, birthing person right now.

And so I've been thinkingabout it from that lens, and also from the lensof what interventions need to be employed toaddress these inequities and disparities as we move forward.

And Jason, I'd love for you toadd to the conversation now.

– Okay, thanks, everyone.

And I wanna just build on whateverybody has been saying.

And I come to this assomeone who looks at places where we live, learn, work, pray and play and how that influences health outcomes, and how community members, in particular, need to be at the centerof both the science and the solutions, the policiesthat we need moving forward, as Denise said.

So when we think aboutresponses to this crisis, we need to think about that health starts in our communities.

Disease management oftenstarts in the clinic or the hospital, whichmeans that we need to treat our neighborhoods, not justindividuals, in this response.

And we what we know is that our health and the health of our communitiesdoesn't happen randomly, as Amani and Osagie and others have said, but it happens deliberately through policies and deliberate practices.

And so in our response, we need to actually change those practices andpolicies in the long term.

And some of those havebeen mentioned already, particularly things like housing, so racist housing policies like redlining, which designated blackcommunities, starting in the '30s, as risky or red, tellingbanks not to issue loans to black folks, denying home ownership, resources to improvecommunities and wealth creation.

Racism in housing wasalso, came in the form of white homeownerassociations that use violence to keep people out ofcertain neighborhoods.

Other housing policy called urban renewal bulldoze existing healthyblack communities, and it was done often in the name ofpublic health and hygiene.

So we have to look internalto our own discipline when we think about responses today.

And in that space ofthose healthy communities were built highways that often pollute our communities today.

So this, all of these things, as folks have mentioned, contribute to those stressorsof living in a segregated, racially residentiallysegregated neighborhood, and that may be the most severe epidemic that we're not addressing.

So we're starting already with solutions that we have to lookat both in this crisis, but as long-term publichealth, anti-racism solutions, things like moratorium on evictions, rent forgiveness, housing all the homeless.

These are things we have proved we can do it in this response, so we need to think aboutthis in the long term.

Amani and others talkedabout those toxic stressors that continue in communities today, that system of local terror known as the war on crime anddrugs, get tough on crime.

It really militarizedour police departments, put all of our local government resources and majority of thosebudgets go into policing.

And the racist sentencing laws, things that are being talked about today, this has got to be part ofour response to this crisis, contributing to incarceration and that stress of police terror, and the impact that'shaving on our bodies.

But decarceration, again, is possible.

It's happening.

It's necessary now, andwe need to move forward with keeping that at thefore of our strategies.

I also look at how localgovernments make land use decisions about what goes where, what opportunities in what places happen.

And this is, like folkshave already mentioned, the opportunity to be healthy, like when a toxic industry is located and allowed to pollute in and next to black and brown communities, this is environmental racism, and we need to address that.

And we know black and browncommunities are more exposed to air pollution, whichcontributes, like folks said, to that asthma and respiratory illness, which puts you at morerisk today from this virus.

And that same environmentalracism limits communities from having thosehealth-promoting resources like clean drinking water, as has been mentioned, or water in the first place like in many indigenous communities.

This is another form ofinstitutional racism, these land use strategies, landuse planning, also known as, it includes land use zoning.

And that shapes our abilityto make healthy choices, such as when jobs, housing or supermarkets are given subsidies tolocate in certain places but not others.

So this is a particularform of institutional racism that gets layered on many others.

And what we're gonna see, I'm fearful, is that local governments are gonna be really strapped for cashin this economic crisis that's accompanying the publichealth crisis we're facing.

And what typically happens is when local governmentsface financial strain, they Institute somethingcalled plan shrinkage, which is just policy speakfor removing supporting, life-supporting services inblack and brown communities.

So these cities start closing things like fire stations and hospitals in those poor communities of color.

We know this has happened before.

In fact, the majority ofhospitals closing today are happening in black communities.

So it's this overlapping set of factors, this structural racism that we need to put at the fore of our response, so that, we need to address themultiple institutions that have allowed, like folks have said, more liquor stores than libraries, more pollution than parks, and more homelessness thanhospital beds in our communities, and recognize it is not thefault of those living there, and we can't treat ourway out of this challenge.

Now, I wanna just also say a little bit about decision making, as Denise suggested, and how we can think todaytogether, moving forward, and recognize that there's also racism in the decision making processes that are happening right nowthat we need to identify.

Who has power and who's at the table in the science and health conversation and policy conversation? So that racism in our institutiondevalues and dehumanizes by systematicallyexcluding certain people.

So in this pandemic, thenarrative is, you know, a common one, but I thinkalso a very misleading one, for example, namelythat science, you know, will ride in on itswhite horse and save us.

This is another form of racismthat we need to identify and address because itignores in that science that the history of medicineand public health have and continue to oversample, experiment on and test on black and brown bodies, all with serious adversehealth implications.

So this is something we need to also put at the fore of our decisionmaking as we move forward, that this history ofexclusion helps explain why many folks don'ttrust the epidemiologists and the decision makers and the modelers who keep saying, you know, “We're going to follow thescience, not the politics, ” but hiding thoseuncertainties and assumptions that's always embedded in our science.

It doesn't make it wrong.

It means we need to make it more explicit as we move forward, and it alsomeans we have to acknowledge a new form, an existing form of expertise which comes in our communities, the assets and expertise that already exists in ourcommunities because it improves not just the scienceand the decision making, but it makes it more equitable and just.

So we're not hearing, for example, from those existing community experts, the community health workerswho are already out there in our communities, the promotoras, the street outreach workerswho are doing things like, you know, interrupting gun violence.

Those folks are expertsin our neighborhoods.

We need to engage them in the solutions moving forward today for coronavirus, the domestic workers, frontlinehealthcare workers of color, the farm workers, and many, many others.

We need to recognize thatthese experiences of racism, there's a local expertisethat we need to address and engage, involve inour decision making.

– Okay, well, thank youso much, Cassie and Jason.

Those were excellent points.

And now, you know, basedoff of those points, I'd like for the panel nowto think about, you know, what are ways that weneed to move forward? How does the anti-racistlens help us move forward in addressing COVID-19? How can we think more creatively about what are the kinds ofthings that we need to do? – So Denise, if I could juststart by making a point that, I just wanna reemphasize apoint that I made earlier, which is that the patternof racial disparities that we're seeing with COVID-19 is consistent with thepattern of disparities that we see across anumber of health outcomes and that we see across anumber of social risks.

And that is the epidemic, right? The epidemic is that once COVID is gone, the racial disparities inhealth are gonna still exist.

And we don't wanna get lulledinto a false sense of security once that's gone, until thenext catastrophe happens and we see the exact same pattern emerge.

And so, you know, I thinkJason brought up a good point about this kind of narrative and mantra around individual responsibility and recognizing that it livesin the systems of our society, and until we actuallylook at those systems and question what kind of unintended, intended or unintendedconsequences might this policy have on this community, have on that community.

My sister sent me a textthis morning, and it, so we hear all thisstuff all over the news kind of talking aboutGeorgia is opening back up and all these places are opening back up.

And there's been a huge outcryamong the black community.

Well, why are you opening up places where it's predominantlyAfrican Americans? Like, we're not gonna open upuntil the golf clubs open up, until, you know, allthe places that are not predominantly populated byAfrican Americans open up.

So even when we think about the decisions that are being made toopen up different places, who populates those places, et cetera, we need to think about those things in terms of who's going to bedisproportionately impacted.

So I guess my point, whatI'm trying to get across is this idea of, and it's something we hear inpublic health all the time.

Health is in all policies.

And so until we look at education policy, transportation policy, food policy, all of these other kind ofwhat many would probably not consider to be healthpolicy, they are health policies because they have, again, whether they'reintended or unintended, they have impacts on health.

And we have to questionwhether or not the policies, practices and norms thatwe're putting into place have the same benefits and same harm, and levy the same harmsacross all communities.

And I think what we seetime and time again, it will be different if what we see in terms of racial differences, well, not even racial differences, if what we saw in health was randomly distributedin the population.

But it's not, and it's because of thenon-random distribution of health and illness in this country that we have to start totackle not only health risks but the social risks thatput certain communities at a greater health disadvantage.

– Yeah, Amani, one of thethings I've been interested in that connects with what you said is how, as more data has been released showing which populations havebeen vulnerable to COVID-19, such as folks who are elderlyand African Americans, that has correlated withincreasing calls to reopen America.

So that is to say that once folks realized that the people who were beingdisproportionately harmed tend to be black folks and old folks, there was this kind of sensibility that kinda, again, correlated, not caused by but correlated with this kind of growing claim that we need to move pastthis and push forward.

And what I wanna suggest is that that correlation really highlights the lingering eugenic ideology that's persisted within our society, that is that there are certain populations that simply don't matter, and that if a disease isdisproportionately harming them, we can let that disease carry its course in some Darwinian fashion andlet it wash these people out and we can get on with our everyday lives.

And so that's why I saidin my earlier comment, it's really important to make sure that we understand COVID-19 in a particular historicalcontext so that you see that there are these kind ofrecurring themes and approaches to vulnerable populations thatrepeat themselves over time, and how that understanding canhelp us respond to COVID-19 and future health epidemicsin a more appropriate fashion.

– Did anyone else have any comments on these points that have been made or examples of approaches that, you know, are coming from an anti-racistlens that can pave the way for interventions into, as Amani pointed out, the pandemic of racism, as well as this pandemic? And I do wanna emphasize, reemphasize something that Amani said, and that is we are living with epidemics.

I mean, right now, forexample, African Americans constitute 13% of the population and 43% of new HIV infectionsand of people living with HIV.

So I don't know if COVIDis going to go away, but are there someinterventions or approaches that we can point tothat might lead the way for showing us how canwe deal more creatively with, you know, addressing racism itself and this very serious disease? And perhaps we can hear from Cassie or Mahasin on this thing.

– Yes, certainly.

I think that is a great point.

And you know, as I've mentioned, the areas that I'm thinking about really are around reproductivehealth and maternal health.

When we saw that COVIDwas quickly turning into a maternal and infant health disaster, I immediately began thinkingwe need to think creatively and address like short termthe things that can be done.

So I mentioned beforeabout birthing people having limited accessto support during COVID.

And so some of the thingsI've been thinking about are how can we quickly move to telehealth versions of support.

So not just telehealth visitswith healthcare providers, but telehealth midwiferycare, health care, telehealth doula care.

And that might, for some populations, mean providing the tablet, providing the data plan, providing those type of thingsthat people may not have to get them through thesecrisis moments, right? It also might mean avoidingthe hospital completely, so serving some movement totry to get birthing people out of hospitals.

Are there opportunities for birth centers? Are there opportunities for home births? And the problem is that the populations that experience thegreatest burden of disease often aren't able to quicklymove into a home birth or quickly have access to birth centers.

There may be no birth centersin their communities at all.

So for me, what I was hoping for was for these creative and quick solutions that would target the people most in need.

I definitely believe a one size fits allapproach will not work.

And we're thinking of thelong-term implications of this.

We need to really infusethe populations that need it with the greatest resource.

– And I, you know, I thinkI would just add on to that, that the interventions thatare really going to tackle the situation thatmarginalized populations find themselves in may not startwith the healthcare system.

I mean, I think what we see throughout history is that sometimes, the worst thing for blackand brown populations is to interact with the healthcare system.

And we have data fromaudit studies that show that when blacks go to theER and go to the hospital, they're less likely toreceive pain medication.

They're less likely to receive recommendations and referralsfor lifesaving procedures.

And so the solutions may not always lie in the healthcare systemand may require us to think about the strengthsand assets in our communities.

I think one of theunique issues with COVID is that a lot of the ways in which we draw oncommunity level resources and sources of support arealso causing us risk right now.

Our social support networksare being strained, and the long-term consequences of that are going to furtherexacerbate health disparities because we're not gonnahave those same buffers.

So we have to make surethat we are rebuilding those networks by makingsure that we do things like focus on mandatorypaid sick leave policies, focusing on redistributingresources so that people whose safety nets aredismantled from this pandemic have a way to refuel them.

And it's gonna require, I think the hard thingfor us to struggle with is that there's conversations in every public healthdepartment across the country, in every hospital systemaround health equity, but I think people reallystruggle with what it means.

I think this idea that weinvest equally in all people is something that peoplecan't wrap their heads around.

Let's invest equally in all of our kids.

It doesn't mean that we do it, but we at least can wrapour heads around it.

But instead, what we have to do is acknowledge that for somepeople, in some communities, we're starting 10 feet under, so we're gonna have to invest more resources into those communities.

And I think that's gonna be, the challenge for us movingforward, is actually doing that.

– And I would add towhat Mahasin is saying.

Like one of the things weknow from national surveys, so the National Opinion Research Council commonly does national surveys to kind of assess theattitudes of the US population.

And racial attitudes, that's one type of attitude.

And so people are asked, doyou believe that everyone should have an equalopportunity for X, Y, or Z? And commonly, we see verykind of high frequency scores suggesting that ingeneral, Americans believe that everyone shouldhave equal opportunities to education, to jobs, to wage.

Do away with labor and wagediscrimination, et cetera.

However, the follow-up question that asks, would you be willing togive up something you have so that these other groups who actually have historically not had it, it doesn't say it like that.

That's the way I would say it.

Would you give up something you have so that others can thrive? Then you actually see thosenumbers start to dwindle, right? You see them start to decline.

And so ideologically, we want to all believe that we endorse kind ofan egalitarian society and believe in the ideal that everyone should have an equalopportunity to thrive, you know.

And people, there's still this mantra of, what do they say? Pull yourself up by your bootstraps.

And Eduardo Bonilla-Silva, a prominent sociologist, and I love this line, is known for saying, “But they took my boots.

“Like I don't have boots.

“I don't have any bootsto pull up, ” right? And so until we give everyone boots, we can't expect for everyone to actually be able to pull them up.

And so I think this isa fundamental challenge we have in our societybetween ideologically, who we want to believe we areand what we're willing to do in terms of our action to really create, like Mahasin was saying, not equality types of interventions, but more targeted universalism, proportionate universalismtypes of interventions where we distribute resources according to need, especially among those who have been historicallydisenfranchised.

– That's a great point, Amani.

And I just wondered, before we shift to taking questions from ouraudience, if there's any, anyone who wanted to make a very brief last comment about solutions.

Jason, did you wanna make a comment? – I just wanted to echo what my colleagues have said right here that it's really importantthat anti-racism strategy, an anti-racist strategy is alsoconfronting white privilege.

And that's got to be historic, like Osagie and others are mentioning, and it's got to be current.

And it's not a one size fits all.

It's got to look at the place privileges and the population privilegesthat white people have and continue to have, and continue to have in our own disciplines of science and public health and medicine.

So you know, one thing wecan do right away, really, is look more closely internallyin our own community, whether that's wherewe work, live and play.

So, and I really agree that we, we need to take this targeted approach, what we call in urbanplanning urban acupuncture, really finding thoseimportant points to intervene, and it's not a one sizefits all across the board.

– Okay.

Thank you all so much.

And now, I'm going totake some of the questions that we've been, that arecoming in through Facebook and ask the panel to address them.

One of the first question is, what can we do on the groundto address health disparities through the pandemic and beyond? Jason or, who would like to tackle that? – Well, I mean, I thinkthere's a lot of things.

Many of them were mentioned.

I mean, right away, we need tobe investing in, like I said, our community-based organizations that are already on the front lines.

Those are also frontline workers, our community-basedorganizations working with youth, working with young people, working with formerly incarcerated folks, working to prevent those otherepidemics we talked about, like gun violence, in our community.

So there's, and this is actuallyhappening as a response.

And, for example, for contact tracing, is to deeply, deeply invest, hire people.

Pay our promotoras, ourcommunity health workers, you know, a really healthy wage to be able to do the work that they do, which is build connection, build trust, and get good healthinformation and services to folks who need it, who maybe not accessing it right now.

We can do that today.

We can do that immediately.

– Okay, thanks so much.

Another similar– – Denise, Can I jump in for that one– – [Denise] Sure, yes.

– As well? Just one thing I was gonna add is be the voice of everythingyou're seeing here.

I think too often, inconversations, casual conversations, when you're, you know, talking about what's going on in the popular news, or you're saying, “Oh, you know, it's coming out that, “you know, minorities aremore likely to experience “complications fromCOVID or to get COVID, ” and people will use thosekind of explanations.

Oh, well, they have a higherproportion of chronic diseases.

Oh, it's caused by this.

Oh, it's caused by that.

And what I would say anyone can do is start calling that out, complicate that, right? They will, there's a reason for that too.

And if you go back further and further, you get to these root causesthat we're discussing here.

And I think the more thatpeople can complicate that, can bring that up in their families and their friend networks, will start to reallychange the conversation.

– Well, Cassie, that's areally excellent point.

I mean, and I think one ofthe main goals of this session was to get conversationsstarted about structural racism, because we're not seeing it.

We're not seeing it in the media.

We're not seeing it necessarilyamongst some of the people thinking about it in terms of health.

So I think that's a really, really excellent recommendation.

Some other questionsthat have come in are, how can we apply an intersectional lens to COVID-19 disparities? – So one thing I would jump in and say about intersectionality, I mean, there are lots ofdifferent intersections that we could consider, but going back to some ofwhat Cassie was talking about, black women in particular, I do a lot of work on black women, on African Americans in general.

But when we look at kind of the intersectionof race and gender, I think we see some verychallenging disparities before us.

We know, for example, that black women comprise the majority ofthe essential workforce.

And so black women, just inthat statistic, excuse me, just in that statistic alone, we know are at greater risk for exposure because they'reout there on the front lines.

And it doesn't mean thatother groups aren't, but we're seeing it really highly among African American women just in terms of theopportunity for risk exposure, the opportunity forexposure because of that.

And so I think we have to, you know, when we think about black women, we also can think about responsibilities for childcare and a number of otherchallenges that create an additional burdenof stress that, again, we already know can set someone up to be more biologically susceptible to a variety of poor health outcomes, COVID just being one of many.

So I think we can talk in a number of ways about the intersection ofnot just race and gender, but race and class, class andgender, race, class and gender and really think about the ways in which, and this gets back to Jason's point about, what did you say, urban acupuncture.

It's really finding those targeted groups, because when we use these kind of population level approaches knowing that the majorityof our population has not been affected, infected, I should say, the majority of our populationhas not been infected.

And so administering interventions to the population atlarge may not actually be the most efficient use of resources, versus identifying the groups, those intersectional groups that are most at risk and shunting resourcestowards those groups that have a more effectiveresponse to COVID-19, but I would argue, to socialchallenges that continue to put the same groups at riskover and over again.

– Okay, thank you.

Thank you, Amani.

That was really important.

Can anyone on the panel address the role of economicdevelopment and gentrification in some of the health issuesthat we've been talking about? – Yeah, I'll start that off, and then I'll perhaps point to Jason.

I think, you know, what's interesting aboutgentrification is I think it is sort of birthed in thisidea of urban renewal and really trying to invest resources into neighborhoods and communities.

And without understandingthe unintended consequences, the potential unintendedconsequences of that, that kind of interventionthat we think would be useful doesn't actually end up being, improving resources for thepeople who need it the most.

So what we understand aboutgentrification is that not only is there this processof involuntary displacement, but even before thathappens, there's an othering that happens in the placesthat you actually live.

And that othering comes with asort of toxic stress response that also increases your risk for a whole variety of health outcomes.

And so when we talk about these anti-racist types of interventions, we can't rely on sort of a blanket policy or sort of a localordinance to, on its own, consider the unintendedconsequences that it may have for marginalized populations.

We have to anticipate it and make sure that there areprecautions put into place, so for example, requiringthat a certain proportion of low income individuals remain in gentrifying neighborhoods.

And so it's this ideaof trying to anticipate what those unintended consequences are and making sure that weaddress them on the front end before we see those consequences play out.

– Yeah, I think that'san excellent response.

And I would just add to that that gentrification and displacement, clearly a significanthealth impact and risk and set of stressors on folks, and often done from, byoutside decision makers.

We got real estate agents.

We got developers.

We've got planners.

All these folks, investment bankers, are driving these changes.

We need to shift who's atthe center of decisions about land use and housing.

So we need these kindof institutional shifts, and like Mahasin said, make sure that folks whoare already in neighborhoods are controlling the decisions about what happens in their communities.

There's no community I've ever visited that doesn't want improvements, but they want the improvementsto be on their terms, and that people who exist andlive there get the benefits.

And that's not what we're seeing, so we need to reallyshift that conversation.

And I think the last thing I would say is we need to take seriouslypublic housing in this country.

We need to stop vilifyingthat that's a bad thing, that that's only gonna leadto concentrations of poverty.

There are ways and lessons from other places and other countries on how to do publichousing well and inclusive, and there are pockets ofcommunities around the country that are doing that.

So that needs to be partof the conversation today about our response to COVID-19.

– And if I could just follow up on something Jason said and Mahasin, Mahasin, you were talkingearlier about buffers, the kinds of buffers, the mainstays in low income communitiesand communities of color that have long beensources of health promotion in non-monetary ways.

They don't have to be kindof economic injection, right? And what we tend to see with urban renewal is that the resourcesthat bridge community and that make community life possible, the social supports, etcetera, that those disappear during times of urban renewal.

And all of a sudden, wehave a new cupcake shop instead of the barber shopwhere everybody would convene, and that was an incrediblesource of community, or the mom and pop bakery, or whatever it may have been, that there's this perception that because we're bringingnew resources into communities, we're uplifting this community.

But the problem is that whenyou don't have community voice, following up on what Jasonsaid, is that the resources that are coming intocommunities are not necessarily the resources that thesecommunities need or want.

– Yes, that's an excellent point, Amani.

We have a question that's come in where people are concernedabout what can we do for poor and elderlyresidents in Richmond, where there is no hospital.

Jason earlier mentioned thathospitals have been closing at a rapid rate in AfricanAmerican communities.

I think right here inBerkeley, there has been, have been protests about the possibility of Alta Bates closing.

Does anyone have a response to this kind of question or issue? – Well, I mean, I don'thave all the response, but I mean, they're exactly right.

The closing of Doctors MedicalCenter a number of years ago really had a bad impact.

That was my point beforeabout hospitals closing around the country, evenright here in the Bay Area, predominantly in communities of color.

There's, you know, a very strong network of community-basedorganizations in West County, across the county, inthe city of Richmond, and many longstanding existingcommunity-based groups are doing great work onthe ground to try outreach to elderly and communities of color.

There's some work, I know, happening in North Richmond, which is kind of the unincorporated part, where there's been a big impact on the closure of affordable housing.

So I would just point that person to maybe check out some of the networks that have been developed in West County.

I know the RYSE organization, R-Y-S-E, has been leading a coalitionof many, many partners in West County to ensurethat folks who need services, like food and care, needto be checked in on, are getting those important services.

– Okay, thanks so much, Jason.

I got questions going in aslightly different direction.

What guiding questionsshould we ask around those, should we ask to people around us as we seek to addressthese more systemic issues that we've been bringing up? In other words, I thinkCassie early mentioned, earlier on mentioned thatpart of what we can all do is to start in conversationswith our family, with our co-workers, questionsto help us think in a frame, a more structural frame of mind.

Does anyone have suggestions about how we can takethat approach better? – So there's, I thinkthere's a lot of power in the question why, and I think something as simple as that.

A wise elder once told me thatquestions clarify thinking.

And at Berkeley, I have hadstudents come into my office, students of color, and convey concern about hearing over and over again how bad blacks are doing, how bad Latinos are doing, how bad Native Americans are doing when we look at health disparities.

So identifying that disparitiesexist, right, which we know, without going further to ask the question why do those disparities exist.

So the conversation oftenstops at the disparities exist, which can, in a lot of ways, naturalize and normalize the differences without interrogating the underlying reasonsfor those disparities.

And so I think even justin simple conversations with one another, well, why is it thatblacks have worse health? Why is it that there's a difference in the underlying distribution of socioeconomic position by race, right? That's not just by happenstance.

There's a history in this countryof the limited opportunity for wealth accumulation becauseof redlining, for example.

There's a limitedopportunity in this country when it comes to academic achievement because of the way thatour schools are funded through properties taxes, which we know is a result of historical redlining and racial residential segregation.

And so I think when westart to ask ourselves why, why and how, then hopefully, it'll force each of us, just as individuals, to digdeeper and really think about kind of the origins of these disparities.

And I think that Cassie made a good point, which is we have to start having this conversation as a country.

It's not enough that wehave this conversation at the Berkeley School of Public Health, at Stanford, at the California DPH.

Like, that's not enough.

People need to be havingthese conversations around their dinner tables every evening, when they take walks.

This hopefully will start to catalyze those kinds of conversations.

– We have a lot of questionscoming in from our audience.

People are interested inways that they can help.

They're interested in waysof reaching out in Berkeley and in ways that we can, oncampus, help black students.

So can any of you describe, and I think this issomething we might be able to follow up on, but whetheror not there are projects in Berkeley, for example, that people could work with, or campus-related projectsthat people could work with to help address what'sgoing on with the pandemic related to race and racism? – So I'll start.

And I think that, you know, unfortunately, the initial sort of calls for work really focused on, you know, understanding the prevalenceof COVID-19 in the population, trying to identify, youknow, sort of vaccines, trying to do contact tracing, you know, sort of really to understandthis at a population level.

And while I think that's important, I think the next stage ofthat is going to really be to collect more data tounderstand the social patterning of not only the current COVID-19 pandemic, but the aftermath of it.

And I think what we'regonna understand soon when we get the data is that, you know, the kind of stark differences that we see based on social sort of hierarchies are going to be even more pronounced.

So there's going to be this post COVID or, you know, sort of erathat we're entering into where, you know, as we see, unemployment is increasing.

We see that, you know, that education is being sort of affected based on, you know, sort of who has access to high quality educationas we shelter in place and what that's going to mean in terms of long-termconsequences of that.

So more and more, youare going to see studies and institutions who arefunding work that's gonna unpack the social determinants of COVID-19, and so there'll be opportunitiesto get involved in that once those sort of studies emerge.

– Thanks.

Were there any more thoughtsfrom the panelists on this? – One organization I'd like to highlight in the city of Berkeley in particular, since you mentioned that, Denise, is Healthy Black Families.

And anyone who's interestedcan visit their website at healthyblackfamiliesinc.


And I'm just reading fromtheir mission statement, which is to educate, engage and advocate for the holistic growth and development of diverse black individuals and families.

Their vision is a society thatis fair, equitable and just, particularly in relation toblack individuals and families.

Health equity is achieved when we no longer see healthdisparities based on race.

And the founder of Healthy Black Families is Vicki Alexander, who isthe former health officer for the city of Berkeley.

And they're just doing a lot to really not only educate, but to provide resources to black families in the city of Berkeley.

So for those who are lookingfor organizations to support who are actively engaged in this work, I would just highlightHealthy Black Families as one of those organizationsin the city of Berkeley.

– And I'd also like to invite everybody to check out the Othering andBelonging Institute's website.

The institute is working veryhard to gather resources.

They are involved in training advocates, and they're working with a lot of people in policy and directly on the ground as a point for resources.

We have been having a wonderfultime with our conversation, but it's going to cometo a close very quickly.

I wanted to ask if the panelists, if they each wanna take 20 or 30 seconds with any final thoughts.

They have to be brief because we have about three minutes left, and so we need to wrap up now.

– So I'll start by justsaying that this is the first of a series of conversationsthat we're going to have.

So stay tuned next week.

We're going to have a panelwith Nancy Krieger on May 1st from four to five p.


So there'll be details on that posted on our School ofPublic Health website.

I think, obviously, oneconversation is not enough, but it at least was an importantstart of the conversation.

I think if you wanna havesome takeaways, you can, you know, sort of have your hashtag.

We've seen them in the media, #Stopblamingblackpeoplefordyingis one of them, #Whatdidyouthinkwasgonnahappen, this is not a surprise, #Weneedtodobetter.

Those are a few that come to mind for me in terms of my closing remarks.

– 20 seconds.

Anyone else? 20 seconds, Amani.

– I can't do 20 seconds.

(laughs) I'd like to say thateveryone as an individual, I mean, we can just startas individuals, right? So just ask yourself whereyou enter this conversation.

We each started with talking about how we enter the conversation.

How do you enter the conversation? And how can you start tohave a rippling effect in your own communities and networks by instigating thesekinds of conversations, and to use the taglineof another organization, to really have courageous conversations about race and theimpact of race and racism in this country, and how itimpacts health disparities? – Osagie, last words? – Yeah, I guess to follow up on what was said earlierby Mahasin and Amani, I think we all have to be okay with having uncomfortable conversations, because if we really wanna get down to the core of this problem around racial disparities and COVID-19, it's a really, reallyuncomfortable conversation.

And once you are prepared for that, then you open yourself up to new ways of thinking about the world around us.

– Anyone else? Okay, well, thank you.

This has been a wonderful experience.

I really enjoyed coming toyou with this great panel of experts, and friends and colleagues.

And all of these are professors.

We're all teaching classes onrace and structural racism.

So please check us out inthe fall when we come back and teach a whole new slate of classes.

Thank you all so much for being with us.

And thanks so much toour Facebook audience who has also been great.


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