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- Hello, welcome everyone.

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Can you hear me fine?

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Good.

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Okay, my name is Jeanne Shea
and I'm the director of the

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health and society program,
and it's so great to see

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so many colleagues and students
and fellow staff members,

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and it is my great honor today

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to present Dr. Clarence, Lance Gravlee.

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I first became aware of Dr.
Gravlee's work several years ago

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when I read his brilliant article,

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"How Race Becomes Biology"

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that traced mechanisms and
pathways by which racism

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leads to disparities in
health along racialized lines.

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I brought this to my colleagues

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and

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due to the generous

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support of all of you, we're able to bring

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Dr. Gravlee here today.

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And I'd like to thank the
departments of anthropology,

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biology, critical race and
ethnic studies program,

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the health and society
program, health sciences,

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the college of arts and
sciences Dean's office,

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and the office of diversity,
equity, and inclusion

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at the Larner College of Medicine.

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It truly takes a village.

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Dr. Gravlee is an associate
professor in anthropology

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at the University of Florida,

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where he did his master's and PhD work.

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He is a medical and
biological anthropologist

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who focuses on critical
biocultural approaches

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to the health consequences
of social inequalities,

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including racism.

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Sorry, this mask is really getting me.

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I also have asthma, so there's my excuse.

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So Dr. Gravlee has done
research in many communities,

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including USA mainland

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and Puerto Rican
African-American communities

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and Amazonian Bolivian
communities, among others.

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He is a member of the health disparities

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and equity promotion study section

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of the National Institutes of Health.

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He is published in many high
profile scholarly journals,

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such as the American
Journal of Human Biology,

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BMC Public Health, the American
Journal of Public Health,

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and Social Science in Medicine,

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and he has numerous grants

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alone from the National Science Foundation

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and the American Heart Association,

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and most distinguished on his CV.

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He is now an honorary Vermonter,

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having deemed our weather refreshing,

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so Dr. Lance Gravlee, welcome
to the University of Vermont.

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(audience claps)

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- Well, Professor Shea,

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thank you so much for that
warm welcome, and it's true.

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It is still hurricane season back home,

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so it's wonderful to get
a little taste of fall

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here in Burlington.

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I would like to thank
the University of Vermont

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for this opportunity to
speak to you all today,

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and for all of you for being here,

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whether you're here in
the room with us now,

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or tuning in online, I'm very
grateful for the opportunity,

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and I take it as a sign, both
of Professor Shea's vision

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and the vibrant intellectual climate here

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at the University of Vermont,

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that she just rattled off such a long list

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of units on campus who have come together

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to have this important discussion,

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so I join Professor Shea
in saying thank you to

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the various deans and program directors

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and department chairs

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who have offered their
support to this event.

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I'd also like to thank
the many people who have

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worked so hard behind the
scenes to make my visit here

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such a stimulating one.

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Those that I know about in
addition to Professor Shea

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include Marilyn Eldred,
Debra Blum, Margaret Gilman,

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and Professor Alison Brody
from the department of biology

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so thank you all, and if there
are others I don't know about

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know that you have my gratitude.

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Now before I proceed, let me note

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that my talk, as the title suggests,

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deals with the harms of racism

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and what I have to say
will land differently

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for each of you,
depending on where you sit

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in relationship to the
violent systems of racism

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and white supremacy.

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If you believe you are white,

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as James Baldwin might've
said, then it is important,

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I think, to confront
racism and white supremacy

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for what they are,

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violent systems of oppression.

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I simply don't know how else
we can redress the harms

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or stand a chance of
dismantling white supremacy

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unless we face that basic fact.

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I also recognize that if you have

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experienced the harms of racism firsthand,

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then my remarks will
mean something different.

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I hope that you will find them empowering,

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maybe enlightening,

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but I also acknowledge that
some of the images and themes

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that I will discuss may be
challenging in a different way,

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and I will try my best to
approach that tension with care.

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So almost 20 years ago,

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Scientific American
inadvertently set up a puzzle

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that has preoccupied me ever since

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with this question posed on
the cover, does race exist?

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Now part of what has kept my
attention all of these years

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is the ambiguity of the question itself.

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The implicit question on the cover

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and the focus of enduring
debate in the biomedical

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and other health-related sciences

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is whether race exists as a
natural, biological division

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of humankind.

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In particular, to what
extent does race capture

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meaningful genetic differences

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that confers susceptibility to disease,

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response to pharmaceutical therapy,

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or other meaningful outcomes?

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The importance of this
question has never waned,

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although

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it

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is in sharper focus now

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as the COVID-19 pandemic wears on.

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So it's an important question,

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but it's incomplete because
we should also be asking

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in what ways does race exist

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as a political, economic,
and social structure

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that has force in people's lives?

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Indeed, that has biological consequences.

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Now today, more than anytime
since I began working

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in this area, I shouldn't
have to work very hard

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to convince you that race
has force in people's lives.

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The Black Lives Matter
movement draws attention

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to the extreme, but
routine forms of violence

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that shorten the lives of
black mothers, fathers,

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sons, daughters.

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We recite the names of
Trayvon Martin, Michael Brown,

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Eric Gardner, Sandra Bland, Tamir Rice,

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the Charleston Nine, Elton
Sterling, Philando Castile,

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Ahmaud Aubrey, Breonna Taylor,
George Floyd, Tony McDade,

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and a shameful number of others

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to reclaim their humanity

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and acknowledge the value of their lives.

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These cases compel us
because of the overt violence

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and devaluation of black
life that they betray,

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but we should be careful not
to allow police brutality

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and overt violence to define or limit

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our understanding of racism

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because the system that
gives rise to such violence

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has more subtle and pervasive effects

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on black lives every day,

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shaping the risk of good or poor health,

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of long lives or premature death.

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And again, current events
make the cost of racism plain.

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The slow violence of systemic
racism and white supremacy

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means that the COVID-19 pandemic

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has exposed the fault
lines of deep seated,

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historically rooted racial
inequities in our society.

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And so, as we mourn all of
the more than 675,000 people

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who have died from COVID-19
in the United States,

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we should also be outraged

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that the age adjusted death rates

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for indigenous, black, and
Latinx people in the U.S.

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were all more than 2.7 times greater

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than for white people in 2020.

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And we should also be clear
that the racialized dynamics

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of COVID-19 and police brutality

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did not just happen to coincide.

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They are in fact deeply intertwined.

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Both crises reflect forms of violence,

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one fast, one slow, rooted in
centuries of state sanctioned,

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racialized oppression.

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Both have been met with
struggle and resistance.

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Each exacerbates the other,

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and both in haunting echoes of history,

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lead disproportionately
to the premature, unjust,

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excess death of black
and indigenous people,

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that is the descendants of those from whom

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settlers took land and of
those they forced to work it.

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And so claims that the current moment

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is unprecedented ring hollow.

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The crises we are living
through now are an extension,

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not an aberration of U.S. history.

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To the extent that any
of it is unprecedented,

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it is the fact that it
is harder and harder

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for people who are racialized
as white to look away.

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Indeed, if we look at the
history of life expectancy

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in the United States,

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here I'm showing you just a
snippet from 1980 to 2006,

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we can see that the good
news is that death rates

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have been coming down for
our population as a whole,

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and

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yet

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the chances of living a long life

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is also distributed along racial lines.

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It's difficult to overstate

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the magnitude of these inequities.

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About 20 years ago, one group
of public health researchers

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estimated that between 1940 and 1999,

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some 4.3 million African
Americans died prematurely

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compared to their white counterparts.

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That works out to about
88,000 people every year

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who died earlier than
they would if death rates

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for black and white
Americans was the same,

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and these inequalities are
not due to any single cause.

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We can find evidence of racial inequities

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in all sorts of biological
parameters, from

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birth weight and body mass,

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certain cancers, cardiovascular disease.

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Just about everywhere we look,

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we find evidence of clear
and consistent inequalities

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in the end points of life.

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And for many observers,

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these disparities appear to
legitimate the assumption

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that race corresponds to some fundamental,

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biological differences
between types of humans.

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Media portrayals like
the one that you see here

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appear to confirm what everybody knows,

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that race is biology,

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and then it sanctions this folk belief

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with the authority of science.

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But this report also highlights

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the conceptual problem with the science,

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because the study on which it's based

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inferred genetic causation
even without genetic data.

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This inference is clearly unwarranted,

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and yet the article was featured

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in the American Journal of
Obstetrics and Gynecology

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as the editors choice of that issue,

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along with an independent
commentary asserting that quote,

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"The genetic link is very strong,"

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all in the absence of genetic data.

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And during the COVID-19 pandemic,

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we've seen similar ideas
reach a broad audience.

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In an April 7th, 2020
interview with NPR News,

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Louisiana senator Bill Cassidy,
who is also a physician,

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speculated that his
African-American constituents

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were at higher risk of death from COVID-19

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because of unspecified genetic reasons.

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Again, this claim is entirely unwarranted

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as there remains no credible evidence

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of racial genetic
differences in susceptibility

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to COVID-19 mortality,
while it is abundantly clear

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that social factors shape
both the risk of exposure

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to SARS CoV-2

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and the distribution
of comorbid conditions

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that increase the likelihood
of severe outcomes.

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And so

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we need to understand

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that there are three
elements, three reasons,

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why race is not a useful way

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for understanding these inequalities.

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The first is that contrary to folk wisdom,

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race is a poor proxy
for what we know about

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patterns of human genetic variation.

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Second systemic racism has
biological consequences,

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which we can see manifested in COVID-19,

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but were also evident beforehand.

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00:17:02,830 --> 00:17:05,590
And third, the embodied
inequalities that we witness

262
00:17:05,590 --> 00:17:09,410
in COVID-19 as in cancer and
diabetes and hypertension

263
00:17:09,410 --> 00:17:13,120
reinforce the folk view of race as biology

264
00:17:13,120 --> 00:17:16,070
and deflect attention from
the modifiable aspects

265
00:17:16,070 --> 00:17:18,423
of our political and economic structure,

266
00:17:19,410 --> 00:17:21,910
which would result in
a healthier population

267
00:17:21,910 --> 00:17:24,240
if we had a more just society.

268
00:17:24,240 --> 00:17:26,010
So I'd like to pick up these ideas

269
00:17:29,044 --> 00:17:31,537
in the context of work
on what some had called

270
00:17:31,537 --> 00:17:35,187
"The Puzzle of Hypertension
in African-Americans."

271
00:17:36,790 --> 00:17:39,560
The first piece of this puzzle is that

272
00:17:39,560 --> 00:17:42,883
in populations of African
ancestry throughout the Americas,

273
00:17:44,040 --> 00:17:46,200
rates of hypertension and
average blood pressures

274
00:17:46,200 --> 00:17:48,150
tend to be higher in
people of African descent

275
00:17:48,150 --> 00:17:50,000
than in others in the same societies,

276
00:17:50,000 --> 00:17:54,000
and this pattern is best
documented in the United States

277
00:17:54,000 --> 00:17:57,900
where we know that hypertension
is roughly 50% more common

278
00:17:57,900 --> 00:18:00,410
among black people than
it is among white people.

279
00:18:00,410 --> 00:18:04,290
Similar trends have been observed
in parts of the Caribbean

280
00:18:04,290 --> 00:18:08,550
and in Latin America, although
the magnitude of inequalities

281
00:18:08,550 --> 00:18:11,860
is nowhere as great as it
is in the United States.

282
00:18:11,860 --> 00:18:14,000
And the first reason that
this puzzle is important

283
00:18:14,000 --> 00:18:16,040
is because of the devastating impact

284
00:18:16,040 --> 00:18:17,910
in terms of public health.

285
00:18:17,910 --> 00:18:19,660
One group of researchers estimated

286
00:18:19,660 --> 00:18:22,650
that racial inequalities in hypertension,

287
00:18:22,650 --> 00:18:24,080
chronic high blood pressure,

288
00:18:24,080 --> 00:18:26,730
account for 15% of black-white disparities

289
00:18:26,730 --> 00:18:29,780
in potential life years lost.

290
00:18:29,780 --> 00:18:32,800
So if we could do one
thing to close the gap

291
00:18:32,800 --> 00:18:36,620
in racial inequalities in life expectancy

292
00:18:36,620 --> 00:18:39,700
dealing with racial
inequalities in hypertension

293
00:18:39,700 --> 00:18:41,743
would have a massive impact.

294
00:18:43,000 --> 00:18:44,790
Another reason that the
puzzle of hypertension

295
00:18:44,790 --> 00:18:49,790
is significant is that generations
of attempts to solve it

296
00:18:50,050 --> 00:18:52,940
have assumed that some
intrinsic racial difference

297
00:18:52,940 --> 00:18:55,070
is at the root of the problem.

298
00:18:55,070 --> 00:18:56,730
And we can see this assumption reflected

299
00:18:56,730 --> 00:18:58,370
even in the language

300
00:18:59,621 --> 00:19:00,830
of biomedical reports.

301
00:19:00,830 --> 00:19:02,910
Consider for example,

302
00:19:02,910 --> 00:19:03,743
this

303
00:19:04,800 --> 00:19:07,927
1981 article in the
Postgraduate Medical Journal

304
00:19:07,927 --> 00:19:11,640
"Is Blood Pressure
Different in Black People?"

305
00:19:11,640 --> 00:19:14,467
Or some 15 years later in the
Journal of Human Hypertension

306
00:19:14,467 --> 00:19:16,430
"Is the pathogenesis of hypertension

307
00:19:16,430 --> 00:19:17,670
different in black patients?"

308
00:19:17,670 --> 00:19:21,480
As if the bodies of black
patients worked differently

309
00:19:21,480 --> 00:19:24,140
than did the bodies of others,

310
00:19:24,140 --> 00:19:27,750
or perhaps most revealingly
this 2000 article

311
00:19:27,750 --> 00:19:30,440
from the Journal of Hypertension,

312
00:19:30,440 --> 00:19:32,530
which implies that the only open question

313
00:19:32,530 --> 00:19:34,730
is which genetic factor is responsible

314
00:19:34,730 --> 00:19:38,100
for excess hypertension among
people of African descent,

315
00:19:38,100 --> 00:19:41,793
not whether it is
primarily a genetic factor.

316
00:19:43,820 --> 00:19:47,060
The same default assumptions
about race, genes, and disease

317
00:19:47,060 --> 00:19:50,090
persist into the present.

318
00:19:50,090 --> 00:19:53,330
Consider for example a recent
review article in the journal

319
00:19:53,330 --> 00:19:56,363
Current Opinions in
Nephrology and Hypertension.

320
00:19:57,581 --> 00:20:00,320
In this review, the authors concede

321
00:20:00,320 --> 00:20:02,980
that the genetic basis
of essential hypertension

322
00:20:02,980 --> 00:20:05,530
remains largely unknown,

323
00:20:05,530 --> 00:20:09,660
and yet they are willing to
assert that racial inequalities

324
00:20:09,660 --> 00:20:11,350
in hypertension pathophysiology

325
00:20:11,350 --> 00:20:13,013
are largely genetic in origin.

326
00:20:14,150 --> 00:20:18,170
They write for example,
"Relative to European Americans,

327
00:20:18,170 --> 00:20:21,380
African-Americans more often
manifest salt sensitivity

328
00:20:21,380 --> 00:20:22,930
with expanded plasma volume

329
00:20:22,930 --> 00:20:24,990
and suppressed plasma renin activity,

330
00:20:24,990 --> 00:20:27,410
non dipping phenotypes, albuminuria,

331
00:20:27,410 --> 00:20:29,630
and end-stage renal disease.

332
00:20:29,630 --> 00:20:32,650
These factors support an
inherited basis for disease,"

333
00:20:32,650 --> 00:20:33,483
they say.

334
00:20:34,560 --> 00:20:38,240
Even if you don't know what
non dipping phenotypes are,

335
00:20:38,240 --> 00:20:40,890
hopefully you recognize the logical flaw,

336
00:20:40,890 --> 00:20:44,980
which is that the researchers
have inferred a genetic cause

337
00:20:44,980 --> 00:20:47,633
based only on differences in phenotype.

338
00:20:48,790 --> 00:20:51,070
And we have known at least since Mendel,

339
00:20:51,070 --> 00:20:53,130
that such inferences are unwarranted,

340
00:20:53,130 --> 00:20:57,400
even for traits as simple as
the hydro color of garden peas,

341
00:20:57,400 --> 00:21:00,793
not to mention complex
phenotypes like blood pressure.

342
00:21:01,740 --> 00:21:04,150
So it remains an open question,

343
00:21:04,150 --> 00:21:06,820
to what extent the phenotypic differences

344
00:21:06,820 --> 00:21:10,160
these authors observe are
attributable to genes,

345
00:21:10,160 --> 00:21:14,260
to environments, or more
likely to complex interactions

346
00:21:14,260 --> 00:21:15,093
between them.

347
00:21:16,440 --> 00:21:17,930
The available evidence, by the way,

348
00:21:17,930 --> 00:21:20,070
undermines the assumption
that in this case

349
00:21:20,070 --> 00:21:22,940
genes have much to do with it at all.

350
00:21:22,940 --> 00:21:26,700
Researchers have spent
incredible sums of taxpayer money

351
00:21:26,700 --> 00:21:28,440
searching for genetic contributors

352
00:21:28,440 --> 00:21:30,193
to racial inequalities in health.

353
00:21:31,210 --> 00:21:34,210
In a systematic review of
research on cardiovascular disease

354
00:21:34,210 --> 00:21:37,810
in particular show that this
effort has been for naught.

355
00:21:37,810 --> 00:21:38,977
Kaufman and colleagues write that,

356
00:21:38,977 --> 00:21:40,790
"Despite the rapid increase in the number

357
00:21:40,790 --> 00:21:42,890
of genomic studies over the past decade

358
00:21:42,890 --> 00:21:44,800
that covered many outcomes,

359
00:21:44,800 --> 00:21:47,530
the accumulated evidence
for a genetic contribution

360
00:21:47,530 --> 00:21:49,970
to cardiovascular disease disparities

361
00:21:49,970 --> 00:21:53,477
in blacks versus whites
has been essentially nil."

362
00:21:56,100 --> 00:21:57,420
Nevertheless,

363
00:21:57,420 --> 00:22:00,450
the assumption that there are
racial genetic differences

364
00:22:00,450 --> 00:22:03,740
in predisposition to
hypertension persists,

365
00:22:03,740 --> 00:22:06,700
and it has pernicious
effects on the practice

366
00:22:06,700 --> 00:22:08,533
of biomedical research.

367
00:22:09,500 --> 00:22:12,960
As one example, consider a
study by Tang and colleagues,

368
00:22:12,960 --> 00:22:15,550
out of Neil Risch's Lab at Stanford,

369
00:22:15,550 --> 00:22:19,140
in which the goal was to
test for associations between

370
00:22:19,140 --> 00:22:23,400
individual level measures
of genetic ancestry.

371
00:22:23,400 --> 00:22:26,563
Described here tellingly
as racial admixture.

372
00:22:27,460 --> 00:22:30,910
And two health outcomes, body
mass index and blood pressure

373
00:22:30,910 --> 00:22:33,240
in African-Americans and Mexican Americans

374
00:22:33,240 --> 00:22:35,390
in the family blood
pressure program study.

375
00:22:36,770 --> 00:22:39,187
The researchers conclude
that their results are quote,

376
00:22:39,187 --> 00:22:42,990
"suggestive of genetic
differences between Africans

377
00:22:42,990 --> 00:22:46,360
and non Africans that
influence blood pressure,

378
00:22:46,360 --> 00:22:49,340
but such effects are likely to be modest

379
00:22:49,340 --> 00:22:51,097
compared to environmental ones."

380
00:22:52,786 --> 00:22:55,303
The second part of this
sentence is correct.

381
00:22:56,620 --> 00:22:58,570
The first is not for two reasons.

382
00:22:58,570 --> 00:23:01,840
First, the study actually produced

383
00:23:01,840 --> 00:23:06,350
no statistically significant
evidence of an association

384
00:23:06,350 --> 00:23:09,443
between African genetic
ancestry and blood pressure,

385
00:23:10,320 --> 00:23:13,570
so their assertion of
genetic differences clearly

386
00:23:13,570 --> 00:23:16,380
stretches beyond the data in a way that

387
00:23:16,380 --> 00:23:18,360
some of the peer reviewers and editors

388
00:23:19,430 --> 00:23:20,533
ought to have caught.

389
00:23:21,930 --> 00:23:24,720
Second, the study
illustrates a more pervasive

390
00:23:24,720 --> 00:23:27,400
and pernicious problem in the role of race

391
00:23:27,400 --> 00:23:29,103
in health-related research.

392
00:23:30,400 --> 00:23:33,120
These researchers examined the association

393
00:23:33,120 --> 00:23:36,050
between two clearly biological parameters,

394
00:23:36,050 --> 00:23:40,690
genetic ancestry, estimated
from DNA, and blood pressure.

395
00:23:40,690 --> 00:23:43,560
If they observed an association,

396
00:23:43,560 --> 00:23:47,710
they attribute it to some unspecified

397
00:23:47,710 --> 00:23:49,570
susceptibility alleles.

398
00:23:49,570 --> 00:23:53,830
That is some form of genetic
variation that is presumably

399
00:23:53,830 --> 00:23:56,000
more common among people
with higher levels

400
00:23:56,000 --> 00:23:58,160
of African genetic ancestry,

401
00:23:58,160 --> 00:24:00,383
and is also linked to blood pressure,

402
00:24:01,440 --> 00:24:05,080
but they have not
identified any such alleles,

403
00:24:05,080 --> 00:24:08,040
and so they have no evidence
to support the inference that

404
00:24:08,040 --> 00:24:12,133
if an association exists, it
is because of a genetic cause.

405
00:24:13,540 --> 00:24:15,673
And another interpretation is possible.

406
00:24:16,750 --> 00:24:18,990
It could also be that the relationship

407
00:24:18,990 --> 00:24:21,240
between these two biological parameters

408
00:24:21,240 --> 00:24:24,663
is entirely mediated through experience.

409
00:24:26,020 --> 00:24:28,440
If being a person of African descent

410
00:24:28,440 --> 00:24:31,460
shapes the life experiences
and exposures one has

411
00:24:31,460 --> 00:24:36,460
in a racially stratified
society, and it surely does,

412
00:24:36,620 --> 00:24:38,930
then genetic ancestry could be associated

413
00:24:38,930 --> 00:24:42,580
with blood pressure through
socio-cultural processes

414
00:24:42,580 --> 00:24:45,570
involving exposure to
discrimination, poverty,

415
00:24:45,570 --> 00:24:48,653
and social stressors
linked to systemic racism.

416
00:24:50,794 --> 00:24:53,860
Now I was ranting about
this particular study

417
00:24:53,860 --> 00:24:56,870
several years ago in one
of my graduate seminars,

418
00:24:56,870 --> 00:25:00,630
and then graduate student Amy
Naan who's now a professor

419
00:25:00,630 --> 00:25:02,480
at University of California San Diego

420
00:25:03,550 --> 00:25:05,280
came to my office hours
a couple of days later

421
00:25:05,280 --> 00:25:06,870
to point out that the data set

422
00:25:07,974 --> 00:25:10,670
that was analyzed in this
study was publicly funded

423
00:25:10,670 --> 00:25:13,320
and therefore publicly
available so she downloaded it

424
00:25:14,270 --> 00:25:16,700
and she found that there were not exactly

425
00:25:16,700 --> 00:25:20,550
robust measures of experience,

426
00:25:20,550 --> 00:25:23,800
but there was one simple measure
that we could make use of

427
00:25:23,800 --> 00:25:27,153
which is the years of education
that people had attained.

428
00:25:28,860 --> 00:25:29,693
So

429
00:25:30,660 --> 00:25:31,750
Amy

430
00:25:31,750 --> 00:25:32,890
and her

431
00:25:32,890 --> 00:25:34,920
mentor Connie Mulligan, and I

432
00:25:36,040 --> 00:25:38,370
reanalyzed the data set and

433
00:25:39,220 --> 00:25:41,410
included this one simple measure,

434
00:25:41,410 --> 00:25:43,220
years of education that
people had attained.

435
00:25:43,220 --> 00:25:46,610
Now surely no one would consider
this to be a robust measure

436
00:25:46,610 --> 00:25:49,690
of all the various ways
in which systemic racism

437
00:25:49,690 --> 00:25:52,800
constrains and shapes people's lives,

438
00:25:52,800 --> 00:25:55,426
and yet in the first
analysis where we exclude

439
00:25:55,426 --> 00:25:58,810
education from the model,
we appear to replicate

440
00:25:58,810 --> 00:26:00,510
what this other group of researchers did,

441
00:26:00,510 --> 00:26:04,080
which is that there
seems to be some modest

442
00:26:04,080 --> 00:26:06,040
though not statistically significant

443
00:26:06,040 --> 00:26:08,400
by conventional standards evidence

444
00:26:08,400 --> 00:26:10,670
that higher levels of
African genetic ancestry

445
00:26:10,670 --> 00:26:13,260
are associated with higher blood pressure.

446
00:26:13,260 --> 00:26:18,030
But even that borderline
evidence holds only if we ignore

447
00:26:18,030 --> 00:26:20,830
the availability of another measure.

448
00:26:20,830 --> 00:26:24,663
Once we include years of
education in the model,

449
00:26:26,020 --> 00:26:29,210
then what Amy found was
that each additional year

450
00:26:29,210 --> 00:26:32,190
of education that people had attained

451
00:26:32,190 --> 00:26:35,330
was associated with about
half a millimeter of mercury

452
00:26:35,330 --> 00:26:36,340
lower blood pressure,

453
00:26:36,340 --> 00:26:39,280
which when you now scale it
up to a population level,

454
00:26:39,280 --> 00:26:40,530
and you think about the differences

455
00:26:40,530 --> 00:26:42,140
between a high school education or not,

456
00:26:42,140 --> 00:26:43,360
a college education or not,

457
00:26:43,360 --> 00:26:44,920
graduate training or not,

458
00:26:44,920 --> 00:26:49,260
we're talking about a
pretty substantial fraction

459
00:26:49,260 --> 00:26:51,933
of the inequalities in blood pressure.

460
00:26:53,220 --> 00:26:55,400
And notice that at the same time,

461
00:26:55,400 --> 00:26:57,610
any evidence that had existed before

462
00:26:57,610 --> 00:27:00,453
for an African genetic
ancestry effect evaporated.

463
00:27:03,020 --> 00:27:06,110
What this set of findings
points us toward is a need

464
00:27:06,110 --> 00:27:08,620
for clarity about the
different kinds of things

465
00:27:08,620 --> 00:27:11,790
people have in mind when they
invoke the concept of race.

466
00:27:11,790 --> 00:27:14,160
Some researchers talk about race

467
00:27:14,160 --> 00:27:16,480
as a proxy for genetic ancestry,

468
00:27:16,480 --> 00:27:19,120
something that increasingly
we can measure directly

469
00:27:19,120 --> 00:27:22,333
so we don't need race as a proxy for that.

470
00:27:22,333 --> 00:27:24,480
And social scientists on the
other hand think about race

471
00:27:24,480 --> 00:27:26,640
as an aspect of social classification,

472
00:27:26,640 --> 00:27:30,790
as part of a system that
arose to classify humans

473
00:27:30,790 --> 00:27:33,460
in the context of political
and economic structures

474
00:27:33,460 --> 00:27:34,480
of white supremacy.

475
00:27:34,480 --> 00:27:38,010
So one of the challenges
for us as health researchers

476
00:27:38,010 --> 00:27:40,950
is to move beyond the
use of race as a proxy

477
00:27:40,950 --> 00:27:42,920
for these very different sorts of things

478
00:27:42,920 --> 00:27:44,270
and try to measure them directly

479
00:27:44,270 --> 00:27:48,253
so that we can test competing
hypotheses more efficiently.

480
00:27:49,750 --> 00:27:52,608
This is the basic motivation
for some of my earlier work

481
00:27:52,608 --> 00:27:54,960
on the Southeastern coast of Puerto Rico,

482
00:27:54,960 --> 00:27:56,990
where I set out to isolate

483
00:27:56,990 --> 00:28:01,550
genetic ancestry from local
forms of social classification,

484
00:28:01,550 --> 00:28:04,520
and the choice of Puerto
Rico was driven by the fact

485
00:28:04,520 --> 00:28:07,720
that generations of social
scientists before me

486
00:28:07,720 --> 00:28:11,070
had documented that the way
people think about color

487
00:28:11,070 --> 00:28:13,280
on the island is different from the way

488
00:28:13,280 --> 00:28:15,850
people think about color on the mainland.

489
00:28:15,850 --> 00:28:18,610
In particular, it sets
up the possibility that

490
00:28:18,610 --> 00:28:21,020
people could have the
same kind of ancestry or

491
00:28:21,020 --> 00:28:24,060
even the same physical
appearance and yet be assigned

492
00:28:24,060 --> 00:28:26,370
to different social categories.

493
00:28:26,370 --> 00:28:29,400
That makes it possible then to consider,

494
00:28:29,400 --> 00:28:31,230
is it really genetic ancestry

495
00:28:31,230 --> 00:28:34,510
or is it the way that people
are classified by others,

496
00:28:34,510 --> 00:28:36,000
and therefore treated,

497
00:28:36,000 --> 00:28:39,085
that helps to drive the pattern of health?

498
00:28:39,085 --> 00:28:41,040
And the punchline from this work is that

499
00:28:41,040 --> 00:28:43,220
the social ascription of color,

500
00:28:43,220 --> 00:28:45,740
the way that people are
identified by others,

501
00:28:45,740 --> 00:28:48,210
was associated with blood pressure,

502
00:28:48,210 --> 00:28:50,933
but that genetic ancestry was not.

503
00:28:52,350 --> 00:28:55,030
So to get to this punchline,

504
00:28:55,030 --> 00:28:57,540
my colleagues and I drew on a range of

505
00:28:57,540 --> 00:28:59,350
social scientific methods beginning from

506
00:28:59,350 --> 00:29:02,031
the classic method of
participant observation,

507
00:29:02,031 --> 00:29:04,320
which means anthropologists
going and hanging out

508
00:29:04,320 --> 00:29:05,570
with people to try to understand

509
00:29:05,570 --> 00:29:07,550
the way that they see the world,

510
00:29:07,550 --> 00:29:09,870
and one day I was sitting in
the shop of a friend of mine

511
00:29:09,870 --> 00:29:11,550
asking questions about race,

512
00:29:11,550 --> 00:29:15,000
like generations of North
American social scientists

513
00:29:15,000 --> 00:29:17,670
had done before me, and
she interrupted me to say

514
00:29:17,670 --> 00:29:20,330
that I was asking all the wrong questions.

515
00:29:20,330 --> 00:29:21,877
She said here, as you see,

516
00:29:21,877 --> 00:29:26,010
"Here there are no
divisions of race, of raza,

517
00:29:26,010 --> 00:29:28,380
but there are divisions of color."

518
00:29:28,380 --> 00:29:29,940
And she went on to explain that

519
00:29:29,940 --> 00:29:31,940
when I was talking about raza,

520
00:29:31,940 --> 00:29:34,090
that it meant something
entirely different on the island

521
00:29:34,090 --> 00:29:35,910
than it meant in the United States,

522
00:29:35,910 --> 00:29:37,330
that it was a form of expressing

523
00:29:37,330 --> 00:29:39,170
Puerto Rican national identity,

524
00:29:39,170 --> 00:29:40,130
that it involved

525
00:29:41,105 --> 00:29:44,520
the singular intermixture of European

526
00:29:44,520 --> 00:29:48,260
and Taino and African
roots, often in that order.

527
00:29:48,260 --> 00:29:50,690
But that people did perceive
differences in color

528
00:29:50,690 --> 00:29:52,940
that shape their everyday experiences,

529
00:29:52,940 --> 00:29:54,840
and so my job as a social scientist then

530
00:29:54,840 --> 00:29:57,970
was to try to understand how do those

531
00:29:57,970 --> 00:30:00,670
classification systems work.

532
00:30:00,670 --> 00:30:03,970
One brief example of the
answer to that question

533
00:30:03,970 --> 00:30:06,600
comes from this image, which is

534
00:30:06,600 --> 00:30:09,330
a representation of the way that

535
00:30:09,330 --> 00:30:11,660
a diverse sample of Puerto Ricans sorted

536
00:30:11,660 --> 00:30:13,490
a set of standardized facial portraits

537
00:30:13,490 --> 00:30:16,230
that varied in skin tone and hair texture

538
00:30:16,230 --> 00:30:17,520
and facial features,

539
00:30:17,520 --> 00:30:18,760
as a way of saying exactly

540
00:30:18,760 --> 00:30:20,310
how are these differences perceived?

541
00:30:20,310 --> 00:30:25,200
In other words, how is color
constructed in this context?

542
00:30:25,200 --> 00:30:26,846
And what matters is

543
00:30:26,846 --> 00:30:29,760
that you see there are
five major groupings,

544
00:30:29,760 --> 00:30:31,870
these, the locally meaningful categories

545
00:30:31,870 --> 00:30:34,530
that shape people's perception of color

546
00:30:34,530 --> 00:30:36,360
and the lines that you see

547
00:30:36,360 --> 00:30:40,670
represent the significance of
both skin color and hair form,

548
00:30:40,670 --> 00:30:44,893
which is to say that color,
color, isn't just about color.

549
00:30:45,810 --> 00:30:47,960
It also differs based on other aspects

550
00:30:47,960 --> 00:30:49,910
of your physical appearance,
like your hair texture,

551
00:30:49,910 --> 00:30:52,960
not to mention non-biological
markers of social status,

552
00:30:52,960 --> 00:30:56,260
like what neighborhood you
live in or what job you have

553
00:30:56,260 --> 00:30:58,500
or where your family comes from,

554
00:30:58,500 --> 00:31:00,260
and we know from the
social science literature,

555
00:31:00,260 --> 00:31:02,520
that all of these things affect

556
00:31:02,520 --> 00:31:06,050
the way that people are
categorized in this context.

557
00:31:06,050 --> 00:31:09,470
What that allows us to do
then is to examine the way

558
00:31:09,470 --> 00:31:11,000
that people are categorized

559
00:31:11,000 --> 00:31:13,610
and how that relates to
the risk of poor health.

560
00:31:13,610 --> 00:31:15,680
We can then combine that with the methods

561
00:31:15,680 --> 00:31:17,770
from human genetics,

562
00:31:17,770 --> 00:31:20,240
using DNA, for example,

563
00:31:20,240 --> 00:31:21,510
to

564
00:31:21,510 --> 00:31:24,220
assay so-called ancestry
informative markers

565
00:31:24,220 --> 00:31:27,790
that produce individual level
measures of genetic ancestry.

566
00:31:27,790 --> 00:31:30,060
This is what the researchers

567
00:31:30,060 --> 00:31:32,430
I was critical of a moment ago just did.

568
00:31:32,430 --> 00:31:35,560
This is a way of trying
to take it into account

569
00:31:36,430 --> 00:31:37,263
differences

570
00:31:38,818 --> 00:31:40,103
in population history.

571
00:31:41,240 --> 00:31:42,440
And then in addition,

572
00:31:42,440 --> 00:31:45,010
my colleague and collaborator
at the University of Florida,

573
00:31:45,010 --> 00:31:49,050
Dr. Connie Mulligan, suggested
that we take that next step

574
00:31:49,050 --> 00:31:51,690
of looking at susceptibility alleles,

575
00:31:51,690 --> 00:31:55,520
that is genetic variants
that might increase the risk

576
00:31:55,520 --> 00:31:57,860
of high blood pressure.

577
00:31:57,860 --> 00:32:01,560
And so in collaboration with
the center for pharmacogenomics

578
00:32:01,560 --> 00:32:03,313
at the University of Florida,

579
00:32:05,280 --> 00:32:10,070
Mulligan and her lab
assayed six polymorphisms

580
00:32:10,070 --> 00:32:13,860
in three genes of the
adrenergic receptor family,

581
00:32:13,860 --> 00:32:16,250
and if you don't know what
those are, that's fine,

582
00:32:16,250 --> 00:32:19,710
just know that this is basically
part of the body's system

583
00:32:19,710 --> 00:32:21,040
that responds to stress,

584
00:32:21,040 --> 00:32:23,610
that's involved in our
fight or flight system.

585
00:32:23,610 --> 00:32:26,220
That's what these genes are involved with.

586
00:32:26,220 --> 00:32:28,260
So we now have three things.

587
00:32:28,260 --> 00:32:30,210
We have the way people are classified.

588
00:32:30,210 --> 00:32:33,180
We have DNA based estimates
of genetic ancestry,

589
00:32:33,180 --> 00:32:36,770
and we have DNA evidence
about candidate genes

590
00:32:36,770 --> 00:32:37,603
for blood pressure.

591
00:32:37,603 --> 00:32:41,320
This sets up the question
about how should we understand

592
00:32:41,320 --> 00:32:42,980
the nature of risk for high blood pressure

593
00:32:42,980 --> 00:32:45,110
in people of African descent?

594
00:32:45,110 --> 00:32:48,240
So the first answer
comes from this result,

595
00:32:48,240 --> 00:32:51,420
which shows you the association between

596
00:32:51,420 --> 00:32:53,820
locally meaningful categories of color.

597
00:32:53,820 --> 00:32:55,460
In this case, it's Blanco or white,

598
00:32:55,460 --> 00:32:57,820
Trigueno or literally wheat colored,

599
00:32:57,820 --> 00:33:00,220
and Negro or black,

600
00:33:00,220 --> 00:33:01,680
along the horizontal axis.

601
00:33:01,680 --> 00:33:04,870
Along the vertical axis,
you see a DNA based estimate

602
00:33:04,870 --> 00:33:06,803
of west African ancestry.

603
00:33:08,210 --> 00:33:11,640
As you might expect,
as you move from Blanco

604
00:33:11,640 --> 00:33:14,680
to Trigueno, to Negro,

605
00:33:14,680 --> 00:33:17,140
you see that the average level

606
00:33:17,140 --> 00:33:21,060
of estimated west African
ancestry increases,

607
00:33:21,060 --> 00:33:23,150
but more importantly

608
00:33:23,150 --> 00:33:27,380
for our purposes here is the
amount of overlap that exists

609
00:33:27,380 --> 00:33:29,130
across these categories.

610
00:33:29,130 --> 00:33:31,950
You can see clearly that
there are certain levels of

611
00:33:31,950 --> 00:33:32,900
estimated

612
00:33:34,250 --> 00:33:36,370
west African genetic
ancestry in which people

613
00:33:36,370 --> 00:33:41,370
could be classified into any
one of these three categories.

614
00:33:42,180 --> 00:33:46,900
This is the core of the
anthropological critique of race,

615
00:33:46,900 --> 00:33:50,360
which says that these socially
constructed categories

616
00:33:50,360 --> 00:33:52,810
are not good proxies for patterns

617
00:33:52,810 --> 00:33:54,410
of human genetic variation,

618
00:33:54,410 --> 00:33:56,870
even when the genetic
markers that we've looked at

619
00:33:56,870 --> 00:34:00,240
have been selected purposely
to pull people apart

620
00:34:00,240 --> 00:34:01,373
into groups.

621
00:34:02,480 --> 00:34:04,960
It also sets up the
possibility of testing,

622
00:34:04,960 --> 00:34:07,570
is it the social categories that you see

623
00:34:07,570 --> 00:34:09,120
along the horizontal axis

624
00:34:09,120 --> 00:34:12,120
or the estimates of genetic ancestry

625
00:34:12,120 --> 00:34:13,180
along the vertical axis

626
00:34:13,180 --> 00:34:15,383
that best predicts blood
pressure variation?

627
00:34:16,560 --> 00:34:18,340
And the answer is

628
00:34:18,340 --> 00:34:19,800
that

629
00:34:19,800 --> 00:34:23,120
the combination of class and color,

630
00:34:23,120 --> 00:34:26,010
so socioeconomic status
in this case measured as a

631
00:34:26,010 --> 00:34:28,823
combination of household
income, education,

632
00:34:30,140 --> 00:34:32,890
that that intersection between
class and color is associated

633
00:34:32,890 --> 00:34:35,593
with blood pressure, but
genetic ancestry is not.

634
00:34:36,810 --> 00:34:38,610
First, if you look at this analysis,

635
00:34:38,610 --> 00:34:41,700
we replicate the same model
that's common in human genetics

636
00:34:41,700 --> 00:34:46,700
in which we look at genetic
estimates of African ancestry

637
00:34:47,340 --> 00:34:50,250
while ignoring the
social and cultural data

638
00:34:50,250 --> 00:34:53,030
that we have about class and color.

639
00:34:53,030 --> 00:34:54,910
And in this first result,

640
00:34:54,910 --> 00:34:57,620
it actually looks like we
provide stronger evidence

641
00:34:57,620 --> 00:34:59,770
than the other group of researchers,

642
00:34:59,770 --> 00:35:02,070
that higher levels of African
ancestry are associated with

643
00:35:02,070 --> 00:35:05,650
higher blood pressure, but
that's true only if you ignore

644
00:35:05,650 --> 00:35:09,270
the ways that class and color
shapes people's experiences.

645
00:35:09,270 --> 00:35:12,650
Once we include class and
social class and color,

646
00:35:12,650 --> 00:35:14,820
as well as the interaction between them,

647
00:35:14,820 --> 00:35:17,920
we see that what evidence
might have existed before

648
00:35:17,920 --> 00:35:21,550
for a genetic ancestry
effect again goes away,

649
00:35:21,550 --> 00:35:24,750
and what matters instead is
especially that interaction

650
00:35:24,750 --> 00:35:27,079
between class and color.

651
00:35:27,079 --> 00:35:30,250
And if you're not familiar
with reading a table like this,

652
00:35:30,250 --> 00:35:31,430
here's what it looks like.

653
00:35:31,430 --> 00:35:36,340
If we model that interaction
between class and color,

654
00:35:36,340 --> 00:35:39,430
it shows us for people in our sample

655
00:35:39,430 --> 00:35:42,130
who were defined by
others, perceived by others

656
00:35:42,130 --> 00:35:45,190
as either Blanco or Trigueno,

657
00:35:45,190 --> 00:35:47,623
white or this intermediate category,

658
00:35:48,620 --> 00:35:51,300
then as they do better socioeconomically

659
00:35:51,300 --> 00:35:54,230
as their income and
their education improves,

660
00:35:54,230 --> 00:35:56,030
so does their health.

661
00:35:56,030 --> 00:35:57,880
This is the pattern that
we're used to seeing

662
00:35:57,880 --> 00:35:59,283
in the industrialized world,

663
00:36:00,583 --> 00:36:04,730
but for people who were
perceived by others

664
00:36:04,730 --> 00:36:06,663
as Negro or black,

665
00:36:07,690 --> 00:36:10,550
then higher levels of socioeconomic status

666
00:36:10,550 --> 00:36:13,553
were actually associated with
higher average blood pressure.

667
00:36:16,400 --> 00:36:18,530
Now, we can't know exactly
what's going on here

668
00:36:18,530 --> 00:36:20,210
with the data that we have available,

669
00:36:20,210 --> 00:36:23,010
but one interpretation is that the people

670
00:36:23,010 --> 00:36:25,100
who were represented at
the upper right-hand part

671
00:36:25,100 --> 00:36:25,933
of this graph,

672
00:36:25,933 --> 00:36:28,990
that is people who are
defined by others as Negro,

673
00:36:28,990 --> 00:36:31,900
but who have achieved
socioeconomic success

674
00:36:33,010 --> 00:36:36,860
live and work in social
contexts that have historically

675
00:36:36,860 --> 00:36:39,353
been dominated by
light-skinned Puerto Ricans.

676
00:36:40,530 --> 00:36:44,953
They are in essence Negros
living in a world of Blancos,

677
00:36:45,890 --> 00:36:48,250
and the likelihood is great,

678
00:36:48,250 --> 00:36:52,340
that as a consequence they
encounter the frustration,

679
00:36:52,340 --> 00:36:55,340
on a day-to-day basis of interpersonal

680
00:36:55,340 --> 00:36:57,400
and institutional discrimination

681
00:36:57,400 --> 00:36:59,560
that leaves a mark on their body,

682
00:36:59,560 --> 00:37:01,743
possibly including
elevated blood pressure,

683
00:37:02,864 --> 00:37:05,570
and this is consistent with
the way people in everyday life

684
00:37:05,570 --> 00:37:07,510
talk about racism in Puerto Rico.

685
00:37:07,510 --> 00:37:10,270
For example, I once asked Dona Mercedes

686
00:37:10,270 --> 00:37:12,230
how she understood racism to operate,

687
00:37:12,230 --> 00:37:15,210
and she said, "You don't
see it much among the poor,"

688
00:37:15,210 --> 00:37:18,187
speaking in reference to
Puerto Rico in particular,

689
00:37:18,187 --> 00:37:20,190
"But among those who are
better off economically,

690
00:37:20,190 --> 00:37:22,890
you see a lot of racism because they often

691
00:37:22,890 --> 00:37:25,900
reject people beneath them."

692
00:37:25,900 --> 00:37:29,250
So all of all of this
evidence lines up to suggest

693
00:37:29,250 --> 00:37:31,310
that what matters about genetic ancestry

694
00:37:31,310 --> 00:37:34,440
isn't a genetic mechanism,
but rather it's the meaning

695
00:37:34,440 --> 00:37:39,130
that we attribute to people
with African ancestry

696
00:37:39,130 --> 00:37:41,333
in racially stratified societies.

697
00:37:43,110 --> 00:37:45,870
Now, I don't want to
leave you with the idea

698
00:37:45,870 --> 00:37:50,870
that this is a simple story
of nurture trumping nature.

699
00:37:50,920 --> 00:37:54,450
My argument is not the
genes are irrelevant

700
00:37:54,450 --> 00:37:58,360
because in fact what we found was that

701
00:37:58,360 --> 00:38:03,160
when we take account of
social class and color,

702
00:38:03,160 --> 00:38:06,120
that it actually alters the evidence

703
00:38:06,120 --> 00:38:08,380
for an association between blood pressure

704
00:38:08,380 --> 00:38:11,683
and those candidate gene
polymorphisms that we examined.

705
00:38:12,640 --> 00:38:15,152
So in this first analysis
that I am showing you,

706
00:38:15,152 --> 00:38:18,140
when we ignore class and color,

707
00:38:18,140 --> 00:38:20,460
we again see that African genetic ancestry

708
00:38:20,460 --> 00:38:22,970
appears to be associated
with higher blood pressure.

709
00:38:22,970 --> 00:38:25,400
There is no evidence that
any of the candidate genes

710
00:38:25,400 --> 00:38:28,990
for high blood pressure are
associated with blood pressure.

711
00:38:28,990 --> 00:38:33,990
However, once we add class
and color to the analysis,

712
00:38:35,660 --> 00:38:39,973
we see that again, the genetic
ancestry effect goes away,

713
00:38:41,130 --> 00:38:45,520
and we now find evidence for
a significant association

714
00:38:45,520 --> 00:38:49,340
between one particular polymorphism,

715
00:38:49,340 --> 00:38:50,740
one particular genetic variant,

716
00:38:50,740 --> 00:38:52,770
that had previously been
associated with blood pressure.

717
00:38:52,770 --> 00:38:55,380
We now see evidence that in our sample too

718
00:38:55,380 --> 00:38:57,760
it is associated with blood pressure,

719
00:38:57,760 --> 00:38:59,660
and the reason this happens

720
00:38:59,660 --> 00:39:03,920
is that yes, at an individual
level, genes matter,

721
00:39:03,920 --> 00:39:06,200
but genes are not distributed
across our species

722
00:39:06,200 --> 00:39:08,300
in color-coded boxes.

723
00:39:08,300 --> 00:39:10,420
Race is not a way of understanding

724
00:39:10,420 --> 00:39:13,650
the distribution of genetic risk,

725
00:39:13,650 --> 00:39:15,730
and it also matters because

726
00:39:15,730 --> 00:39:18,450
if we take seriously
the idea that phenotype,

727
00:39:18,450 --> 00:39:20,730
the observable parts of
our biology are a product

728
00:39:20,730 --> 00:39:24,060
of genotype and environment
then we need to approach both

729
00:39:24,060 --> 00:39:27,280
with equal rigor and the
better we can take account

730
00:39:27,280 --> 00:39:29,620
of environmental exposures,

731
00:39:29,620 --> 00:39:32,610
like with taking into account
social class and color,

732
00:39:32,610 --> 00:39:34,540
the more likely we are
to understand the way

733
00:39:34,540 --> 00:39:37,300
that genes actually do
matter for individuals

734
00:39:37,300 --> 00:39:39,083
in a non-racial way.

735
00:39:42,620 --> 00:39:45,170
So for nearly the last decade

736
00:39:46,420 --> 00:39:50,360
colleagues including Dr.
Mulligan and I have taken

737
00:39:50,360 --> 00:39:54,350
the challenges from this
work to a new context,

738
00:39:54,350 --> 00:39:56,590
working with community partners

739
00:39:56,590 --> 00:39:59,490
in the African-American community
in Tallahassee, Florida,

740
00:40:00,720 --> 00:40:03,850
and time doesn't allow
me to go into great depth

741
00:40:03,850 --> 00:40:05,720
about this work, but I want to highlight

742
00:40:05,720 --> 00:40:10,010
one particular set of findings
that has emerged from it,

743
00:40:10,010 --> 00:40:13,140
which is that we began this work

744
00:40:13,140 --> 00:40:15,300
by asking people to tell us their stories

745
00:40:15,300 --> 00:40:17,280
of how they experience race and racism,

746
00:40:17,280 --> 00:40:18,840
and in the process,

747
00:40:18,840 --> 00:40:21,330
we learned that many of the existing ways

748
00:40:21,330 --> 00:40:23,430
that researchers approach the study

749
00:40:23,430 --> 00:40:25,810
of discrimination in
health omits some of what

750
00:40:25,810 --> 00:40:27,750
is most meaningful to people,

751
00:40:27,750 --> 00:40:29,990
and that is that people are affected

752
00:40:29,990 --> 00:40:32,590
not only by what happens to them,

753
00:40:32,590 --> 00:40:35,120
but also by what happens
to those around them.

754
00:40:35,120 --> 00:40:38,205
This is the notion of
vicarious racism, where

755
00:40:38,205 --> 00:40:41,720
the extent to which your
own experience is shaped

756
00:40:41,720 --> 00:40:45,260
by other people's experiences of racism,

757
00:40:45,260 --> 00:40:47,020
and in another set of analyses,

758
00:40:47,020 --> 00:40:50,550
we found that NPR actually
says it a little more

759
00:40:50,550 --> 00:40:53,170
in a straightforward
manner that knowing someone

760
00:40:54,130 --> 00:40:57,650
who faced discrimination
may affect blood pressure

761
00:40:57,650 --> 00:41:01,230
and significantly, we found
that this association appeared

762
00:41:01,230 --> 00:41:04,440
to operate through a
different biological pathway

763
00:41:04,440 --> 00:41:09,220
than was the case for direct
exposure in one's own life.

764
00:41:09,220 --> 00:41:11,650
In more recent work, we have also shown

765
00:41:11,650 --> 00:41:15,090
in the same community in Tallahassee

766
00:41:15,090 --> 00:41:18,850
that higher levels of
exposure to discrimination,

767
00:41:18,850 --> 00:41:20,550
when people perceive that discrimination

768
00:41:20,550 --> 00:41:23,070
to be based on race,

769
00:41:23,070 --> 00:41:26,380
shows up with shortened telomere links

770
00:41:26,380 --> 00:41:28,890
and telomeres are the end
caps of your chromosomes.

771
00:41:28,890 --> 00:41:33,740
They are sometimes regarded
as a marker of cellular aging

772
00:41:33,740 --> 00:41:35,130
because as we age,

773
00:41:35,130 --> 00:41:37,600
the ends of our telomeres
get shorter and shorter

774
00:41:37,600 --> 00:41:38,940
if they're not repaired,

775
00:41:38,940 --> 00:41:40,700
so this is often used as a marker

776
00:41:42,700 --> 00:41:44,093
of cellular aging.

777
00:41:45,320 --> 00:41:47,920
This finding also inverts
our usual way of thinking

778
00:41:47,920 --> 00:41:50,280
about the relationship
between race and genes,

779
00:41:50,280 --> 00:41:52,320
because what it shows is that

780
00:41:52,320 --> 00:41:55,940
it's not that race is mapped
on to genetic variants

781
00:41:55,940 --> 00:41:57,660
that increase the risk of poor health.

782
00:41:57,660 --> 00:42:00,420
Instead, it's that exposure to racism

783
00:42:01,470 --> 00:42:03,840
can take such a toll on the body

784
00:42:03,840 --> 00:42:06,120
that it can literally grind down the ends

785
00:42:06,120 --> 00:42:07,323
of your chromosomes.

786
00:42:11,070 --> 00:42:13,680
In other work with colleagues

787
00:42:13,680 --> 00:42:17,510
at the College of Medicine
at UF led by Michelle Cardel,

788
00:42:17,510 --> 00:42:20,390
we've also extended
this work to understand

789
00:42:20,390 --> 00:42:23,430
how experiences of
discrimination can be related

790
00:42:23,430 --> 00:42:25,810
to other sorts of
physiological end points,

791
00:42:25,810 --> 00:42:29,440
including the severity
of metabolic syndrome

792
00:42:29,440 --> 00:42:32,020
among African-Americans in
the Jackson Heart study,

793
00:42:32,020 --> 00:42:35,400
and these various studies
contribute to a burgeoning body

794
00:42:35,400 --> 00:42:39,430
of research that has linked the
experience of discrimination

795
00:42:39,430 --> 00:42:41,460
to poor health outcomes,

796
00:42:41,460 --> 00:42:44,690
both markers of physiology
and of health behavior

797
00:42:44,690 --> 00:42:46,700
ranging from blood
pressure and breast cancer

798
00:42:46,700 --> 00:42:50,630
to body mass index, abdominal
adiposity, preterm birth

799
00:42:50,630 --> 00:42:54,980
on to HIV testing,
smoking, and alcohol use.

800
00:42:54,980 --> 00:42:57,350
And of course, it's not just a matter

801
00:42:57,350 --> 00:43:00,080
of how individuals
experience discrimination

802
00:43:00,080 --> 00:43:01,700
in their day-to-day lives,

803
00:43:01,700 --> 00:43:06,270
but also the structures
of racism as manifested,

804
00:43:06,270 --> 00:43:09,107
for example, in race-based
residential segregation

805
00:43:09,107 --> 00:43:11,523
and the concentration of poverty.

806
00:43:12,934 --> 00:43:14,390
And we increasingly understand the way

807
00:43:14,390 --> 00:43:17,150
that these large scale
structural inequalities

808
00:43:17,150 --> 00:43:19,810
are linked to health and development

809
00:43:19,810 --> 00:43:23,113
as reflected here in the
likelihood of low birthweight.

810
00:43:24,890 --> 00:43:27,790
And as we consider the unfolding pandemic

811
00:43:27,790 --> 00:43:29,590
in the United States,

812
00:43:29,590 --> 00:43:32,520
I've recently argued that
we need to understand

813
00:43:32,520 --> 00:43:34,750
the synergistic interactions

814
00:43:34,750 --> 00:43:37,730
that occur between systemic racism,

815
00:43:37,730 --> 00:43:40,870
as it manifests again, in
segregation, in our workplaces,

816
00:43:40,870 --> 00:43:43,540
in our schools, in our homes,

817
00:43:43,540 --> 00:43:46,010
to the concentration
of poverty and wealth,

818
00:43:46,010 --> 00:43:48,830
to the racialized nature
of mass incarceration

819
00:43:48,830 --> 00:43:50,520
and hyper policing

820
00:43:50,520 --> 00:43:54,504
to the disinvestment in social safety nets

821
00:43:54,504 --> 00:43:56,807
and ways that these various factors

822
00:43:56,807 --> 00:44:01,210
can shape the likelihood of
cardio-metabolic disorders

823
00:44:01,210 --> 00:44:03,720
like diabetes and hypertension,

824
00:44:03,720 --> 00:44:05,810
as they also shape the
likelihood of exposure

825
00:44:05,810 --> 00:44:08,270
to the SARS coronavirus two

826
00:44:08,270 --> 00:44:11,053
and to interactions among
all of these things.

827
00:44:13,620 --> 00:44:18,240
So let me try to end on
a forward looking note,

828
00:44:18,240 --> 00:44:20,320
to ask the question of what can we do

829
00:44:20,320 --> 00:44:22,700
in the face of emerging
evidence about the ways

830
00:44:22,700 --> 00:44:26,340
that systemic racism
harms people's health,

831
00:44:26,340 --> 00:44:29,420
and I'd like to identify three arenas

832
00:44:29,420 --> 00:44:30,850
in which we can intervene.

833
00:44:30,850 --> 00:44:32,880
The first is pedagogy,

834
00:44:32,880 --> 00:44:35,970
which seems appropriate as
I'm here at a university,

835
00:44:35,970 --> 00:44:40,373
the second is in practice,
and the third is in policy.

836
00:44:41,260 --> 00:44:43,240
So as teachers and in the classroom,

837
00:44:43,240 --> 00:44:48,240
we have an obligation to
counter false ideas about race,

838
00:44:48,410 --> 00:44:51,610
notably the idea that
race is a meaningful way

839
00:44:51,610 --> 00:44:54,600
of understanding human genetic variation.

840
00:44:54,600 --> 00:44:57,920
And likewise, we have an
obligation to explain what we mean

841
00:44:57,920 --> 00:45:00,770
by systemic racism and
to trace the pathways

842
00:45:00,770 --> 00:45:04,640
through which systemic racism
constrains people's lives

843
00:45:04,640 --> 00:45:06,393
and causes material harm.

844
00:45:08,090 --> 00:45:11,690
In our practice, particularly
in the realm of medicine,

845
00:45:11,690 --> 00:45:13,910
we have to move from race based medicine,

846
00:45:13,910 --> 00:45:16,380
which assumes intrinsic differences,

847
00:45:16,380 --> 00:45:20,720
to race conscious medicine
and medical practice,

848
00:45:20,720 --> 00:45:23,160
which is aware of the ways
in which race as a political

849
00:45:23,160 --> 00:45:26,840
and economic system
can harm people's lives

850
00:45:26,840 --> 00:45:30,183
and prevent them from following
doctor's orders for example.

851
00:45:31,320 --> 00:45:34,000
And at the level of policy,

852
00:45:34,000 --> 00:45:37,450
we have to think bigger about redressing

853
00:45:37,450 --> 00:45:42,450
the historical and persistent
harms of white supremacy.

854
00:45:42,450 --> 00:45:47,070
One compelling way to think
about this is a recent analysis

855
00:45:47,070 --> 00:45:51,920
by Jean Richardson and
colleagues early in the pandemic.

856
00:45:51,920 --> 00:45:53,860
They asked themselves the question of

857
00:45:53,860 --> 00:45:56,570
how might the pandemic have been different

858
00:45:56,570 --> 00:45:59,710
if the United States had paid
reparations to the descendants

859
00:45:59,710 --> 00:46:03,490
of enslaved people in the United States,

860
00:46:03,490 --> 00:46:06,710
as we fleetingly promised
after the Civil War?

861
00:46:06,710 --> 00:46:09,560
And what they found was
that if the United States

862
00:46:09,560 --> 00:46:14,190
had paid reparations to
produce a just society,

863
00:46:14,190 --> 00:46:17,600
that the transmission rate
of SARS coronavirus two

864
00:46:17,600 --> 00:46:20,103
would have decreased, as it says,

865
00:46:21,420 --> 00:46:25,400
between 31 and 68%.

866
00:46:25,400 --> 00:46:27,400
Now this means that certainly

867
00:46:27,400 --> 00:46:29,900
many fewer black and brown
people would have died

868
00:46:29,900 --> 00:46:31,800
as a consequence of COVID-19,

869
00:46:31,800 --> 00:46:34,320
but it also means that every one of us

870
00:46:34,320 --> 00:46:36,340
would have been better off

871
00:46:36,340 --> 00:46:40,370
because the transmission of
the virus across our society

872
00:46:40,370 --> 00:46:42,083
would have been less.

873
00:46:45,520 --> 00:46:48,510
In a word then, I leave
you with the idea that

874
00:46:48,510 --> 00:46:50,810
there is no race without racism,

875
00:46:50,810 --> 00:46:53,030
that any question we ask about race,

876
00:46:53,030 --> 00:46:55,840
whether it's about health
or any other factor

877
00:46:55,840 --> 00:46:58,320
is in fact a question about racism

878
00:46:58,320 --> 00:47:01,380
and that our obligation is
to understand what racism is,

879
00:47:01,380 --> 00:47:05,070
how it operates and what
effect it has on people

880
00:47:05,070 --> 00:47:07,340
and on the conduct of research.

881
00:47:07,340 --> 00:47:08,550
I'm looking forward to

882
00:47:08,550 --> 00:47:11,480
what I hope is a fruitful,
stimulating discussion.

883
00:47:11,480 --> 00:47:13,580
I thank you all for your attention.

884
00:47:13,580 --> 00:47:14,617
Thank you.

885
00:47:14,617 --> 00:47:17,367
(audience claps)

886
00:47:25,180 --> 00:47:27,750
So it looks like we have
a couple of microphones,

887
00:47:27,750 --> 00:47:31,630
so if you have a question or comment,

888
00:47:31,630 --> 00:47:33,360
please just signal to us so that we can

889
00:47:33,360 --> 00:47:35,883
hopefully have a rich discussion,

890
00:47:43,400 --> 00:47:44,353
- [Woman] Call on someone.

891
00:47:56,067 --> 00:47:58,960
- [Short] Hi, Short
Smith, he/him pronouns.

892
00:47:58,960 --> 00:48:03,260
What inspired you to take
on this line of research

893
00:48:03,260 --> 00:48:04,890
since you pointed out it's contrary

894
00:48:04,890 --> 00:48:07,703
to what would be seen as the normal path?

895
00:48:10,510 --> 00:48:13,773
- Well, the answer starts a long time ago.

896
00:48:14,860 --> 00:48:17,190
So all of my degrees are in anthropology,

897
00:48:17,190 --> 00:48:20,240
and I learned as an undergraduate

898
00:48:20,240 --> 00:48:23,210
that race was a social
construct, not a biological fact.

899
00:48:23,210 --> 00:48:26,480
I thought that we had more or
less dispensed with that idea

900
00:48:27,420 --> 00:48:28,800
in the mid 20th century,

901
00:48:28,800 --> 00:48:31,720
and then I was beginning graduate school,

902
00:48:31,720 --> 00:48:36,190
and I encountered the way that
at that time in the mid 1990s

903
00:48:36,190 --> 00:48:38,290
medical students were at
the University of Florida

904
00:48:38,290 --> 00:48:39,600
being taught to think about race.

905
00:48:39,600 --> 00:48:42,320
It was common practice then,
and I don't think just at UF,

906
00:48:42,320 --> 00:48:43,750
but everywhere

907
00:48:45,240 --> 00:48:46,890
for

908
00:48:46,890 --> 00:48:49,320
physicians in training to be taught

909
00:48:49,320 --> 00:48:50,570
to think in terms of race,

910
00:48:50,570 --> 00:48:52,870
and the way this showed up was that

911
00:48:52,870 --> 00:48:56,690
I was asked to play the role
of an attending physician,

912
00:48:56,690 --> 00:49:00,110
and a second year medical student said,

913
00:49:00,110 --> 00:49:02,100
Mr. Johnson's a 52 year old black man

914
00:49:02,100 --> 00:49:03,850
who presents with a chronic cough,

915
00:49:03,850 --> 00:49:05,450
and as a snotty graduate student, I said,

916
00:49:05,450 --> 00:49:06,890
wait, just a minute.

917
00:49:06,890 --> 00:49:10,220
What exactly does his blackness
have to do with his cough?

918
00:49:10,220 --> 00:49:11,600
And she said, honestly,

919
00:49:11,600 --> 00:49:13,510
that's just what they teach us to do,

920
00:49:13,510 --> 00:49:15,340
and it seems strange to me

921
00:49:17,090 --> 00:49:19,670
that 19th century ideas
about race and genes

922
00:49:19,670 --> 00:49:21,630
might be circulating in that context,

923
00:49:21,630 --> 00:49:24,170
and so it was at that
point, I started reading

924
00:49:24,170 --> 00:49:27,610
about how race was being used in

925
00:49:27,610 --> 00:49:29,580
medical education and clinical practice,

926
00:49:29,580 --> 00:49:32,575
in epidemiological
research and realize that

927
00:49:32,575 --> 00:49:34,490
there were a lot of untested assumptions

928
00:49:34,490 --> 00:49:36,180
that were continuing to circulate.

929
00:49:36,180 --> 00:49:39,170
Now, a lot of scholars
have been pushing back

930
00:49:39,170 --> 00:49:41,760
on that practice and most
medical schools have abandoned

931
00:49:41,760 --> 00:49:44,690
that idea of teaching
people to identify race

932
00:49:44,690 --> 00:49:47,340
in the first line of the
history of present illness.

933
00:49:47,340 --> 00:49:49,160
I see the dean of your medical
school nodding his head

934
00:49:49,160 --> 00:49:51,293
so I'm assuming that's true here as well,

935
00:49:52,760 --> 00:49:55,923
and yet there's still a lot
of these assumptions still,

936
00:49:57,170 --> 00:49:58,780
but for me, it was really just

937
00:50:00,080 --> 00:50:02,850
an awareness of the
injustice that resulted

938
00:50:04,417 --> 00:50:07,660
from carrying forward ideas that

939
00:50:08,530 --> 00:50:11,700
are fundamentally indistinguishable

940
00:50:11,700 --> 00:50:15,970
from 19th century reasoning
about race and disease.

941
00:50:15,970 --> 00:50:18,400
Certainly the vocabulary has changed,

942
00:50:18,400 --> 00:50:21,600
the science is more technically
specific, but many of

943
00:50:21,600 --> 00:50:22,810
the assumptions

944
00:50:24,060 --> 00:50:25,950
about what race is

945
00:50:27,310 --> 00:50:28,880
are alive and well

946
00:50:28,880 --> 00:50:30,893
in many disciplines.

947
00:50:41,310 --> 00:50:44,410
- [Roxanna] Hi, Roxanna del Rio, she/her.

948
00:50:44,410 --> 00:50:47,950
Did you compare disparities in health

949
00:50:47,950 --> 00:50:51,060
between the differing races,

950
00:50:51,060 --> 00:50:53,060
is there any improvement

951
00:50:54,100 --> 00:50:57,700
50 years ago compared to today?

952
00:50:57,700 --> 00:50:59,960
- There definitely have
been signs of improvement.

953
00:50:59,960 --> 00:51:02,510
Thank you for that question.

954
00:51:02,510 --> 00:51:04,080
The improvement has been slow.

955
00:51:04,080 --> 00:51:06,653
If we look for example at life expectancy,

956
00:51:07,670 --> 00:51:11,020
racial inequalities in
life expectancy in 1996

957
00:51:11,020 --> 00:51:13,840
were exactly what they had been in 1946,

958
00:51:13,840 --> 00:51:17,460
so despite the progress of
the Civil Rights Movement

959
00:51:17,460 --> 00:51:19,863
and the legislation of the 1960s,

960
00:51:21,020 --> 00:51:22,560
during that 50 year timeframe,

961
00:51:22,560 --> 00:51:26,850
there was no discernible
impact in terms of longevity.

962
00:51:26,850 --> 00:51:29,220
In the last 10 or 15 years that had

963
00:51:29,220 --> 00:51:31,740
fortunately begun to change, and the

964
00:51:31,740 --> 00:51:35,585
racial inequities in life expectancy

965
00:51:35,585 --> 00:51:38,850
had begun to close so that in 2019,

966
00:51:38,850 --> 00:51:41,000
they were at the lowest level
that we've ever recorded

967
00:51:41,000 --> 00:51:42,113
in the United States.

968
00:51:42,980 --> 00:51:46,890
Unfortunately COVID-19
has set the clock back

969
00:51:46,890 --> 00:51:48,800
at least 10 years because of

970
00:51:48,800 --> 00:51:52,140
the disproportionate
impact of the pandemic

971
00:51:52,140 --> 00:51:57,140
and so has erased a decade of
gains in racial inequities.

972
00:51:59,600 --> 00:52:02,250
What I hope is that

973
00:52:03,110 --> 00:52:04,310
the

974
00:52:04,310 --> 00:52:07,020
renewed attention to and growing awareness

975
00:52:07,870 --> 00:52:12,460
of the various ways that racism
produces these inequalities

976
00:52:12,460 --> 00:52:16,150
will lead to stronger resolve
to do something about it,

977
00:52:16,150 --> 00:52:17,090
which means

978
00:52:18,630 --> 00:52:21,910
going beyond individual
level sorts of interventions

979
00:52:21,910 --> 00:52:25,680
and thinking about ways
that we need to restructure

980
00:52:25,680 --> 00:52:28,200
our political and economic system

981
00:52:30,315 --> 00:52:31,620
to make it possible for everyone

982
00:52:31,620 --> 00:52:33,743
to live a full, healthy life.

983
00:52:35,120 --> 00:52:36,140
Yes?

984
00:52:36,140 --> 00:52:36,973
Do you need?

985
00:52:37,860 --> 00:52:38,793
Okay, sorry.

986
00:52:42,430 --> 00:52:44,030
And Professor Shea, when
you have an opportunity,

987
00:52:44,030 --> 00:52:46,490
there's another hand in
the front row, thank you.

988
00:52:46,490 --> 00:52:49,183
- [Sophie] Hi, Sophie
McCunic, she/her pronouns.

989
00:52:50,140 --> 00:52:52,030
Like you've mentioned,

990
00:52:52,030 --> 00:52:55,960
the COVID 19 pandemic exposed so much

991
00:52:55,960 --> 00:52:57,483
in regards to this issue,

992
00:52:58,410 --> 00:53:00,923
and I think something else
it exposed was the fact

993
00:53:00,923 --> 00:53:05,030
that so many Americans
don't believe in science

994
00:53:05,030 --> 00:53:09,210
and scientific data so
how do you propose we

995
00:53:09,210 --> 00:53:12,180
present this type of data or just

996
00:53:13,277 --> 00:53:16,670
have a lot of the populations
see it from this perspective

997
00:53:16,670 --> 00:53:19,870
and understand the importance
of research like this

998
00:53:19,870 --> 00:53:21,610
when a lot of the population in America

999
00:53:21,610 --> 00:53:23,623
doesn't believe in science?

1000
00:53:25,290 --> 00:53:26,123
Thank you.

1001
00:53:27,470 --> 00:53:29,538
- So a softball question.

1002
00:53:29,538 --> 00:53:30,930
(audience laughs)

1003
00:53:30,930 --> 00:53:33,120
Yeah. I mean, thank you for raising

1004
00:53:34,310 --> 00:53:36,090
such an important issue about

1005
00:53:38,695 --> 00:53:42,440
how can you communicate
what we know from science

1006
00:53:42,440 --> 00:53:43,700
when the stakes are, you know,

1007
00:53:43,700 --> 00:53:45,750
literal matters of life and death,

1008
00:53:45,750 --> 00:53:49,610
when as you say it is apparent that that

1009
00:53:49,610 --> 00:53:51,850
scientific reasoning and lines of evidence

1010
00:53:51,850 --> 00:53:54,510
don't resonate for everyone,

1011
00:53:54,510 --> 00:53:57,460
and I don't think that I
actually have an answer

1012
00:53:57,460 --> 00:53:58,293
to that question.

1013
00:53:58,293 --> 00:54:00,590
I think you've identified
it as an important problem.

1014
00:54:00,590 --> 00:54:02,860
The way I might build on your observation

1015
00:54:06,720 --> 00:54:09,750
is to encourage all of us
to be thinking about ways

1016
00:54:09,750 --> 00:54:12,280
that we need to think big,

1017
00:54:12,280 --> 00:54:15,890
that the solution will not
come in the form of band-aids.

1018
00:54:15,890 --> 00:54:18,830
I would suggest that some
of the same political forces

1019
00:54:18,830 --> 00:54:23,370
that have led people no
longer to believe in science

1020
00:54:23,370 --> 00:54:26,150
are also at the root of
why the inequities exist

1021
00:54:26,150 --> 00:54:27,480
in the first place,

1022
00:54:27,480 --> 00:54:31,340
and thinking about the
way that those dynamics

1023
00:54:31,340 --> 00:54:32,720
intersect

1024
00:54:32,720 --> 00:54:34,170
is crucial.

1025
00:54:34,170 --> 00:54:37,010
I'm reminded of another recent study

1026
00:54:37,010 --> 00:54:39,960
in Public Health Reports
that you see behind me,

1027
00:54:39,960 --> 00:54:42,170
where researchers identified

1028
00:54:43,450 --> 00:54:45,080
843

1029
00:54:45,080 --> 00:54:47,100
state laws

1030
00:54:47,100 --> 00:54:49,237
that are linked to structural racism,

1031
00:54:49,237 --> 00:54:52,000
and many of these laws also

1032
00:54:52,000 --> 00:54:53,090
result

1033
00:54:53,090 --> 00:54:56,680
in a disinvestment in
our educational system

1034
00:54:56,680 --> 00:54:59,840
and foster mistrust in our
government and in science,

1035
00:54:59,840 --> 00:55:02,700
and so thinking about the ways that

1036
00:55:03,680 --> 00:55:07,250
structural racism and white supremacy harm

1037
00:55:07,250 --> 00:55:09,670
their targets first and worse,

1038
00:55:09,670 --> 00:55:14,460
it also has detrimental
effects for the entire society

1039
00:55:14,460 --> 00:55:17,180
because of the ways that it results in

1040
00:55:17,180 --> 00:55:22,180
the underfunding and
dismantling of the public good

1041
00:55:22,350 --> 00:55:24,910
including education,

1042
00:55:24,910 --> 00:55:25,780
and so

1043
00:55:27,410 --> 00:55:29,300
I think I feel safe
saying here in Burlington

1044
00:55:29,300 --> 00:55:30,850
of all places, that this is a time

1045
00:55:30,850 --> 00:55:33,480
that we really have to
be thinking really big

1046
00:55:35,230 --> 00:55:37,680
about what the solutions will be,

1047
00:55:37,680 --> 00:55:40,606
and the solutions will not be in the realm

1048
00:55:40,606 --> 00:55:42,010
of biomedicine, frankly.

1049
00:55:42,010 --> 00:55:45,300
These are fundamentally political problems

1050
00:55:45,300 --> 00:55:48,083
that will require political solutions.

1051
00:55:50,120 --> 00:55:51,530
There's a lot of good that,

1052
00:55:51,530 --> 00:55:52,660
of course,

1053
00:55:52,660 --> 00:55:55,060
we can do in the meantime
and whether it's in medicine

1054
00:55:55,060 --> 00:55:57,250
or public health or policy,

1055
00:55:57,250 --> 00:55:59,760
but yeah, the solutions are gonna require

1056
00:55:59,760 --> 00:56:01,260
a much greater political will.

1057
00:56:02,570 --> 00:56:03,403
Yes.

1058
00:56:07,660 --> 00:56:09,373
- [Marina] I'm Marina, she/her.

1059
00:56:10,920 --> 00:56:14,589
I wanted to ask you about,
first of all, I love your.

1060
00:56:14,589 --> 00:56:15,995
- Sorry, can you hold that
just a little bit closer?

1061
00:56:15,995 --> 00:56:18,048
I'm having a little difficulty
hearing you, thanks.

1062
00:56:18,048 --> 00:56:19,440
- [Marina] Sorry.
- Thank you.

1063
00:56:19,440 --> 00:56:21,770
- [Marina] I wanted to ask you about,

1064
00:56:21,770 --> 00:56:23,930
I loved your speech by the way,

1065
00:56:23,930 --> 00:56:26,800
but I wanted to ask about sort of

1066
00:56:27,760 --> 00:56:30,260
I guess if you ever thought
of using sort of like,

1067
00:56:31,480 --> 00:56:33,720
what about people that are
more than one race, you know,

1068
00:56:33,720 --> 00:56:36,830
within the medical field
where race has been brought up

1069
00:56:36,830 --> 00:56:38,020
as like an argument of like, oh,

1070
00:56:38,020 --> 00:56:39,500
that's just what they teach us,

1071
00:56:39,500 --> 00:56:42,100
but there are people that
are biracial, multiracial,

1072
00:56:42,100 --> 00:56:45,910
multiethnic that are more
than one race, and so it's,

1073
00:56:45,910 --> 00:56:48,230
have you ever thought of
using that as an argument

1074
00:56:48,230 --> 00:56:51,190
within your research towards
people that believe race

1075
00:56:51,190 --> 00:56:54,600
as biological when in fact it's not?

1076
00:56:54,600 --> 00:56:56,770
- Yeah, that's such a
great idea to point out

1077
00:56:56,770 --> 00:57:00,160
the people who don't necessarily
fit into a single checkbox

1078
00:57:00,160 --> 00:57:01,610
on the census forms, right?

1079
00:57:01,610 --> 00:57:05,150
Which is a growing and
growing number of Americans.

1080
00:57:05,150 --> 00:57:07,950
There's an interesting thing
that I recently read about,

1081
00:57:07,950 --> 00:57:10,380
which is that the rise
of direct to consumer

1082
00:57:10,380 --> 00:57:13,643
genetic ancestry services
like 23 and me, and so forth.

1083
00:57:16,020 --> 00:57:17,960
Some researchers suggest has also led

1084
00:57:17,960 --> 00:57:21,740
to a fundamental shift
in the number of people

1085
00:57:21,740 --> 00:57:23,830
who perceive themselves as multiracial,

1086
00:57:23,830 --> 00:57:27,090
that in the 2020 census, the number jumped

1087
00:57:27,090 --> 00:57:29,730
and many people are attributing
this to the fact that

1088
00:57:29,730 --> 00:57:32,910
some people now have
reports from 23 and me

1089
00:57:32,910 --> 00:57:35,410
or ancestry.com that says
they're not just one thing,

1090
00:57:35,410 --> 00:57:36,243
but they're actually,

1091
00:57:36,243 --> 00:57:39,524
their ancestry can be
traced to different places.

1092
00:57:39,524 --> 00:57:41,260
So I haven't done.

1093
00:57:41,260 --> 00:57:44,770
I think certainly the awareness
of how these categories

1094
00:57:44,770 --> 00:57:48,570
are fluid can be a way of
de-stabilizing people's assumption

1095
00:57:48,570 --> 00:57:51,550
that race is some natural thing
that just exists out there

1096
00:57:51,550 --> 00:57:52,383
in the world.

1097
00:57:54,515 --> 00:57:57,750
There is some interesting research on

1098
00:57:57,750 --> 00:58:01,160
how this produces health inequities.

1099
00:58:01,160 --> 00:58:03,390
I'm reminded, your question
reminds me in particular

1100
00:58:03,390 --> 00:58:05,493
of work by Dr. Camara Jones,

1101
00:58:06,490 --> 00:58:08,750
former president of the American
Public Health Association,

1102
00:58:08,750 --> 00:58:10,640
she was at the CDC for awhile.

1103
00:58:10,640 --> 00:58:13,220
While she was at the CDC, she developed

1104
00:58:14,140 --> 00:58:17,793
a set of questions called
the reaction to race module,

1105
00:58:18,800 --> 00:58:20,590
and these questions were taken up by

1106
00:58:20,590 --> 00:58:23,210
state departments of health in the routine

1107
00:58:23,210 --> 00:58:26,150
epidemiological
surveillance that states do.

1108
00:58:26,150 --> 00:58:27,930
There's a so-called behavioral risk factor

1109
00:58:27,930 --> 00:58:29,520
surveillance survey,

1110
00:58:29,520 --> 00:58:32,110
and the link to your question here is that

1111
00:58:32,110 --> 00:58:35,800
these questions ask not only
how do you identify your race,

1112
00:58:35,800 --> 00:58:40,650
but also how do you think other
people identify your race?

1113
00:58:40,650 --> 00:58:43,630
And what Dr. Jones found was that

1114
00:58:43,630 --> 00:58:45,950
in cases where there was discordance,

1115
00:58:45,950 --> 00:58:48,030
that is people identify
themselves one way,

1116
00:58:48,030 --> 00:58:51,130
but they think other people
see them another way,

1117
00:58:51,130 --> 00:58:54,170
that when other people categorize them as

1118
00:58:54,170 --> 00:58:57,950
in ways that were closer to white,

1119
00:58:57,950 --> 00:58:59,900
that their health was better as well

1120
00:58:59,900 --> 00:59:02,050
which suggests that
there's some way in which

1121
00:59:02,050 --> 00:59:03,100
these identities are fluid,

1122
00:59:03,100 --> 00:59:05,820
there's how I see myself,
there's how other people see me,

1123
00:59:05,820 --> 00:59:08,220
and that what really might
matter in terms of health

1124
00:59:08,220 --> 00:59:09,520
is the way that other people see me,

1125
00:59:09,520 --> 00:59:11,610
because that conditions the way that

1126
00:59:11,610 --> 00:59:14,270
society at large will treat me.

1127
00:59:14,270 --> 00:59:16,940
But I think there's a
lot of interesting work

1128
00:59:16,940 --> 00:59:20,016
that could be done to
extend this idea about

1129
00:59:20,016 --> 00:59:22,320
people who have multi-racial identities

1130
00:59:22,320 --> 00:59:25,526
and I can't wait to read your
PhD dissertation about that.

1131
00:59:25,526 --> 00:59:28,526
(audience laughing)

1132
00:59:29,480 --> 00:59:31,312
- [Kate] Kate Simms, she/her.

1133
00:59:31,312 --> 00:59:32,913
So I'm wondering,

1134
00:59:33,810 --> 00:59:36,120
this presentation talked a
lot about blood pressure,

1135
00:59:36,120 --> 00:59:39,640
and you've mentioned other
like health areas as well,

1136
00:59:39,640 --> 00:59:41,930
and I'm wondering if
you're seeing a pattern

1137
00:59:41,930 --> 00:59:44,625
across all health disparities, things like

1138
00:59:44,625 --> 00:59:48,150
cardiovascular disease,
cancers, stuff like that

1139
00:59:48,150 --> 00:59:52,330
if this is like a pattern
across all health disparities,

1140
00:59:52,330 --> 00:59:54,680
or if there's different influences for

1141
00:59:54,680 --> 00:59:58,770
different kinds of health issues.

1142
00:59:58,770 --> 01:00:00,090
- Very good question.

1143
01:00:00,090 --> 01:00:03,680
So all leading causes of
death in the United States

1144
01:00:03,680 --> 01:00:06,600
exhibit some racial inequities.

1145
01:00:06,600 --> 01:00:09,170
The reason that I focus
on blood pressure is that

1146
01:00:10,891 --> 01:00:14,360
it is one of the cases
where the assumption

1147
01:00:14,360 --> 01:00:17,510
is most prevalent that the answer lies

1148
01:00:17,510 --> 01:00:19,970
in some racial genetic factors.

1149
01:00:19,970 --> 01:00:21,375
In fact,

1150
01:00:21,375 --> 01:00:24,162
this idea was formalized with

1151
01:00:24,162 --> 01:00:28,240
the so-called slavery
hypothesis for hypertension,

1152
01:00:28,240 --> 01:00:29,170
which held that

1153
01:00:30,560 --> 01:00:33,170
mortality rates during
the Middle Passage of

1154
01:00:33,170 --> 01:00:35,860
the Atlantic Slave Trade were so high

1155
01:00:35,860 --> 01:00:37,972
that Africans who were
enslaved in west Africa

1156
01:00:37,972 --> 01:00:42,150
and survived the passage to the Americas

1157
01:00:42,150 --> 01:00:45,610
were ones who survived from
salt depleting conditions,

1158
01:00:45,610 --> 01:00:48,720
diarrhea, vomiting, and
so that those people had

1159
01:00:48,720 --> 01:00:50,620
a genetic predisposition to

1160
01:00:51,960 --> 01:00:53,840
retain sodium

1161
01:00:53,840 --> 01:00:55,690
differences in sodium
metabolism that caused them

1162
01:00:55,690 --> 01:00:58,263
to be able to retain
more hydration levels,

1163
01:00:59,500 --> 01:01:01,030
and this idea,

1164
01:01:01,030 --> 01:01:05,260
it's one of these just so
stories that circulate so widely,

1165
01:01:05,260 --> 01:01:07,430
it started to appear in clinical textbooks

1166
01:01:07,430 --> 01:01:10,690
about hypertension before any

1167
01:01:10,690 --> 01:01:13,940
scholarly article was
ever published about it,

1168
01:01:13,940 --> 01:01:16,360
before any evidence was collected

1169
01:01:16,360 --> 01:01:18,480
to test the hypothesis

1170
01:01:19,370 --> 01:01:21,860
and subsequent work that
has tested those hypothesis

1171
01:01:21,860 --> 01:01:24,377
shows that it actually doesn't work.

1172
01:01:24,377 --> 01:01:26,550
The genetic differences
we would presume exist

1173
01:01:26,550 --> 01:01:29,220
between west Africans and
descendants of enslaved Africans

1174
01:01:29,220 --> 01:01:32,880
in the Americas, those genetic
differences don't exist

1175
01:01:32,880 --> 01:01:34,090
in any of the studies that have looked

1176
01:01:34,090 --> 01:01:36,500
and it doesn't line up with
all the historical record,

1177
01:01:36,500 --> 01:01:38,930
but the reason that I
focused on hypertension,

1178
01:01:38,930 --> 01:01:41,590
it's a key test case where

1179
01:01:41,590 --> 01:01:43,440
so many people assume
that the answer is genetic

1180
01:01:43,440 --> 01:01:45,750
that if we can show that in
that case it doesn't work,

1181
01:01:45,750 --> 01:01:48,330
the hope is that it causes
a broader rethinking,

1182
01:01:48,330 --> 01:01:51,278
and there's a broader
rethinking happening across

1183
01:01:51,278 --> 01:01:52,610
many different fields.

1184
01:01:52,610 --> 01:01:55,469
There's some really good
news from last week,

1185
01:01:55,469 --> 01:01:58,300
the New England Journal of
Medicine published an editorial

1186
01:01:58,300 --> 01:02:01,450
along with two new papers,

1187
01:02:01,450 --> 01:02:02,920
providing

1188
01:02:02,920 --> 01:02:05,140
race free

1189
01:02:05,140 --> 01:02:07,290
equations to estimate kidney function.

1190
01:02:07,290 --> 01:02:09,400
There's been an ongoing debate about

1191
01:02:09,400 --> 01:02:11,880
the equations that clinicians use

1192
01:02:11,880 --> 01:02:14,320
to evaluate the health
of people's kidneys,

1193
01:02:14,320 --> 01:02:18,340
and the equations that have
been in use historically

1194
01:02:18,340 --> 01:02:20,590
have a correction factor

1195
01:02:21,690 --> 01:02:23,170
that resets the threshold

1196
01:02:23,170 --> 01:02:25,140
at which people could be
referred for treatment

1197
01:02:25,140 --> 01:02:27,510
like dialysis or for where

1198
01:02:27,510 --> 01:02:30,920
they could be put on a
transplant list, for example,

1199
01:02:30,920 --> 01:02:33,040
and it has the effect that

1200
01:02:33,040 --> 01:02:35,500
black patients actually
have to present sicker

1201
01:02:36,350 --> 01:02:38,770
than do others in order to
receive the same treatment.

1202
01:02:38,770 --> 01:02:40,850
So there's been a lot of scholarship

1203
01:02:40,850 --> 01:02:42,080
pushing back on this idea.

1204
01:02:42,080 --> 01:02:43,740
There's been a lot of advocacy,

1205
01:02:43,740 --> 01:02:45,880
much of it driven by medical students

1206
01:02:45,880 --> 01:02:47,430
at institutions around the U.S.

1207
01:02:48,577 --> 01:02:51,160
And so just last week,

1208
01:02:51,160 --> 01:02:54,870
some new estimating equations
that don't include race

1209
01:02:54,870 --> 01:02:56,780
were published in the New England Journal.

1210
01:02:56,780 --> 01:02:58,830
New England Journal
published an editorial saying

1211
01:02:58,830 --> 01:03:02,035
we need to leave race
correction factors behind

1212
01:03:02,035 --> 01:03:06,700
and new clinical standards
of care have been advanced

1213
01:03:06,700 --> 01:03:09,390
where physicians are encouraged not to use

1214
01:03:09,390 --> 01:03:11,620
these race correction factors anymore.

1215
01:03:11,620 --> 01:03:13,540
So yeah, it cuts across a lot of

1216
01:03:14,890 --> 01:03:17,963
organ systems, lots of
different domains of medicine,

1217
01:03:19,562 --> 01:03:21,012
and good things are happening

1218
01:03:22,510 --> 01:03:24,387
to move beyond race-based medicine

1219
01:03:24,387 --> 01:03:25,913
in a lot of those fields as well.

1220
01:03:28,790 --> 01:03:29,930
- [Girl] Okay Annie Sachs, she/her,

1221
01:03:29,930 --> 01:03:31,910
so I know someone mentioned how

1222
01:03:31,910 --> 01:03:35,710
oftentimes people tend not
to trust healthcare systems

1223
01:03:35,710 --> 01:03:39,120
just because of like past history,

1224
01:03:39,120 --> 01:03:44,120
but I know that oftentimes
doctors tend to discredit

1225
01:03:44,150 --> 01:03:45,960
their black and brown patients

1226
01:03:45,960 --> 01:03:49,920
and do not listen to their
complaints of symptoms

1227
01:03:49,920 --> 01:03:52,170
due to the racial prejudices

1228
01:03:52,170 --> 01:03:53,940
so how do you suggest that we change that

1229
01:03:53,940 --> 01:03:57,033
culture in hospitals and
among medical professionals?

1230
01:03:59,650 --> 01:04:02,273
- Yeah, another very important question.

1231
01:04:03,790 --> 01:04:04,890
You know, I think that

1232
01:04:06,384 --> 01:04:10,363
a lot of medical schools
are attuned to the problem

1233
01:04:10,363 --> 01:04:15,250
that you're describing and
many have instituted programs

1234
01:04:15,250 --> 01:04:20,250
that attempt to combat implicit
bias that leads physicians,

1235
01:04:21,050 --> 01:04:23,100
unconsciously or consciously,

1236
01:04:23,100 --> 01:04:27,680
but most often I believe
unconsciously to make decisions

1237
01:04:28,640 --> 01:04:31,750
that are shaped by

1238
01:04:31,750 --> 01:04:33,350
racial biases.

1239
01:04:33,350 --> 01:04:35,580
So I think a lot of people
are actually really working

1240
01:04:35,580 --> 01:04:36,513
on that problem.

1241
01:04:37,360 --> 01:04:40,280
What I would suggest is
that it is necessary,

1242
01:04:40,280 --> 01:04:41,320
but insufficient

1243
01:04:42,670 --> 01:04:44,340
because

1244
01:04:44,340 --> 01:04:47,930
one potential downside of
the focus on implicit bias

1245
01:04:48,770 --> 01:04:51,110
is that it suggests that the problem

1246
01:04:51,110 --> 01:04:53,490
is in individual people's minds,

1247
01:04:53,490 --> 01:04:55,650
that the problem is in
sort of hearts and minds,

1248
01:04:55,650 --> 01:04:58,190
the way we see and treat one another,

1249
01:04:58,190 --> 01:04:59,540
and I believe that that does matter,

1250
01:04:59,540 --> 01:05:02,220
the way we see and treat
one another does matter,

1251
01:05:02,220 --> 01:05:04,130
but if that's how we understand racism,

1252
01:05:04,130 --> 01:05:05,950
we're really missing the picture

1253
01:05:05,950 --> 01:05:07,750
because we have to understand racism

1254
01:05:07,750 --> 01:05:08,940
as a system of oppression.

1255
01:05:08,940 --> 01:05:11,500
We have to understand the
way that it is embedded

1256
01:05:11,500 --> 01:05:14,880
in social structures and political systems

1257
01:05:14,880 --> 01:05:17,720
and economic inequalities,

1258
01:05:17,720 --> 01:05:20,735
and so where that matters
is we have to think about

1259
01:05:20,735 --> 01:05:23,940
who's coming to the med
school in the first place?

1260
01:05:23,940 --> 01:05:26,860
Who are the faculty at the medical school?

1261
01:05:26,860 --> 01:05:29,720
So whether we're thinking
about an organizational level

1262
01:05:29,720 --> 01:05:31,540
or in local government
or in state government

1263
01:05:31,540 --> 01:05:32,840
or in federal government,

1264
01:05:32,840 --> 01:05:35,360
if we want to address racial inequities,

1265
01:05:35,360 --> 01:05:36,430
we have to think structurally,

1266
01:05:36,430 --> 01:05:39,110
we have to think about how can
we transform the structures

1267
01:05:39,980 --> 01:05:43,020
so that we don't
recapitulate the inequality.

1268
01:05:43,020 --> 01:05:46,340
So I would say it's good to continue work

1269
01:05:46,340 --> 01:05:47,870
at the individual level,

1270
01:05:47,870 --> 01:05:51,463
but if that becomes seen as the solution,

1271
01:05:52,350 --> 01:05:54,850
then it actually is going
to be very short-sighted

1272
01:05:55,840 --> 01:05:58,703
because the real problem is structural.

1273
01:06:03,570 --> 01:06:06,350
- [Diana] Hi, Diana, she/her.

1274
01:06:06,350 --> 01:06:07,603
My question is about,

1275
01:06:08,540 --> 01:06:09,730
you talked a lot in

1276
01:06:11,058 --> 01:06:13,030
your research about predisposition.

1277
01:06:13,030 --> 01:06:17,050
I'm wondering how much
treatment or lack thereof

1278
01:06:17,050 --> 01:06:18,130
contributes to

1279
01:06:19,410 --> 01:06:23,680
a higher premature death
rate in African-Americans and

1280
01:06:28,874 --> 01:06:32,820
how much treatment is the issue between

1281
01:06:32,820 --> 01:06:34,690
being well and not.

1282
01:06:34,690 --> 01:06:36,400
- Yeah, that's a really good question.

1283
01:06:36,400 --> 01:06:38,410
So certainly inequities in treatment

1284
01:06:39,320 --> 01:06:41,550
are an important piece of the problem.

1285
01:06:41,550 --> 01:06:43,143
About 20 years ago,

1286
01:06:44,348 --> 01:06:46,733
it was at that point the
Institute of Medicine,

1287
01:06:47,721 --> 01:06:49,570
now it's the National Academy of Medicine,

1288
01:06:49,570 --> 01:06:52,093
produced a report called
called Unequal Treatment,

1289
01:06:53,060 --> 01:06:56,700
which systematically reviewed
the available evidence

1290
01:06:56,700 --> 01:06:58,270
about

1291
01:06:58,270 --> 01:07:01,320
inequalities in clinical care

1292
01:07:01,320 --> 01:07:02,950
and found overwhelming evidence

1293
01:07:02,950 --> 01:07:06,260
from every domain of medicine

1294
01:07:07,600 --> 01:07:10,600
that there were significant inequalities

1295
01:07:10,600 --> 01:07:12,740
in medical decision-making and

1296
01:07:15,678 --> 01:07:17,428
in delivering the standard of care.

1297
01:07:22,290 --> 01:07:25,620
What I'm not so sure about
is how big a fraction

1298
01:07:25,620 --> 01:07:29,840
of the racial inequities
in say life expectancy

1299
01:07:29,840 --> 01:07:31,650
can actually be attributed
to those differences

1300
01:07:31,650 --> 01:07:33,260
in clinical care, because

1301
01:07:34,450 --> 01:07:36,260
this is not exactly my area of research,

1302
01:07:36,260 --> 01:07:39,040
but I do know of work that
is attempted to estimate

1303
01:07:39,040 --> 01:07:43,060
how much of population level
death, mortality rates,

1304
01:07:43,060 --> 01:07:46,310
and so forth, how much
inequalities in death rates

1305
01:07:47,390 --> 01:07:51,210
can be attributed to differences
in access to healthcare

1306
01:07:51,210 --> 01:07:53,760
or in the quality of healthcare,

1307
01:07:53,760 --> 01:07:55,050
and the estimates vary there,

1308
01:07:55,050 --> 01:07:57,690
but it's something on
the order of about 10%,

1309
01:07:57,690 --> 01:08:00,580
which is to say that we
could fix all of the problems

1310
01:08:00,580 --> 01:08:03,470
in inequitable access to healthcare,

1311
01:08:03,470 --> 01:08:05,440
and the problems wouldn't
necessarily go away

1312
01:08:05,440 --> 01:08:09,120
because what's at stake is who
gets sick in the first place.

1313
01:08:09,120 --> 01:08:12,410
Now if there's a social
pattern to who gets sick

1314
01:08:12,410 --> 01:08:14,690
in the first place and
then that is compounded

1315
01:08:14,690 --> 01:08:16,920
by inequalities in the provision of care,

1316
01:08:16,920 --> 01:08:19,800
then of course, that makes things worse,

1317
01:08:19,800 --> 01:08:22,960
but I would say that we should
be careful not to assume

1318
01:08:22,960 --> 01:08:25,200
that healthcare will be a sole solution,

1319
01:08:25,200 --> 01:08:26,810
that we also have to be thinking

1320
01:08:27,710 --> 01:08:29,350
more broadly in terms of prevention

1321
01:08:29,350 --> 01:08:33,243
and in who gets sick in the first place.

1322
01:08:36,100 --> 01:08:37,490
- [Juan] Hello, hello.

1323
01:08:37,490 --> 01:08:39,430
My name is Juan Florencia.

1324
01:08:39,430 --> 01:08:40,560
- Sorry, can you wave your hand?

1325
01:08:40,560 --> 01:08:41,420
I haven't found where you are.

1326
01:08:41,420 --> 01:08:42,780
- [Juan] Yes, thank you.
- Okay, hi.

1327
01:08:42,780 --> 01:08:44,490
- [Juan] So my name is Juan Florencia.

1328
01:08:44,490 --> 01:08:46,510
I use he/him pronouns.

1329
01:08:46,510 --> 01:08:48,187
First want to thank you Dr. Gravlee

1330
01:08:48,187 --> 01:08:50,960
for a wonderful conversation today.

1331
01:08:50,960 --> 01:08:52,200
I really enjoyed it

1332
01:08:53,770 --> 01:08:56,900
and I just want to touch
on a couple of things.

1333
01:08:56,900 --> 01:09:00,610
So I believe it was Clarence
Graham who propagated

1334
01:09:00,610 --> 01:09:03,900
that idea about the Middle Passage,

1335
01:09:03,900 --> 01:09:07,540
which was totally
predicated on him reading

1336
01:09:07,540 --> 01:09:09,703
Alex Haley's fictional Roots,

1337
01:09:11,320 --> 01:09:13,060
and I really appreciate you

1338
01:09:14,660 --> 01:09:17,480
talking about how we need to
think about racism differently

1339
01:09:17,480 --> 01:09:22,090
in terms of structural and
thinking about how it's

1340
01:09:22,090 --> 01:09:27,090
racist power that generates
racist ideas to support

1341
01:09:27,480 --> 01:09:30,630
the types of policies and laws they enact,

1342
01:09:30,630 --> 01:09:34,600
and then redirect that
blame away from the policies

1343
01:09:34,600 --> 01:09:36,300
to make them look normal,

1344
01:09:36,300 --> 01:09:40,160
then redirect that onto the
very people they've racialized

1345
01:09:40,160 --> 01:09:40,993
to begin with.

1346
01:09:42,340 --> 01:09:44,420
I have to say though that I am

1347
01:09:46,000 --> 01:09:48,290
not optimistic,

1348
01:09:48,290 --> 01:09:49,170
but hopeful

1349
01:09:50,320 --> 01:09:52,590
regarding the future of health equity

1350
01:09:52,590 --> 01:09:55,040
because since the Civil War,

1351
01:09:55,040 --> 01:09:58,980
we've only experienced three notable or

1352
01:09:59,960 --> 01:10:03,860
types of health equity
victories, the Freedmen's Bureau,

1353
01:10:03,860 --> 01:10:06,630
the Social Security
Act, Medicare, Medicaid,

1354
01:10:06,630 --> 01:10:10,010
and most recently the Affordable Care Act,

1355
01:10:10,010 --> 01:10:13,780
all of which have come
under tremendous attack

1356
01:10:15,170 --> 01:10:16,940
as evidenced by

1357
01:10:17,780 --> 01:10:20,520
the Affordable Care Act,
trying to be dismantled

1358
01:10:21,480 --> 01:10:22,620
and constantly

1359
01:10:24,510 --> 01:10:26,990
in the hands of the Supreme Court.

1360
01:10:26,990 --> 01:10:29,627
So I agree with you that our political

1361
01:10:29,627 --> 01:10:32,930
and economic conditions
need to be restructured, but

1362
01:10:32,930 --> 01:10:34,680
how do we go about

1363
01:10:34,680 --> 01:10:39,310
doing something as
monumental as addressing

1364
01:10:40,240 --> 01:10:45,240
like global predatory
capitalism mixed with racism

1365
01:10:46,970 --> 01:10:51,200
as the exercised version
of white supremacy

1366
01:10:52,938 --> 01:10:55,840
when everything like our
democracy, our country,

1367
01:10:55,840 --> 01:10:58,670
and our institutions are all founded on

1368
01:10:58,670 --> 01:11:01,893
those twin pillars of power.

1369
01:11:03,290 --> 01:11:04,123
Thank you.

1370
01:11:07,040 --> 01:11:09,410
- I kind of want to see your talk now.

1371
01:11:09,410 --> 01:11:10,243
Yeah.

1372
01:11:11,540 --> 01:11:16,120
I just would like to co-sign
everything that you just said,

1373
01:11:16,120 --> 01:11:19,670
except I'm gonna try to
express a little bit more,

1374
01:11:19,670 --> 01:11:21,065
maybe a little bit more hope.

1375
01:11:21,065 --> 01:11:23,040
I think what's important
about what you're saying is

1376
01:11:23,040 --> 01:11:25,040
that you're diagnosing the problem right

1377
01:11:26,534 --> 01:11:31,534
by recognizing racial
capitalism as the core structure

1378
01:11:32,430 --> 01:11:34,790
that shapes the likelihood
that people are gonna live

1379
01:11:34,790 --> 01:11:37,060
long lives or short lives,

1380
01:11:37,060 --> 01:11:40,710
and so I think it's that
kind of big thinking,

1381
01:11:40,710 --> 01:11:45,030
asking those questions is
a huge step forward, right?

1382
01:11:45,030 --> 01:11:47,489
Because even some of the examples

1383
01:11:47,489 --> 01:11:48,322
that you talked about,

1384
01:11:50,080 --> 01:11:50,913
did you identify

1385
01:11:50,913 --> 01:11:52,740
Social Security as one of those?

1386
01:11:52,740 --> 01:11:53,840
Yeah, okay.

1387
01:11:53,840 --> 01:11:57,150
Well if you really look at the
history of Social Security,

1388
01:11:57,150 --> 01:12:00,050
you see how it was also an
instrument of white supremacy

1389
01:12:00,050 --> 01:12:03,410
because of the ways that
agricultural and domestic workers

1390
01:12:03,410 --> 01:12:07,010
were excluded, which was a compromise

1391
01:12:07,010 --> 01:12:10,420
that had to be made with Southern senators

1392
01:12:10,420 --> 01:12:13,210
who did not want those dollars

1393
01:12:13,210 --> 01:12:14,920
going to black people in the south,

1394
01:12:14,920 --> 01:12:18,330
and so we have to simply open our eyes

1395
01:12:18,330 --> 01:12:20,230
to the enduring reality

1396
01:12:21,250 --> 01:12:23,980
of white supremacy as the
fundamental structure,

1397
01:12:23,980 --> 01:12:27,670
the fundamental political
structure of our society.

1398
01:12:27,670 --> 01:12:31,557
So the more we can have that conversation,

1399
01:12:31,557 --> 01:12:35,380
the more we can talk about
that historical context

1400
01:12:35,380 --> 01:12:37,630
and about what's really at stake here,

1401
01:12:37,630 --> 01:12:39,230
the more hopeful I am
about the possibility

1402
01:12:39,230 --> 01:12:40,520
of doing something about it.

1403
01:12:40,520 --> 01:12:42,810
If we think about it instead as well,

1404
01:12:42,810 --> 01:12:45,330
we just need different
anti-hypertensive medications

1405
01:12:45,330 --> 01:12:50,330
for black people, then that
simply serves to naturalize

1406
01:12:50,720 --> 01:12:54,710
the very inequities that
our society has produced

1407
01:12:54,710 --> 01:12:59,250
and has the effect then of
letting us all off the hook.

1408
01:12:59,250 --> 01:13:04,100
So I appreciate very much the
sources of your pessimism,

1409
01:13:04,100 --> 01:13:04,933
and

1410
01:13:06,000 --> 01:13:07,490
it's very daunting for sure,

1411
01:13:07,490 --> 01:13:08,730
but simply asking the question

1412
01:13:08,730 --> 01:13:12,670
and bringing that framework
into the analysis I think

1413
01:13:12,670 --> 01:13:15,200
moves us a little bit
closer to the possibility of

1414
01:13:15,200 --> 01:13:16,450
doing things differently.

1415
01:13:19,800 --> 01:13:22,743
- [Gall] Hi, my name's Gall,
I use she/her pronouns,

1416
01:13:24,200 --> 01:13:26,470
I was wondering, I feel
as though a big part

1417
01:13:26,470 --> 01:13:30,110
of solving the issues that you
brought up in this speech is

1418
01:13:30,110 --> 01:13:33,370
listening and including people of color in

1419
01:13:34,210 --> 01:13:35,610
like the fight almost,

1420
01:13:35,610 --> 01:13:38,140
and I was wondering how
you and your research

1421
01:13:38,140 --> 01:13:41,380
and how other social
scientists are including

1422
01:13:41,380 --> 01:13:44,810
their voices and their
opinions, other than

1423
01:13:44,810 --> 01:13:49,810
just studying the outcomes
of racism on people of color,

1424
01:13:49,970 --> 01:13:52,620
but rather having them, you know,

1425
01:13:52,620 --> 01:13:55,230
do hands-on work and share their knowledge

1426
01:13:55,230 --> 01:13:58,290
versus the people who are studying them

1427
01:13:58,290 --> 01:14:00,117
like sharing their knowledge.

1428
01:14:00,117 --> 01:14:00,950
Thank you.

1429
01:14:00,950 --> 01:14:03,423
- Yeah, thank you so
much for that question,

1430
01:14:04,450 --> 01:14:06,220
and by way of answering it,

1431
01:14:06,220 --> 01:14:09,000
I first want to refer all of you

1432
01:14:09,000 --> 01:14:11,440
to a really important investigative report

1433
01:14:11,440 --> 01:14:13,490
published by Stat,

1434
01:14:13,490 --> 01:14:18,290
which is an online magazine
subsidiary of Boston Globe

1435
01:14:18,290 --> 01:14:19,687
that focuses on health and medicine,

1436
01:14:19,687 --> 01:14:21,320
and last week they published

1437
01:14:22,530 --> 01:14:24,300
a piece

1438
01:14:24,300 --> 01:14:27,260
that adopted language from

1439
01:14:27,260 --> 01:14:28,143
Elle Lett,

1440
01:14:29,640 --> 01:14:34,640
who described what she sees
as a health equity tourists,

1441
01:14:35,300 --> 01:14:38,740
and the rush of especially
white researchers

1442
01:14:38,740 --> 01:14:41,290
who are colonizing this space

1443
01:14:41,290 --> 01:14:44,450
to take advantage of the
sudden influx of resources

1444
01:14:44,450 --> 01:14:47,090
that the National Institutes
of Health and others are

1445
01:14:47,090 --> 01:14:47,923
pouring at this,

1446
01:14:47,923 --> 01:14:51,990
and very often in the
process recapitulating

1447
01:14:53,000 --> 01:14:57,330
the structural inequities
that exist in the first place.

1448
01:14:57,330 --> 01:15:00,940
And so there, there is
a real responsibility,

1449
01:15:00,940 --> 01:15:04,020
especially for white researchers,

1450
01:15:04,020 --> 01:15:05,390
to

1451
01:15:05,390 --> 01:15:07,100
do our homework,

1452
01:15:07,100 --> 01:15:08,770
to study the

1453
01:15:08,770 --> 01:15:13,180
generations of especially
black and indigenous scholars

1454
01:15:13,180 --> 01:15:15,440
who have been making these
arguments in various ways

1455
01:15:15,440 --> 01:15:16,310
for a long time.

1456
01:15:16,310 --> 01:15:19,230
I gave a talk in the biology
department earlier today where

1457
01:15:19,230 --> 01:15:21,780
I was quoting W. Du Bois from 1899,

1458
01:15:21,780 --> 01:15:24,390
who basically laid it out for us,

1459
01:15:24,390 --> 01:15:25,630
in many ways.

1460
01:15:25,630 --> 01:15:27,920
So I think to do our
homework, to understand,

1461
01:15:27,920 --> 01:15:29,520
to respect this intellectual tradition,

1462
01:15:29,520 --> 01:15:31,620
to recognize the ways in which

1463
01:15:31,620 --> 01:15:33,180
we have been miseducated

1464
01:15:34,060 --> 01:15:37,530
because of the nature of white supremacy.

1465
01:15:37,530 --> 01:15:39,100
In the last 18 months,

1466
01:15:39,100 --> 01:15:41,440
I've been doing this work
since I was a graduate student

1467
01:15:41,440 --> 01:15:44,030
in 1997, and in the last 18 months,

1468
01:15:44,030 --> 01:15:48,250
I had to confront all of the
things that I should have read

1469
01:15:48,250 --> 01:15:51,603
in grad school that nobody
ever asked me to read.

1470
01:15:52,740 --> 01:15:55,810
No member of my dissertation
committee asked me to read,

1471
01:15:55,810 --> 01:15:59,440
no peer reviewer of my articles
or my grants said, Hey,

1472
01:15:59,440 --> 01:16:01,160
how do you relate this to Dubois,

1473
01:16:01,160 --> 01:16:04,370
or which any of the countless other people

1474
01:16:04,370 --> 01:16:05,670
who've been having these conversations,

1475
01:16:05,670 --> 01:16:07,400
and, you know, I was able to,

1476
01:16:07,400 --> 01:16:09,120
like nobody ever pressed me on that

1477
01:16:09,120 --> 01:16:11,010
so that's a fundamental issue, I think,

1478
01:16:11,010 --> 01:16:14,730
and just the ways that we
all are sort of miseducated

1479
01:16:14,730 --> 01:16:18,230
by who gets erased from the canon.

1480
01:16:18,230 --> 01:16:21,830
I also think that we have an obligation to

1481
01:16:21,830 --> 01:16:24,560
partner with people in ways that don't

1482
01:16:24,560 --> 01:16:27,700
recapitulate power
inequities, but rather try to

1483
01:16:27,700 --> 01:16:29,950
distribute resources in
a more equitable way.

1484
01:16:29,950 --> 01:16:32,530
So the work that I briefly
touched on in Tallahassee

1485
01:16:32,530 --> 01:16:34,610
has happened in the context of

1486
01:16:34,610 --> 01:16:36,725
a community academic partnership

1487
01:16:36,725 --> 01:16:39,670
that I co-founded with
Ms. Myesha Mitchell,

1488
01:16:39,670 --> 01:16:42,460
who's a community
organizer from Tallahassee,

1489
01:16:42,460 --> 01:16:44,230
and our

1490
01:16:44,230 --> 01:16:46,620
framework has been based in

1491
01:16:46,620 --> 01:16:49,500
principles of community-based
participatory research,

1492
01:16:49,500 --> 01:16:53,670
where there are university
researchers like me,

1493
01:16:53,670 --> 01:16:56,320
but there are also
members of the community,

1494
01:16:56,320 --> 01:16:58,970
representatives, community
based organizations,

1495
01:16:58,970 --> 01:17:00,363
policy makers,

1496
01:17:01,650 --> 01:17:03,373
and we become partners,

1497
01:17:04,945 --> 01:17:07,340
equal partners with mutual respect,

1498
01:17:07,340 --> 01:17:10,410
recognizing that each of us
brings something to the table,

1499
01:17:10,410 --> 01:17:13,870
and this has to also come
with real material commitments

1500
01:17:13,870 --> 01:17:15,600
from the university.

1501
01:17:15,600 --> 01:17:17,810
So I'm very proud of the fact that in

1502
01:17:17,810 --> 01:17:21,760
the last three grants that
we got to support our work

1503
01:17:21,760 --> 01:17:24,990
from private foundation and from

1504
01:17:24,990 --> 01:17:26,870
the National Science Foundation,

1505
01:17:26,870 --> 01:17:29,990
that more than half of the money

1506
01:17:29,990 --> 01:17:34,023
that we won in those grants
went to the community,

1507
01:17:34,930 --> 01:17:39,930
and you probably don't appreciate
just how unusual that is

1508
01:17:40,460 --> 01:17:42,303
because most universities,

1509
01:17:43,990 --> 01:17:46,040
if you as a researcher write a grant,

1510
01:17:46,040 --> 01:17:49,060
say it's going to cost me
$200,000 to do the research.

1511
01:17:49,060 --> 01:17:51,147
Then the university has what's called a

1512
01:17:51,147 --> 01:17:54,210
facilities and administrative
fee or indirect costs,

1513
01:17:54,210 --> 01:17:55,170
they're sometimes called

1514
01:17:55,170 --> 01:17:58,200
and different universities
negotiate the rate

1515
01:17:58,200 --> 01:17:59,130
with the federal government.

1516
01:17:59,130 --> 01:18:01,290
At my university, University of Florida,

1517
01:18:01,290 --> 01:18:03,780
that indirect cost rate is 52%

1518
01:18:03,780 --> 01:18:06,940
so that means that when I
submit that grant proposal,

1519
01:18:06,940 --> 01:18:09,300
it's gonna be the $200,000
that I say I need,

1520
01:18:09,300 --> 01:18:11,000
plus the university is
going to impose a tax

1521
01:18:11,000 --> 01:18:13,640
of 52% of dollars that goes
just to the university,

1522
01:18:13,640 --> 01:18:14,990
and often that money just,

1523
01:18:14,990 --> 01:18:16,510
it's to keep the lights
on at the university,

1524
01:18:16,510 --> 01:18:18,800
it's used for good things,

1525
01:18:18,800 --> 01:18:20,290
but what happens then is when researchers

1526
01:18:20,290 --> 01:18:21,880
come into communities

1527
01:18:22,930 --> 01:18:26,180
and the community doesn't
have a financial stake

1528
01:18:26,180 --> 01:18:27,660
in the grant

1529
01:18:27,660 --> 01:18:29,420
that it actually vastly,

1530
01:18:29,420 --> 01:18:33,260
it recapitulates and exacerbates
these power inequities

1531
01:18:33,260 --> 01:18:35,760
between university researchers
and the communities

1532
01:18:36,700 --> 01:18:38,840
where we do the research
in order to benefit

1533
01:18:38,840 --> 01:18:40,240
our own careers,

1534
01:18:40,240 --> 01:18:43,750
and so there's a fundamental
structural problem there

1535
01:18:43,750 --> 01:18:45,140
that has to be addressed.

1536
01:18:45,140 --> 01:18:45,983
And so,

1537
01:18:47,321 --> 01:18:50,853
there's a lot there, but
thank you for the question.

1538
01:18:54,551 --> 01:18:59,551
(woman giving instruction
in the background)

1539
01:19:04,683 --> 01:19:07,363
(audience claps)

1540
01:19:07,363 --> 01:19:08,280
Thank you.