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0:23
Dr. Del Rio: Good evening.
0:24
Dr. Del Rio: And good and good afternoon for those on the West Coast. This is Dr. Carlos, Del Rio. Dr. Del Rio: Number, professor of medicine at Emory University School of Medicine and professor of global health and epidemiology at Emory University.
0:37
Dr. Del Rio: And one of the co chairs of the covered 19 conversations expert Advisory Group Welcome to the six webinars in this code 19 conversation series, brought to you by the National Academy of Medicine and the American Public Health Association.
0:51
Dr. Del Rio: I would like to thank
0:56
Dr. Del Rio: I would like to thank our co sponsors. Dr. George Benjamin. Benjamin executive director of the American Public Health Association and Dr. Victor is our president of the national accounting medicine for his support on this important effort.
1:09
Dr. Del Rio: We're also grateful for the input of the expert advisory group and my co chair. Dr. Nick Nicholas Nicholas Nicole Lori. You can find it all about the advisory listed on the cover 19 conversations page. Dr. Del Rio: The purpose of the series is to explore the state of the science. I'm covered 19 to inform policymakers public health and healthcare professional. Scientists business leaders and the public.
1:33
Dr. Del Rio: More information on the series and recording so past webinars are available of the code 19 conversations page.
1:40
Dr. Del Rio: Today webinar has been approved for 1.5 continuing education credits bi CH e s see me see me and see pH, none of the speakers have any relevant financial relationships to disclose. Dr. Del Rio: Please note that if you want to continue continuing medical education credit, you should have registered with your first and last name. Dr. Del Rio: Everyone who wants credit must have their own registration other participants today will receive an email within a few days with CPD
2:07
Dr. Del Rio: Conflicts calm with information and claiming credit. If you have any questions or topics you'd like us to address today or in future webinars. Dr. Del Rio: Please enter them in the Q AMP a box or email us as a PHA at a pH a.org if you experience technical difficulties during the webinar, please enter your questions in the Q AMP a box as well.
2:28
Dr. Del Rio: Please pay attention to the chat for announcements and how to troubleshoot the webinar will be recorded and the recording transcript and slides will be available uncommon covered 19 conversations.org now I would like to introduce our moderator for today's webinar.
2:45
Dr. Del Rio: Dr. Deborah Paris will be our moderator. Dr. Paris is the senior vice president of organizational culture inclusion and actually at Simon's College in Boston. Dr. Del Rio: Dr Parris primary objectives, our commitment to a commitment is to make someone's university of the most inclusive campus in New England. Dr. Del Rio: Dr. Paris is responsible for expanding Simon's significant progress and practice underlying the universe's commitment to diversity, equity inclusion.
3:11
Dr. Del Rio: Prior to joining Simon's Dr Parris spent 20 years leading research and evaluation philosophy, including substantial investment in equitable Research and Evaluation Debra, over to you to frame today's conversation.
3:24
Dr. Perez: Thank you, Carlos, which Seems
3:28
Dr. Perez: I'm so delighted to be a part of this important conversation. I want to thank Dr. Perez: The advisory committee as well as my personal thanks to George's Benjamin for his courageous leadership over these many years and raising important issues like Dr. Perez: Equity and Inclusion as Carlos said, my name is Deborah joy business and I'm the Senior Vice President for organizational culture inclusion equity at Simmons University and my preferred pronouns.
4:00
Dr. Perez: First of all, that wherever you are. And whatever you do, you are doing so on the sacred land of people who came before you Dr. Perez: And the land that you are occupying and that Simmons, we recognize that all teaching and learning takes place on indigenous lands and for us that land is located in the Dr. Perez: North and mark and the master students. Um, so I I came across this quote that I wanted to share for our conversation today and it's by powerful lady.
4:30
Dr. Perez: From the pedagogy of the oppressed, looking at the past must only be a means of understanding more clearly what and who they are, so that they can more wisely build the future. Dr. Perez: And that's what this conversation is about today is understanding what we can learn about what's going on now that can help us in the future as well as what we can learn about a pandemics and and crisis of the past.
4:58
Dr. Perez: That will help us resolve disparities today on today's webinar code 19 and health equity exploring disparities and long term health impacts. Dr. Perez: Look at the disproportionate impact of code 19 has on underrepresented. Dr. Perez: Minority and marginalized communities, what we can do to combat these disturb and health inequities what we can learn from those past pandemics on how to provide equitable care for all
5:23
Dr. Perez: each panelist will have 15 minutes to present and then we will turn it over to you, our audience for a QA Dr. Perez: Before I introduce the panelists and I will introduce them one at a time. Dr. Perez: I want to set the stage for today's conversation by sharing some opening remarks and setting the broader context of what we all are facing right now with regard to inequity nationally and regarding
5:48
Dr. Perez: Issues like Xenophobia of racism and discrimination. So in the public health community. Many of my colleagues on this call have been involved in Dr. Perez: Research that really has highlighted the impact of social determinants in our health and on our health care and they've been doing this for decades. Dr. Perez: And what we're seeing play out right now in this pandemic is textbook inequities racism institutional structural racism and socio economic disparities.
6:18
Dr. Perez: These are the key factors that have been exacerbating the effects on people of color of this pandemic. Dr. Perez: I'm just today. I'm sure many of you read the article in the New York Times title, the terrible price, the days of deadly racial. This is a coven 19 Dr. Perez: Where researcher and incredible scholar activist and a woman who I deeply admire a scientist Dr Kamara Phyllis Jones talked about research that she had just published
6:50
Dr. Perez: Describing the effects of an Excel etc accelerated aging and she said that article that we have evidence that the wear and tear of racism, the stress of it is responsible for the differences in health outcomes in the black population compared to the white population.
7:06
Dr. Perez: Dr. Jones in 2019 study comparing 71 individuals 48 of them black with a team of UCLA. Scientists found evidence that racist experiences may lead to increased inflammation and black. Dr. Perez: Americans heightening the risk of serious illness, including heart disease. When we think about the disparities of the equities that we see today, we cannot ignore the historical impact of racism on our health.
7:33
Dr. Perez: Globally, what we are seeing in terms of these inequities that are not unlike more localized crises like Katrina. Do you all remember that conversation.
7:43
Dr. Perez: Who was left behind for the consequences of sorts of terminus impact on their health. Dr. Perez: These pandemic inequities what we're seeing right now in terms of infection rates death rates hospitalization and testing are are just mirroring the disparities of prior crises. Dr. Perez: Many of these disparities are rooted in inequities such as the high rates of co-morbidities among communities of color.
8:12
Dr. Perez: Who are more susceptible to code black and Latin next adults are more likely to suffer from obesity and diabetes and non Hispanic whites. Dr. Perez: Asthma is also more prevalent among African Americans and next communities adults and children, certainly being low income are more likely to have more chronic health conditions. Dr. Perez: But it's also the economic fragility of many of our communities, not, not all workers have the ability to work from home. I recently heard
8:44
Dr. Perez: Someone posted like it's enough of the praising of the essential workers, the cleaning folks that grocery workers a food service workers. Dr. Perez: You know, do more than just praise them, but really support them and understanding that this professional impact that this pandemic is having on those without the benefit or the privilege of having sick time a decent pay and the ability to stay home.
9:09
Dr. Perez: I think what's interesting about this pandemic is that it's only been recently that folks have turned their attention to the collecting the data that would demonstrate the evidence of this in equity. Dr. Perez: The CDC publishes a weekly morbidity and mortality report and then their last report or the early reports they they indicated that include inclusiveness of some of the data.
9:34
Dr. Perez: As early as April six, or as late as April six Louisiana became one of the first states to release a cobra 19 data by race other cities and states follow here in Massachusetts. It wasn't until after something Dr. Perez: That folks who are mandated the collection of racial ethnic data. And just as an aside when they first released a report 53% of the Dr. Perez: deaths were unknown race, ethnicity, which just indicates how little information was collected
10:04
Dr. Perez: In Michigan, black people make a 14% of the population but 40% of the best in Wisconsin. When we hear later about Wisconsin black people are 7% of the population but 33% of the deaths in Mississippi black people 38 38% of population with 61% of the Dr. Perez: Chicago blacks makeup 30% of the population but 56% of the deaths and in New York, where the country's highest number have impacted African Americans are twice as likely to die than whites.
10:36
Dr. Perez: You know, we could go on and on. And this is not just true about this is true about hospitalization cities like Chicago LA and New York City are seeing higher rates of hospitalization.
10:47
Dr. Perez: For example,
10:49
Dr. Perez: In in Illinois 43% of those people who were
10:56
Dr. Perez: Died were African American, but only 28% of those who were tested were African American Dr. Perez: And other information at least about testing is that the initial indication show that doctors are far less likely to refer African Americans for testing when they visit a clinic with Dr. Perez: Symptoms for Kobe than they are to recommend others testing. I mean, if you think about the the genesis of this pandemic in the United States. The first population that was
11:27
Dr. Perez: Called in for testing traveled abroad, leaving exposed and potentially infecting Dr. Perez: Many communities because there was no testing available. So they were focusing on the more affluent of folks who were traveling abroad in terms of testing. Dr. Perez: And and in that time that the disease. Obviously progress and we quickly and let's have these these incredible disparities.
11:52
Dr. Perez: I'll close by just saying that among these things. It's not just the condition itself. It's not this the issue the illness itself is what surrounds the illness that makes it possible for someone to to survive and thrive. Dr. Perez: Food and financial insecurity low income families being more dependent on food pantries more and more over issues like unemployment unstable or substandard housing.
12:16
Dr. Perez: can perpetuate these disparities and certainly poverty. Poverty is concentrated in communities of color, particularly among the disabled and the elderly. Dr. Perez: So today we want to focus much of this conversation, not on recounting these differences. I have just done. But turning to our experts to really get attention to what are the equitable solutions. What do we do now.
12:40
Dr. Perez: How can we learn from the past. What worked in the past. What can we implement now that will help address if not mitigate some of these disparities. So let me introduce our speakers.
12:55
Dr. Perez: First up, we have Dr. Sandra Quinn. Dr. Perez: Dr. Quinn is the professor and chair of the Department of Family science and Senior Associate Director of the Maryland Center for Health Equity Dr. Perez: At the School of Public Health and University of Maryland. She is currently principal investigator on a project examining vaccine misinformation on this information on social media platforms.
13:18
Dr. Perez: Are research team pioneered new measures to identify the impact of perceived racial fairness racial consciousness and discrimination on vaccine uptake. Dr. Perez: And she led to national surveys during a 2010 and one influenza pandemic examining public attitudes towards emergency use authorizations for drugs and vaccines.
13:39
Dr. Perez: She was the first to conduct an empirical tests of disparities and risk to set stability and access to care, that can exacerbate existing health disparities among racial and ethnic minorities in a pandemic. Dr. Perez: She is a member of the National Academies of Science, Engineering and medicine committee on evidence, evidence based practices for public health emergency preparedness and response.
14:02
Dr. Perez: I'm so delighted to turn this over to the presentation to Dr. Quinn and if Dr. Quinn gets going to lay out why vulnerable populations are definitely differentially impacted by the pandemic, including broad discussion of social determinants. Dr. Perez: And what can we learn from these past pandemics. Dr. Quinn.
14:22
Dr. Quinn: Thank you, Dr. Press and thank you to a pH and the National Academy of Medicine for inviting me here today Dr presses detail. Much of the tragedy that we see reflected in these headlines today. Dr. Quinn: Why are blacks dying immigrant communities facing catastrophic pandemic Indian country at higher risk minority community hospitals and minority communities struggle.
14:47
Dr. Quinn: And all of these things were predicated on social determinants of health that lead to a disproportionate pack of all the chronic disease that we just heard about diabetes, heart disease, asthma. Next slide.
15:03
Dr. Quinn: The social determinants of those health disparities are not new. They're not new to cove it. We know that Dr. Quinn: But they they have left us with an underlying burden of chronic disease that put people at risk for severe disease. So let's talk about what we have seen from the past and where we're going to call to action. Next slide. Dr. Quinn: Very simply, we know that we have an existing burden of chronic disease. What we have not grappled with
15:34
Dr. Quinn: as effectively as set the risk of being exposed to this new virus are not evenly distributed across our population. Dr. Quinn: And so at the heart of the you know that fundamental underlying racism and associated poverty. We also have, you know, the creation of environments healthy environments from poor housing. Dr. Quinn: To ongoing exposure to toxic substances, the living and food deserts that place people in in unhealthy environments.
16:08
Dr. Quinn: We know that racism is also at the heart of poor investment and public education, which is directly tied Dr. Quinn: To limit and employment opportunities. So when we think about risk of exposure to coven 19 we are thinking about the people who are going to the grocery store for us.
16:28
Dr. Quinn: To help protect us the garbage collector. The janitorial staff but also home health aides. There are a variety of people whose limited employment opportunities puts them sort of at the bullseye for exposure to this virus on a daily basis. Next slide.
16:52
Dr. Quinn: But that we noticed some of the other factors is none of this is news to us, but there are a couple of things that are important since 2017, we know that the percentage of our population that are uninsured is rising again.
17:05
Dr. Quinn: The inadequate investment public health infrastructure that Dr. Benjamin knows all too well. It's an evidence in my own county Prince George's County where the per capita expenditure on health and human services is $38 and some sense.
17:25
Dr. Quinn: In Montgomery County next door that per capita expenditure is $224 in some sense. So that infrastructure that we need today more than ever hit is struggling Dr. Quinn: We've been watching hospitals close and rural areas around around the country. And we also know that the racial bias and discrimination and health care is not news, but it is also still here, and it is a factor affecting whether people get adequate care. Next slide.
18:01
Dr. Quinn: So in 2009 my research team was funded by CDC and at the start of the H1 in one flu pandemic, we decided to operationalize bloom and shine and colleagues model on health disparities during a flu pandemic. Dr. Quinn: We've talked already about the differences in social position based on income, education, occupation, race, ethnicity immigrant status. So all of these things that make a difference and disparities to exposure.
18:34
Dr. Quinn: But also they underline the disparities to susceptibility, particularly to severe coven 19 disease and they underlie those disparities and access to adequate treatment.
18:49
Dr. Quinn: Once the diseases development but develop, but even prior to that now access to adequate care for those those chronic diseases that put people at risk. Dr. Quinn: All this comes together in ways that are devastating and then that leads to the kinds of her reflect statistics that Dr. Press just shared of death and hospitalization illness. Next slide.
19:17
Dr. Quinn: So in 2009 2010 we conducted a Longitudinal Survey. And I'm just going to highlight a couple of things here. Dr. Quinn: And what we found was that there were a number of issues related to disparities in exposure susceptibility and access to care. Dr. Quinn: The first one that I want to highlight is that work related inability to social distance. So remember what we've been seeing playing out the restaurant workers.
19:45
Dr. Quinn: The people going to the grocery store in shopping, the people who do not have sickly Dr. Quinn: The people who cannot do their jobs at home, like many of us are doing the people who will lose their jobs if they are not on their job site. Dr. Quinn: And what we found was, well, that affected all the groups in our survey whites African Americans English speaking and Spanish speaking like next
20:08
Dr. Quinn: People fruit Spanish speaking people. That was really a significant factor. They could not social distance from work. Dr. Quinn: The difficulty of accessing healthcare, which was to in 2009 and 2010, particularly for Spanish speaking Latinos has been exacerbated in these last several years of anti immigrant
20:33
Dr. Quinn: actions and policies and the bottom line is, what did that give us at the end when we looked at our longitudinal sample midway or toward the end or the H1 in one pandemic. Dr. Quinn: These disparities and particularly that absence of sickly contributed to a population attributable risk of 5 million additional flu cases in the general population and 1.2 million among Latinos, that is a toll that is simply too high to peg again. Next slide.
21:11
Dr. Quinn: So I was asked to think about what are the lessons we should have learned and obviously one of them was passing a national security policy. Dr. Quinn: We have not really done that in a way that that covers all employees, no matter how big the company or the workplace there in Dr. Quinn: And we've really might grappled with and recognize that in our workforce. We are dependent upon entire groups of people who are largely Dr. Quinn: Racial and ethnic minorities and certainly often rural
21:44
Dr. Quinn: But entire groups of people in our workforce that stay at risk because they can only do their jobs there. So, think for a moment about the Meatpacking plants. Dr. Quinn: And who was working in those meatpacking plants says that are now forced to continue to work. Dr. Quinn: We, we began to move with the Affordable Care Act that increased access to health care. But obviously, as we all know, we have a long ways to go.
22:10
Dr. Quinn: But not just the access, but is that healthcare acceptable. Dr. Quinn: Is it's sensitive and how we address racial bias and discrimination, we're starting to we're doing some work in that area. I think we're going to hear some of our colleagues talk about it in a moment, but we've got a long ways to go.
22:29
Dr. Quinn: We always say you don't start building partnerships at the time of the public health emergency. So do we have, and had we seize the opportunities. Dr. Quinn: To create the partnerships between communities that are most devastated here and their health departments in the healthcare system.
22:47
Dr. Quinn: But I would argue there's one other really important thing is we could have had a pandemic plan that was informed by a health equity and lands and buy a health and all policies approach. Next slide.
23:04
Dr. Quinn: So how do we bring that health equity lens and the health and all policies lens to this coded Dr. Quinn: 19 response and recovery and I say I add in recovery here because we will get there at some point. Dr. Quinn: So one of the things goes back to what Dr. Press mentioned is that we really need to institutionalize reporting.
23:28
Dr. Quinn: We've seen better reporting this happened. By the way, also make one in one where initially we were not getting this kind of data. But it's not just reporting of the Dr. Quinn: Cases and deaths and that's what we've been getting more sporadically we need who's been tested, then what are the cases, what are the hospitalizations. What are the deaths for each of
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Dr. Quinn: The populations that are severely impacted here.
23:58
Dr. Quinn: I believe we also need to think about the policies that are being and practices that are being put into place in hospital settings.
24:08
Dr. Quinn: We all know the story of too few ventilators and too few ICU beds. The question is how to do providers make that dreadful decision of who gets those and who doesn't. Dr. Quinn: And my fear is that if you come in with many comorbidities as many African Americans and Latinos.
24:32
Dr. Quinn: And others may do that you may actually be disadvantaged from the time you come into the, the, er, in terms of your access to these scarce medical resources. That's a tough at the colon practical problem. Dr. Quinn: We've see local localities, and states begin to address, you know, how do we make sure our safety net and other programs. Dr. Quinn: Help to sustain families and communities that are particularly vulnerable.
25:04
Dr. Quinn: They, they may have been poor. To start with, they may have lost jobs and may have more than 1% of households. It's not jobs. Dr. Quinn: And they have been dealing with the wear and tear is Dr. Jones talks about of racism and that daily stress. How do we make sure they stay Dr. Quinn: Protected during this pandemic. So prohibiting evictions prohibiting rent increases, for example. Dr. Quinn: Making sure that local funds and state funds support schools who so they can still handout.
25:38
Dr. Quinn: Meals to students that would be on free and reduced lunch. So there's a whole array of complex programs that are needed to help protect people from falling further into a vulnerable position becoming homeless going hungry in this pandemic.
25:57
Dr. Quinn: What I haven't seen, to some extent, and I think we're here from some localities that are better at this than others. Dr. Quinn: Is our people from our effective communities really being integrated into the task force discussions of how do we reopen and how do we recover. Dr. Quinn: And I'm not seeing that. And the way I think we need to have it there.
26:21
Dr. Quinn: And more everything. How do we integrate and what kind of data related to health equity to we need to both plan for that reentry and plan for the recovery and monitor so that, again, we don't compound these disparities further. Next slide.
26:42
Dr. Quinn: We know community engagement. Anyone who's been working health equity and health disparities. We know communications vital. Dr. Quinn: You know it, it brings the assets of communities and increase the stress. There are a whole range of reasons. We all know Dr. Quinn: But I think there's some specific things here. Let's engage communities on where these test sites are are the places where people have access to, when
27:07
Dr. Quinn: Public transportation is kind of do they trust those places. Let's educate communities about what this testing means who can get tested and under what circumstances. Dr. Quinn: And thirdly, we are hearing about hiring contact tracers all over the country. The question is how will we prepare them. Dr. Quinn: To work with community members from food may, that may different by race or ethnicity or or linguistically or in other ways that are important.
27:38
Dr. Quinn: But we also know, and Dr. Press mentioned this, that people are encountering barriers right now to getting tested and to getting care. Dr. Quinn: Going into the are being told to go home and then when they come back, it's too late. So we need to really hear from communities today on what are the things are encountering and what is feasible to change what can we change today and Maryland, we will be having our first color of
28:10
Dr. Quinn: Facebook live event tomorrow night with Maryland legislators, but I believe all across the nation. We need to be able to hear concerns worries and needs from affected communities. Dr. Quinn: And finally, I think we're all heart mitts. The one hope. I think we see is when we know that all the assets that is Dr. Quinn: That exists in every community are stepping forward. It was links yesterday in Prince George's County an African American sorority out don't
28:45
Dr. Quinn: giving out meals to people. So they're not hungry. So there are a whole range of things that we need to be doing to engage communities to help them and to help us do a better job of preventing further disparities last. Next slide.
29:03
Dr. Quinn: I wouldn't have spent all these years, focusing on vaccine disparities and I couldn't in good conscience walk away from this talk without addressing this Dr. Quinn: So here's what I know, I know, year after year, African Americans get the flu vaccine at lower rates. There's a history to that there are there issues of trust. There's the burdens of racing history. There's the burdens of the Tuskegee study, there's
29:31
Dr. Quinn: Missed Opportunities when health care providers don't offer the vaccine at a visit. So I think we need to start today. We know that there is going to be the second way. Dr. Quinn: At the time of the flu season. So how do we get community health workers and leaders engaged now on planning for, you know, increasing that flu vaccine uptake, it's critical for form.
29:56
Dr. Quinn: But moreover that's talking about reaching out to the community. But how do we make sure that that our providers, the pharmacies. Dr. Quinn: And other providers have adequate supplies. We know that is often an issue and an emergency in Trusted Computing settings that are convenient and people will go to Dr. Quinn: But we also know that that participation clinical trials for many reasons. We're all familiar with.
30:24
Dr. Quinn: Is a challenge and that many African Americans Americans, Latinos, Native Americans don't participate. But I also know from our own research that they're often not asked to participate and they may be willing Dr. Quinn: So, again, to be ready and to have a vaccine that we know may be safe and effective for everyone that's critical. Dr. Quinn: And finally, we're starting to see the first emergency use authorization of a therapeutic drugs.
30:53
Dr. Quinn: Coming probably this week and we know that there's a possibility of emergencies authorized code and 19 vaccines. Dr. Quinn: We have to work with communities to get them ready and I would also argue we have to work with health care providers so they can do a better job at making the case for vaccines. Next slide. Dr. Perez: Sondra. I just want to note that we're at time so
31:19
Dr. Quinn: This is the last slide. Right.
31:22
Dr. Quinn: We're now faced with the fact is Dr. King said that to Mars. Today we're confronted with the Fierce Urgency of Now Dr. Quinn: And this unfolding conundrum of life in history there is such a thing as being too late. There's no time for apathy or complacency. This is a time for rigorous and positive actions.
31:42
Dr. Quinn: To prevent the further tide, the tsunami of death, but also to lay the foundation at changing those social determinants, so that we are not in this position again. Thank you. Dr. Perez: That's fantastic. Thank you so much, Dr. Quinn, you know, I really appreciate the context to set and around the challenges of African Americans and Latinx have received receiving
32:08
Dr. Perez: Treatment and you mentioned the respirators and not just because the decisions are made based on the comorbidities that they may or may not have but also let's acknowledge that there's bias, right, and that how
32:22
Dr. Perez: What we know from the literature is that they are likely to receive adequate treatment, regardless of comorbidities. And so that bias has to be taken out of the system. And sorry, I really appreciate your, your insights to about the
32:39
Dr. Perez: Setting impact of these anti immigrant policies and how that is all connected to these disparities. I'm super excited now to turn the mic over to Dr. Dr. Perez: Jeanette colic, let me tell you a little bit about Dr. Perez: Dr Wallach, she has had over a decade of progressive public health experience representing the life course, she began her career as an intern and the City of Milwaukee.
33:04
Dr. Perez: Health Department and after graduate school, she returned to Wisconsin to serve at the UW Madison's director prevention and campus health initiatives. Dr. Perez: Prior to her transition to the association of maternal and child health programs in DC Dr Wallach serve as the associate director women and infants health Dr. Perez: And she is also a since in September 2018 returned to her hometown of Milwaukee to serve as the Commissioner of Health. She's inspired and motivated to move
33:38
Dr. Perez: The M HD forward to maximize community impact. Dr. Perez: Dr. Quality diverse set of experiences continues to motivate her to advocate and represent Dr. Perez: Those who are unable to have a seat at the table, she's going to talk to us about how looking at Nationwide data and sharing how communities of color are more severely impact and highlight details.
34:00
Dr. Perez: From other jurisdictions at data and she's also going to talk about a very interesting topic which is what has been the impact on the commuter communities and how that relates to urban community. So let me turn over the mic to dr color.
34:17
Dr. Kowalik: Thank you, Dr. Perez. Good afternoon, everyone. It's a pleasure to be here today. So I first want to acknowledge Dr. Benjamin for the opportunity to this learn and grow and public health and just the Dr. Kowalik: The joy and benefit of being a member of a PHA a little that we know would be locking arms virtually to fight a pandemic. So definitely all of these opportunities for engagement.
34:42
Dr. Kowalik: Are very, very useful and necessary now more than ever. I used to be the chair of the Health Administration section on the past chair. I'm also a member of the maternal child health section. Dr. Kowalik: So I just want to shout out my sections. And I also want to thank a few folks before I dive in, MAYOR TOM BARRETT for the opportunity to serve my hometown.
35:04
Dr. Kowalik: The marquee Common Council, the health department staff, past and present, including our lab was one of the first in the state to start testing code at 19 Dr. Kowalik: And then other health departments in our county. There are 10 others. So when people say MILWAUKEE HEALTH DEPARTMENT IS JUST A CITY OF MILWAUKEE. Dr. Kowalik: And there are 10 other health apart, since there is CUDA hey Hales corners Greendale Greenfield Franklin North Shore.
35:34
Dr. Kowalik: Oak Creek, St. Francis South Milwaukee while would Tosa and West Allis. So since we declared an emergency we you know now have our Dr. Kowalik: First case on Friday the 13th in March than that activated us into this emergency mode. So the health department of Milwaukee ends up serving as a lead for the county's public health emergency response.
35:56
Dr. Kowalik: So just to give you a little sense of what Maki is about walkies about 87 miles north of the city of Chicago. So most people know where Chicago is so if you can just think North. That's where Milwaukee is Dr. Kowalik: The city has about six 600,000 people and the county as a whole is about a million. So the way I have this broken out here is using the census data. The first
36:21
Dr. Kowalik: Numbers are for the county and the second numbers are for the city just to show you a comparison of how the demographics breakdown for our population. Dr. Kowalik: And as you can see the race and ethnicity of our area is pretty diverse. We are a majority minority city, which is very important because that also impacts how we drive
36:44
Dr. Kowalik: Public health and our community. You can also see disability uninsured or not having health insurance status poverty and median income. So again, some of these mentors here will continue to play out as we talk about our coven response.
37:02
Dr. Kowalik: The next slide is just a general snapshot of what the city of marquis health department is all about. So we Dr. Kowalik: Went through this rebuilding phase and we're still in it now, but our vision is living your best life Milwaukee. And our mission is to advance to help and equity. Dr. Kowalik: Of our kids to science, innovation and leadership and we're seeing that play out very heavily in our team pandemic response. And then these are our values.
37:29
Dr. Kowalik: The next slide is just to give you a little sense of what is going on in Milwaukee. So some people know about this through our equity work and other people may not Dr. Kowalik: But I want to just acknowledge some of the drivers behind why we're even talking about race and ethnicity and covert 19 Dr. Kowalik: Why we were one of the first jurisdictions to report on this level of data, noting that all epidemiologists know you always collect race and ethnicity data.
37:57
Dr. Kowalik: But you don't necessarily share it publicly until you feel confident that the data is value or valid, should I say so at the state level in 2018 my chief of staff lead this initiative to address. Dr. Kowalik: Public health and declare it has a racism as a public health issue Lillian pain. Then at the county level in May. Dr. Kowalik: There was a declaration as well through the Office of African American affair. So through Chris ably and Nicole Richie
38:28
Dr. Kowalik: And then in July of last year, the city of Milwaukee declared racism as a public health issue. So there are a number of people at the table. Dr. Kowalik: We have our gear initiatives, there's a city one and health department one but just to show that there was some background to how we were addressing race and ethnicity and equity.
38:45
Dr. Kowalik: In the city of Milwaukee and and we were in early stages of really bringing about true change throughout our city because, as you can imagine, there's a lot of work that still needs to happen.
38:55
Dr. Kowalik: The next slide is just showing you a comparison of an old redlining that from 1938 and this is from the University of Richmond, but this is Marcie County. Dr. Kowalik: And the green is best. The blue is still desirable yellow is definitely declining and red is hazard. So you can see Dr. Kowalik: This North side of town and install side where there's these pockets and then you can see listed here Locky County and then a blue is the city of Milwaukee.
39:25
Dr. Kowalik: So just highlighting where the majority of the cases are looking at cases by zip code for 100,000 so the zip code 532 to three has a rate of Dr. Kowalik: Five 591 53205 which is on the south side has a rate of 539 53210 which is where I grew up as a rate of 499
39:50
Dr. Kowalik: And 53216 which is north side which is where our first hotspot was identified has a rate of 471. So just to give you a comparison when you're looking at other jurisdictions, what's happening and how are in equities. Dr. Kowalik: Playing out the next slide is just a snapshot of showing what has occurred from week one. Again, noting Friday the 13th.
40:14
Dr. Kowalik: All the way up through last week. So initially we saw the majority of our cases among African American men that were middle aged Dr. Kowalik: Also, the majority of the deaths. Early on, were African American. But as time went on we started seeing that the climb. Dr. Kowalik: We also started to see more problems with the race and ethnicity quality as far as the data. So, like the one note about 50% of variables, not being available. And now we are at the
40:43
Dr. Kowalik: 28 or 29% for the city of Milwaukee. So we're working on filling in the gap and some of those unknowns. We also know Dr. Kowalik: That that also could be attributed to people, not feeling comfortable about releasing Dr. Kowalik: Or sharing their race and ethnicity data with their providers because of fear of discrimination or being treated differently or having different access to services.
41:04
Dr. Kowalik: We also know that there's some issues along the continuum from electronic health and medical records to lab to the electronic disease surveillance system. So this is just to give you a sense of where things are at since we received our or detected. Our first case.
41:21
Dr. Kowalik: The next slide is a little bit about our election. Everybody knows Wisconsin had an in person election during a pandemic and we really fought hard Dr. Kowalik: Number of health officers from around the state, as well as our Wisconsin Public Health Association and Wisconsin. Dr. Kowalik: Association of local health departments and boards and health work together to really petition legislators to not have an impersonal action during a pandemic, but that was overturned.
41:48
Dr. Kowalik: So we were required to really consolidate polling sites in the city of Milwaukee. Dr. Kowalik: And still hold an in person election and it was extremely challenging. So again, the health department staff and Election Commission staff and other volunteers that worked on this effort. I just want to acknowledge and salute.
42:04
Dr. Kowalik: Of the hard work that went into setting up a social or physical distancing enhanced cleaning educating providing masks and face coverings to people, to prevent the spread of covert 19 Dr. Kowalik: So this is just the kind of outline when we say election activity. What does it mean if they were co worker volunteer if they actually dropped a valid off at a site.
42:25
Dr. Kowalik: curbside voting was also something that came up and of course traditional voting voting at a polling site. So our initial data show that seven people in the city of Milwaukee had
42:37
Dr. Kowalik: In fact, infection coven 19 infection associated with election activities. But according to our last analysis now 40 people in a county. And so we're finding that data now and we plan to have Dr. Kowalik: An update later this week because, of course, the media is waiting for more information about that, but I just want to stress.
42:57
Dr. Kowalik: That we can look at correlation, but of course we can't establish causation. Because again, all of the factors that go into analyzing multiple variables. Dr. Kowalik: Across people that voted. But as you can imagine, who is most likely impacted by this, people of color in the inner city. So just stay tuned for more information on that.
43:17
Dr. Kowalik: I also want to highlight just a sense of what's happening here and the need to be able to address race and ethnicity and coven 19 Dr. Kowalik: So we were providing daily media briefs and that was like local media you know your NBC, CBS all of your stations. Dr. Kowalik: So we reported that earlier by like we to the data that I just shared with you about how the majority of our cases were African American, as well as fatalities.
43:47
Dr. Kowalik: That one point they had 100% of fatalities were African American. So that got picked up nationally. The first Dr. Kowalik: news outlet or periodical that cover that was essence magazine and that was in March, March 26 the next was April 1 was Atlanta Black Star. Again, these are two, you know, not marquee center local
44:11
Dr. Kowalik: periodicals or media outlets but covering other spaces. Then, on April 3 pro publica covered or shared and more detailed information about what was happening in the city of Milwaukee. Dr. Kowalik: And then from that point on, we started to see more interest more push with the larger jurisdictions sharing their data more states sharing their data.
44:36
Dr. Kowalik: There's this push for the CDC to share their data. And then there's the Kaiser Family Foundation issue brief that was released on April 7 Dr. Kowalik: And then there's some other research that still coming out that hasn't been peer reviewed yet, but should be coming out this summer. Dr. Kowalik: So again, just highlighting the process of what's happened here in Milwaukee.
44:58
Dr. Kowalik: And I know I haven't really gone into detail about the commuting piece, but it's important because as I noted the difference between Dr. Kowalik: More hockey and the City of Chicago. There's a lot of people that move between our jurisdictions, as well as some of the other counties that are in between Milwaukee and Cook County. Dr. Kowalik: But then there's also a number of people that either work in a city of Milwaukee and live in the suburbs.
45:21
Dr. Kowalik: Or vice versa. So we have a lot of movement that's happening. So the first case and southeastern Wisconsin was in a suburb called walk a shot, which is a Western Southern predominantly white more fluent. Dr. Kowalik: Eventually, our first case in Milwaukee was someone that had contracted the virus from a walk that walk a shot case.
45:41
Dr. Kowalik: And then our second case was an African American male that had contracted the virus from visiting in Atlanta. So just from those two activities traveling Dr. Kowalik: Commuting, if you will, and then going like domestic travel that's Dr. Kowalik: How we got our first cases. So it's important to note that there was so much emphasis on international travel a very little on just movement period.
46:04
Dr. Kowalik: That that's a missed opportunity for us. So again, there's a lot of work that still needs to happen, but we're glad that we're all talking and we're learning from one another. And, you know, looking at the past and what we need to do now, so Dr. Kowalik: My last slide is just acknowledging Dr. Kowalik: This marquee health department team. Oh, the fragmented today. But yes.
46:26
Dr. Perez: Wrap it up, that'd be great. Dr. Kowalik: Yeah, sure. So just wrapping up here. What are some things that we can do to address the acute situation and in the future. Dr. Kowalik: acutely we need to provide support for people that still have to go to work. So providing hazard pay, making sure people have their personal protective equipment.
46:44
Dr. Kowalik: Providing some subsidies are free, as far as basic human needs suspending rent and mortgage, making sure people have health care, all of that is extremely important right now but long term, we need to be revisiting and conversation about reparations. Dr. Kowalik: And making sure that people are being paid fairly for the work that they're doing. You should have to work three jobs to equal what a white man can make
47:06
Dr. Kowalik: So, you know, again, just how all this is related. We're not going to fix it. Unless we're willing to really dismantle the system and rebuild it. Dr. Perez: That's wonderful. Thank you so much Dr Wallach, I really appreciate your insight on the whole commuter experience and how important it is to
47:23
Dr. Perez: To focus on that community and i and i love this, this notion of really looking at systemic change versus, you know, at the individual level. So, so thank you so much that we're going to turn it over to Dr. Mayer Shaw.
47:38
Dr. Perez: Dr. Shaw has served as the executive director of the local health authority for Harris County Public Health Dr. Perez: The nationally accredited county public health agency for the nation's third largest county with set four points for 7 million people since 2013 Dr. Perez: He upon completing his medical training, Dr. Shaw began his career as an emergency department physician at Houston's Michael the bakey
48:06
Dr. Perez: Virginia Medical Center. He started his a form of public health journey as a chief medical officer of Galveston county health district to oversee its Clinical Health System and infection infectious disease portfolio. Dr. Cha holds multiple leadership positions.
48:25
Dr. Perez: In entities like him and national academy of sciences, engineering and medicine that us Dr. Perez: Senators, he's Dr. Perez: Pro trust for America's Health for public health law and the Texas Medical Association. So previously served as president of NATO, which is a National Association for Dr. Perez: City and County Health Officers and represents and represents the nation's 33,000 local health department so
48:50
Dr. Perez: Please welcome and and I'll turn the mic over to Dr. Shaw was going to talk to us about how to combat these disparities and in cases of death in communities of color. And what do we know about rural communities. Dr. Shaw, please. Dr. Shah: Degeneres. Thank you for having me. And thank you everybody for for your fantastic my colleagues for their presentations. Dr. Quinn.
49:14
Dr. Shah: absolutely spot on, and Dr Wallach always great to to see you again. It's been a while since we last connected obviously on better terms before this this pandemic. Unfortunately, hit Dr. Shah: So I really want to thank the National Academies, as well as a PHA and all the other organizers of this of this webinar. This is an extremely important.
49:36
Dr. Shah: Opportunity for us to share what's happening on the front lines. And I know that you all know this, but just so we underscore that I am a a Dr. Shah: unapologetic Firm believer and the the community as well as the role of the local public health department and I do not apologize for that, because I sing that. Dr. Shah: From the hymn book every single day and lately I've been shouting it. So I just wanted to make sure to to say that right up front.
50:08
Dr. Shah: The, the real issue that I think we've continued to have in our communities. Dr. Shah: as we as we fight this pandemic is the real challenge that is at the bottom of my slide here, which is this hashtag and visibility crisis, unfortunately. Dr. Shah: We no longer have that in visibility, everybody is looking at public health. Now, but over the years as I had forwarded this concept of invisibility crisis.
50:34
Dr. Shah: It was really about the lack of capacity building that was really the lack of investment in public health. Dr. Shah: And that is really come to bear. Now, as we all know, as we're looking across the globe, and especially across the country. Dr. Shah: And public health agencies as well as public health systems, not really having those resources. In fact, not having the resources.
50:58
Dr. Shah: To be able to respond effectively. And I think that is a significant challenge that I'm hopeful that we can continue to work towards. But as you all know, Dr. Shah: It is going to be a process. So as I move to the next slide here. I want to just remind everybody that Harris County is is big and diverse and complex. We are the third largest county in the US with 4.7 million people. Dr. Shah: We would be that makes us larger than 25 states we are
51:33
Dr. Shah: Larger than the State of Rhode Island when it comes to geographic spread and in to add to the complexities, the geopolitical and socio demographic complexities Dr. Shah: We have no majority population in Harris County we have over 40% Hispanic 30 some percent Caucasian 18% African American and 8% Asian and so it's a very diverse community with multiple languages over 90 consulates and all sorts of other
52:05
Dr. Shah: Socio demographic diversity types of ways to look at our community that certainly comes into play when we're in the midst of coven 19. Next slide.
52:20
Dr. Shah: And as I said earlier, I do believe very strongly that that public health is is very much that invisible workforce. Dr. Shah: Everything that we do and usual times. Obviously, there's no social distancing in the slides. Dr. Shah: But you know restaurant inspections and certainly water quality responding to emergencies. Dr. Shah: Picking up dangerous animals are trying to adopt out not so dangerous animals and all sorts of other activities behind the scenes, whether
52:47
Dr. Shah: It's for individual vaccinations, or if you see it just right to the Harris County Public Health insignia is the H1 and one mass vaccination efforts during 2009 2010 that the end of the day when public health does its job. It's largely invisible. Next slide.
53:06
Dr. Shah: The premise that we have in our community is that health really happens where you live, learn, work worship and play. Dr. Shah: And these are really there's so many different ways of looking at at us and it's again slicing a community or how a public health. Dr. Shah: Department or a system really responds to a community's health, but these social determinants of health really drive and the structural determinants as well. Dr.
53:30
Dr. Shah: What we are accomplishing in our communities, but it really in our minds, we very much tried to parlay it into this place matters concept which really allows us then to respond as well as plan in advance of and a response that's needed. Next slide.
53:48
Dr. Shah: In November of 2019 it seems ages ago now, we launched a 2020 vision of health in Harris County. It was a landmark study for a 10 year roadmap for the third largest county in the United States, and we called it Harris cares Dr. Shah: A vision of health in Harris County. Next slide. If you go to that. Dr. Shah: And obviously the website was there, you can go to here's kind of Public Health website as well to
54:14
Dr. Shah: To download it. There were five key findings and I want to just highlight these than the first one is probably the one that I want to really highlight is this 24 year Dr. Shah: Difference and life expectancy based on where you live, and I know we've seen this across the country. And I think underscores the existing inequities that really come into play as you layer on top of that coven 19 and certainly the next Dr. Shah: Four bullets here about social vulnerability, the SPI looking at
54:47
Dr. Shah: The distance to healthcare access the lack of health insurance. And also, obviously, the concern about under insurance and certainly healthcare access in general, as well as specifically Dr. Shah: Certain conditions like obesity as well as chronic health conditions like hypertension and diabetes and heart disease that come into play in coven 19 were existing well in advance of coven. Next slide.
55:19
Dr. Shah: Is this comes through. You might have to keep clicking because it'll come through. There you go. Unfortunately, we never have a dull moment, it appears in Harris County. Dr. Shah: From Tropical Storm Allison on forward. We have unfortunately been a part of a significant number of large scale emergencies and this
55:35
Dr. Shah: Does not even take into account the smaller ones. And so when we sometimes have tropical storms. We don't even think about them as emergencies, because we're faced with Dr. Shah: Hurricanes like Katrina and Rita and Harvey and I can all the other kinds of natural disasters as well as what I would point out in the top right is and the H1 and one Dr. Shah: Which our department was responding for 18 months in the midst of that mild pandemic. And so while it feels like we are.
56:06
Dr. Shah: Have this has been going on for several months, and it has been. Unfortunately, we are still in this and it's going to continue to affect us in our communities for time to come. Next slide.
56:20
Dr. Shah: So I think you all know this. It's obviously a cover 19 a global threat you know just really looking at, unfortunately, that the United States now has a third of the cases across the globe. Dr. Shah: Which I think is also a point of note that we do need to be thinking about as well as the number of deaths that we've had in this country. Next slide.
56:45
Dr. Shah: And I do want to point out the public health challenges and solutions at the end of the day. Dr. Shah: Do not recognize borders and if there's ever an underscoring of global and domestic health being intertwined. Dr. Shah: And why we must invest in global health and and thinking about global health inequity. This is absolutely the time for us to be thinking about this, but this obviously predates coven 19 and the pandemic that that is at hand. Next slide.
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Dr. Shah: Our response here locally started way back in January, I'd actually started about January 8 or ninth around the time that we learned about what was happening. Dr. Shah: With coven 19 officially but we were watching it even over the New Year holidays. Dr. Shah: I would say that January 23 and when we all came together as our first in person meeting again not socially.
57:35
Dr. Shah: Distance at that time. And as it does, it does seem odd when you look at pictures that are pre social distancing and post social distancing and you can really have a moniker in terms of where in the response we were as well as our first cases. Dr. Shah: In Harris County in March and and then in April, as we focused our county elected official County Executive judge Lena Hidalgo
58:00
Dr. Shah: Laid out just yesterday, the three T's of testing tracing and treating that at the end of the day that we were very much mindful of the fact that Dr. Shah: We needed to respond on behalf of our community. And I do want to underscore with Dr. Quinn and Dr Wallach also said, which is that initially there was this incredible amount of of
58:21
Dr. Shah: vilification of the Asian American community in Harris County, to the point where our China Town our Asian American businesses saw about a 60% drop in businesses and restaurants. Dr. Shah: And and and grocery stores, because there was this this real concern about what was happening. Dr. Shah: In China, even though at that time there was no evidence that we had any cases here in Harris County and there was a lot of
58:49
Dr. Shah: Beautiful diversity aspects of what is makes us strong as a community, but also there's some ugliness, which obviously we saw in social media and throughout. So I do want to make sure to mention that as well. Next slide.
59:05
Dr. Shah: This dashboard really illustrates that what Dr Wallach Dr. Shah: Described which is at the end of the day what we're really trying to do is to share data share information. Dr. Shah: To give the public the best opportunity to understand what's happening. And there it is very complicated because Dr. Shah: A lot of the times we are we're being asked to share data points which have not been cleaned up. Or if not, there's not not honestly accurate.
59:32
Dr. Shah: And that has been a significant concern of ours, and I will say one of those includes that when we were wanting to release race and ethnicity data, we found that 35 to 40% Dr. Shah: Of the the information was in the box of unknown or or indeterminate or incomplete and it was because we were receiving laboratory results that simply had Umar Sha a date of birth.
59:56
Dr. Shah: And a phone number and a positive and that was it. And we had to go find that individual which is not just contact racing. It's actually pre contact racing. Dr. Shah: Of case tracing, which has been an incredible challenge as well. And then other people who simply did not want to provide information as well. Next slide.
1:00:15
Dr. Perez: We have about five minutes. Dr. Sean Dr. Shah: You got it.
1:00:19
Dr. Shah: So we've we've been now been very assertive about testing sites and including pop up testing sites and rotating testing sites. Dr. Shah: And I think this has been brought up before and I'll just underscore that we have to FEMA sites that are in large stadiums that are set up for testing.
1:00:37
Dr. Shah: But we recognize that we also needed to set up testing where people were especially with socio economic issues and and obviously transportation issues and and and vulnerabilities. So we have now been moving Dr. Shah: quite aggressively in fact are doubling our, our pop up sites that are in now communities, especially communities of color, but not just that, but what we're calling testing deserts, because it really is like a food desert that you just don't have testing their next slide.
1:01:08
Dr. Shah: And here's some example of those testing site placements and I do want to remind you that there are Dr. Shah: The both Harris County and there is the city of Houston health department we work in partnership with our city. Dr. Shah: Partners as well. We're using SPI the social vulnerability index and
1:01:25
Dr. Shah: socio economic factors and this real concept of testing. So we can actually understand a desert so we can understand where exactly we need to be. And that really has helped us move into directions throughout our community. Next slide.
1:01:41
Dr. Shah: And as you can see, this is where we're seeing individuals coming from this is a heat map. So it's obviously not it's protecting the privacy, but you can see where people are coming from. Dr. Shah: To test, but you also see areas where people are not coming from and that is an equal piece of the visualization, which is very much about how do we really understand how to get to. Is it because people there.
1:02:05
Dr. Shah: Are testing elsewhere or they don't they don't need to be tested or is it really that they don't have access to testing, which is really a significant concern. Next slide.
1:02:18
Dr. Shah: And our outreach has also been very equity focused from languages to again partnering with key partners to really understand best how we can get into various again LL W WP live, learn, work worship and play to continue to respond in communities. So we can be of the community. Next slide.
1:02:41
Dr. Shah: The three t's. As I mentioned a multi disciplinary team that now we're sending out to congregate settings, especially looking at vulnerable. Dr. Shah: Vulnerabilities and communities to really understand where nursing homes might have less resources than a nursing home and another part of the community. And that's also now in play and we launched this just yesterday. Next slide.
1:03:06
Dr. Shah: So dressing inequities of code 19 communities of color in our minds is really the Dr. Shah: Long term solutions mistaken to consideration where communities live, learn, work worship and play. Dr. Shah: And really, that we want to make sure that the data is driving decision making to inform those strategies and solutions and that we mitigate Dr. Shah: As best we can, long standing health inequities. But we're in the midst of an overwhelming pandemic.
1:03:30
Dr. Shah: It is it is it is almost as if we're layering on top the existing inequities and wanting to do everything we can. So obviously, we do not worse in those Dr. Shah: And then certainly the data piece from race, ethnicity, location, age, etc. That helps keep health inequities a central focus of our response in procurement and analyzing as well as visualization of that data.
1:03:54
Dr. Shah: And finally, this the last couple of points here of this is no time for politics. The other realities of public health is inherently political and that is a very big challenge that we have and that Dr. Shah: We have to remember it is ultimately about community trusts and we have to work together and yet we know that not everybody is always working in that direction. Next slide.
1:04:14
Dr. Shah: And I'm almost done here, the race, ethnicity, this is some example of some of the information as you can see we we've had, especially with our African American or black community that we have had an Dr. Shah: Over the number, the percentage of the of the of the representation in our community. We've had more cases more deaths.
1:04:38
Dr. Shah: That is a concern. We're continuing to try to unpack, whether it's because of the underlying health conditions or if it's really related to the, the, some other factor that we're also looking at and certainly a very similar concerned with our Hispanic Latino community. Next slide.
1:04:56
Dr. Shah: I always bring this in Dr. Shah: This is the the football metaphor. Everybody's heard this, perhaps, I would say, public health is the offensive line to the football team. Everybody knows number four in our community is our quarterback the health care system. Dr. Shah: But we really are the offensive line that nobody really gives credit to number 68 or number 71
1:05:15
Dr. Shah: And we need to raise that visibility. When you raise visibility, there's value when you have value, then you have validation by pro health resources or pro health policies. Dr. Shah: Not right now. I would dare say that we have a visibility crisis, not an invisibility crisis.
1:05:31
Dr. Shah: But I think people still don't fully understand what public health does. And so they're really trying to fill the blanks in of what is contact tracing great concept new concept public health has been with this concept for decades. Next slide.
1:05:47
Dr. Shah: So let me close by saying that this a few images here. The image on the in the in the middle is when I responded after the earthquake in Port Au Prince. Dr. Shah: And just remind me of the kids there. And I always with with take this back with my own children and thinking that everybody, every child has the opportunity and should have the opportunity for
1:06:08
Dr. Shah: For for the optimal health that all of us should be enjoying in a community, regardless of where we are across the globe or here locally. Dr. Shah: The team on the left here. This is our Harris County Public Health team. Dr. Shah: Before again coven 19 and I would just say that, you know, it takes a village and our team is fantastic and and what they have done and accomplished. I'm so humbled by working with them.
1:06:33
Dr. Shah: Working for them, actually, in so many ways. And finally, on the right here. Dr. Shah: This is when I had hair wasn't grey back in 2005 at Hurricane Katrina response at the Astrodome and I asked for an official form to 14 which was not about new items or or widgets, but it was for common sense.
1:06:52
Dr. Shah: And that has stayed with me for this 15 years here that kind of public health. Just makes common sense and we need to continue to invest in it, but we also need to invest in it because it makes sense for the benefit of our communities. Dr. Torres, I'll turn it back to you. Thank you. Dr. Perez: Thank you so much, Dr. Shaw. Our first question is for Dr Wallach Dr koala. Could you provide more information about how contact tracing is being used in Milwaukee.
1:07:18
Dr. Perez: And how you're ensuring the workforce for contact tracing. I know Dr. Quinn had mentioned before how important Community Engagement is when you're doing this kind of work. So can you talk about some of the strategies that you're you're Dr. Perez: Implementing in Milwaukee, with regard to navigating trust and cultural issues.
1:07:40
Dr. Kowalik: Yes, it's been very challenging. I mean, the reason why I moved back home for this opportunity is because of some of the issues with management of the health departments. Dr. Kowalik: A rebuilding which included like over your organizational process and filling a number of vacancies or something that we're still in the process of doing Dr. Kowalik: So we had to initially bring back some retired nurse's to our communicable disease unit.
1:08:08
Dr. Kowalik: To help with some of that capacity issues. Eventually we started reassigning other health department staff to our CD unit to assist with the case investigations and contact tracing so Dr. Kowalik: As of earlier this week and and noting, it's Wednesday that we had 19 people that were working
1:08:27
Dr. Kowalik: As far as our health department, then we're also are able to bring on or leverage the support of other health departments in our county and then a state health department which is based in Madison had worked on bringing some additional supports for contact tracing. Are they had
1:08:47
Dr. Kowalik: Acquired and train about 100 people to assist. So those individuals are overflow. When we hit our capacity, but we have also added a whole nother wave of health department staff to our Dr. Kowalik: Case investigation and contact tracing activities because, as we're ramping testing up. We need to make sure that we have enough people to
1:09:09
Dr. Kowalik: Go up. So there's a number of quality improvement measures that are being implemented or in the process of being implemented. So we can look at Dr. Kowalik: How long does it take to complete an investigation, including a contact tracing right now, it's about seven days. So we're looking at bringing that number down Dr. Kowalik: We also have about a 92% completion of for reaching out to anybody that is a case or contact
1:09:37
Dr. Kowalik: That other 8% we're working on some of those issues. There are related to just logistical challenges with getting a hold of folks one, for instance. Dr. Kowalik: Is that our health department normally has a private feature. When we call people. So how often are you or how likely are you to answer the phone if you get a private call also
1:09:57
Dr. Kowalik: Trying to use some technologies we're talking to our city attorney's about using social media or other ways to reach out to people to say, hey, call back to health department. Dr. Kowalik: So we're just trying to be a little bit more nimble, kind of like what we do for FBI and HIV word for the D is to be more successful in our outreach and investigation efforts.
1:10:19
Dr. Perez: Thank you so much, Dr. Quality Dr. Quinn, can you unmute yourself, please. This question is for you. You know, perhaps, given your H1 and what the background. Can you talk about how unique this American
1:10:33
Dr. Perez: trend is it's a question around these disparities is what's happening here in the US with regard to marginalized populations in other countries happening.
1:10:46
Dr. Quinn: I think that's a great question. And I think we can look at in different places around the world. And it's playing out differently. Dr. Quinn: So there's been a lot of focus in the last couple of weeks on Sweden and how sweetness managing this pandemic and largely going about it. It's Dr. Quinn: You know, sort of daily life and hopes of grading herd immunity. But I also think about Sweden as many Scandinavian countries and European countries.
1:11:16
Dr. Quinn: These are countries that have built in access to health care. They have built in some of the family supports that are really vital to help families. Some of them have some guaranteed. Dr. Quinn: Foundation in terms of income, but in countries where that is not the case. And, you know, you can look as we all know, across Dr. Quinn: You know, many vulnerable parts of the world. So, from South America wearing Guayaquil and Ecuador.
1:11:45
Dr. Quinn: You know, people are dying on the literally being left on the streets and they are people who are the most vulnerable among that's I think what makes to me. Dr. Quinn: What is so disturbing is that this is the United States, and we should be able to provide some fundamental supports to enable people to live a healthy life. No matter whether it's pandemic or not.
1:12:16
Dr. Quinn: And we're not so that marginalized populations across the world are always going to be more vulnerable, but it doesn't have to be that
1:12:28
Dr. Perez: It's a great point. Thank you, Dr. Shaw. This next question is for you if you can please unmute your mic.
1:12:36
Dr. Shah: Sure. Dr. Perez: Oh, Dr. Shaw. Not much has been shared you did share on your slide some data on Asian Americans, you also commented on the issues of xenophobia and racism, with regard to this.
1:12:50
Dr. Perez: You know pandemic and interestingly in the data you showed you showed that Asian Americans only represent about 3.7% of the death, the Dr. Perez: The desk and 7% of the population. So in some ways they're under represented. Could you speak to Dr. Perez: Data for Asian Americans that are experiencing racism and and comment on those trends as their data collection on the on the lived experience of Asian American communities, how, how are you and others working on that issue.
1:13:23
Dr. Shah: Thank you for that question. And let me start also by saying that I'm Dr. Shah: A member of the Asian American community. So I also, you know, recognize the, the real challenge, not just in the data. Dr. Shah: Side of the house, but actually in the awareness and raising the awareness side of the houses, you know that.
1:13:40
Dr. Shah: It's also Ramadan right now for Muslims and we're continually getting a lot of questions from our Muslim community about how to bring together people in a spiritual way very similar to during Easter and Dr. Shah: Good Friday and Passover about again being emotionally together and physically apart. And that's been a challenge. Obviously, and in different faith communities as well. So I wanted to point that out but
1:14:07
Dr. Shah: To your point, you know, this is still in process. I mean, there's really a lot of data. Dr. Shah: Metrics and measures that we don't really have. We have not enabled to unpack a lot of this where we're, we're trying to do our best to just get rudimentary information out. Dr. Shah: But I'll be honest, it's nowhere near what we would like to get out. And if you look at our hair scares
1:14:31
Dr. Shah: Study that I described earlier, it is markedly more complete and markedly more robust in looking at all sorts of different data. Dr. Shah: Measures and and we simply when you're in the midst of an overwhelming pandemic, not an excuse, by the way. Dr. Shah: But you simply are really trying to get as much information out but you're really trying to respond as as quickly and and methodically as you can.
1:14:59
Dr. Shah: To protect the community. And so I think there has been this challenge of response. Dr. Shah: That also has all that has has dovetailed into then how do you then share information to protect communities. So what we've really relied on Dr. Shah: Again is one policymakers and elected officials in certain communities like Asian American communities to really say.
1:15:20
Dr. Shah: Hey, can you help us get the word out in these communities as well as we've we've focused our attention on these communities. If we see that there is a lack of Dr. Shah: Either testing or messaging or other kinds of activities happening. And then finally, it's really bringing this all together and saying that it's it's it's really about Dr. Shah: The, the raising of awareness of how people protect themselves that magically regardless of your race or ethnicity or national origin or your
1:15:50
Dr. Shah: immigration status. You are not any less or more protected from a virus that is impacting all of us in a way that if we if it goes unfettered, we are all going to have untoward consequences, and I will just close with saying that
1:16:06
Dr. Shah: I really don't like the term vulnerable populations vulnerable communities. Dr. Shah: Because I think we all are vulnerable. It's what is it in those communities. That is what how more likely is it that something can actually move us into the vulnerability Dr. Shah: Piece. And we know that that is a real term that a lot of us really have trouble with. And so I just want to bring that up as well. Dr. Parents
1:16:31
Dr. Perez: Thank you so much, Dr. Shaw. Back to you, Dr. Quinn reflecting on your pandemic conceptual model. Are there some immediate actionable steps that healthcare providers and community health workers might take to implement that model. And that might address these disparities.
1:16:53
Dr. Quinn: It's a great question. And so, you know, and so we think about the model. First, the, the risk of exposure and the differential risk of exposure and healthcare workers. Dr. Quinn: And EMT and our first responders are a huge risk, of course. So I think some of the things that we really could think about is, I mean,
1:17:15
Dr. Quinn: In the best of all possible worlds we would have employers, be they hospital systems be the grocery stores with a meatpacking plants, making sure people are adequately protected when they go to work and you know we've seen disproportionate sort of
1:17:35
Dr. Quinn: You know, we've seen that has not played out consistently for everyone. So I think that's one. But I also think for health care providers. Dr. Quinn: Who are in local health departments, much as you've heard from Harris County and Milwaukee are really doing their best to reach out to communities. Dr. Quinn: That may be at at higher risk to address them and help them be aware that and be and be cognizant of testing. Make sure testings accessible to them.
1:18:09
Dr. Quinn: But I think there are a couple of other things and and one is, you know, the long term issue. I think we all know in terms of susceptibility because of the burden of chronic disease. I mean, yes, long term. Dr. Quinn: All of those social determinants that that drive those are things that that have been challenges and remain challenges. But there are other things that I think are
1:18:35
Dr. Quinn: You know if this is not a reminder for healthcare systems to to really work hard at integrating much more prevention and chronic disease management. Dr. Quinn: And being aware of that and our policymakers, turning to as we've done in Maryland to budget models were hospital system really actually have a financial incentive to keep people healthy and out of the hospital.
1:19:05
Dr. Quinn: But I wouldn't do one last thing. And that is, is also related to access to care and Dr. Pres. You, you, you captured. What was in my mind and didn't come out of my mouth, and that was that. Dr. Quinn: You know I'm struck often when I see the news at night and the diversity of the healthcare workforce, you see. Dr. Quinn: As you know, patients are leaving the hospital. I mean, I am amazed and and and thrilled to see that.
1:19:41
Dr. Quinn: And I know that you know the exactly the point you raised up to what extent do we still have a lot of work to do to address racial bias and to have our systems begin to say, you know, Dr. Quinn: Are we looking at this with a health equity lens. Are we making some of these decisions about scarce resources, you know, are we checking ourselves in terms of what bias. We're bringing into that room and this is hard work and a very stressful situation.
1:20:19
Dr. Perez: That's a great insight. Dr. Quinn Dr Wallach other question here, and probably each of you could probably address this, but this, you know, the issue. The challenge with data, as you know, as often for certain populations, it is
1:20:35
Dr. Perez: non existent right so Native American indigenous populations Native Hawaiian Pacific Islanders those committees are often left out. Dr. Perez: And and the question has to do with the mental health impact on communities that are that we can't measure. Right, so maybe I'll
1:20:55
Dr. Perez: Start with Dr Wallach about kind of how do you address issues of data that don't fully reflect the entire population or the experience of the most marginalized and and this this question was referring to earlier point around what the impact of the wear and tear principle. Dr. Perez: To communities in terms of mental health and stressors, so Dr Wallach, why don't you start us off with that.
1:21:20
Dr. Kowalik: Yeah, definitely. I'm glad that this question was posed, because I know that there is a lot of concern about how what, who do we focus on, you know, we tend to look at Dr. Kowalik: Who has the greatest disparity and put a lot of energy and resources into that versus kind of zooming out and looking at it from all across the board. Some of the challenges with that are related to some of the points made earlier about lack of funding under resourced, you know, limited
1:21:50
Dr. Kowalik: Opportunities for local health departments to really address all of these various groups and even within say black or African American there's groups and cultures within so Dr. Kowalik: Just even with our outreach of looking at how are we really zooming out and and zooming in and meeting the needs of everyone. So, you know, we're entering week eight
1:22:13
Dr. Kowalik: Of our responses, meaning once we had our first case. So we're tailoring and adjusting things as much as possible, but we're basically telling people in the community. You don't need permission to help Dr. Kowalik: The messaging, the foundation of the messaging needs to be the same, but the way you go about doing it have added so providing Dr. Kowalik: Groups of resources to be able to address the various reference refugee populations and other groups that are
1:22:46
Dr. Kowalik: In our communities across the country, there needs to be an understanding that, yes, because you don't see them taking up 60% or or representing 60% of your cases that doesn't mean that you only focus on the 60, you have to also be able to address everyone so
1:23:04
Dr. Perez: Just Dr. Kowalik: Deploying other groups to help. That's my recommendation. Dr. Perez: Wonderful. Thank you for calling. I guess maybe turn to you, Dr. Shaw because you earlier mentioned in your comments kind of Dr. Perez: You know the end visibility of public health right like no news is good news. No one ever appreciates public health until something goes wrong.
1:23:23
Dr. Perez: And before the pandemic. It was, you know, a foodborne illness or anything, but that would draw attention to public health and and now we know because of the Dr. Perez: Decades of underinvestment underfunding of public health and the undoing of public health. We're in the situation we're in. Can you talk about how local public health and stay in and and state health departments can support.
1:23:53
Dr. Perez: Strengthening the public health infrastructure.
1:23:58
Dr. Shah: Yeah, thank you for that. And that is the the deepest question is, is how do we sustain this this this value proposition and know that, to me it's the three V's as I, as I mentioned, and Dr. Shah: One of my staff members actually reminded me of the fourth v. And I never thought of it. So in visibility crisis and
1:24:20
Dr. Shah: raise the visibility. The first be the raising the value when people value something they wanted. They want to do something about it. That's validation with Pro health resources pro health funding. Dr. Shah: But the fourth V was virus and you know I I will be honest that I this attention to, to public health comes every time there's an emergency.
1:24:46
Dr. Shah: And it goes away. There's not the sustainability to continue for people to follow and even now, you've seen this this in the, in the, the concept of heroes. Dr. Shah: Right. The heroes in the healthcare side. I'm a physician, I see patients I you know I I've been at Texas Motor Center for 2025 years I get all that Dr. Shah: I absolutely believe that our, our brothers and sisters in the healthcare system are absolutely heroes and she rose and all those things, however.
1:25:15
Dr. Shah: Public Health our epidemiologists that are working their tails off at two in the morning. Dr. Shah: That are doing everything they can without the recognition and then also get people looking at their field and saying, why were you not able to do this, why can you not step up like that when we didn't invest in you. Dr. Shah: And we didn't believe in you. They're actually asking questions about should we even stay in this field.
1:25:44
Dr. Shah: So I think it really gets to a deeper conversation that is well past this pandemic that we need to have a very deep discussion and a look in the mirror, as a society, what do we value. And how are we going to invest in that value. And that's not happening now, unfortunately. Dr. Perez: Yeah, and sad to say, and I spent many years before coming to higher ed 20 years in philanthropy, working with some Dr. Perez: Incredible foundations, including the Robert Wood Johnson Foundation.
1:26:18
Dr. Perez: The anti Casey Foundation, the quarter but and more Foundation. And I remember our assessments in public health preparedness back in 2005 and how it was hard for anyone to envision back then that that investment was worth it. Right. And here what we're facing what we're facing you know
1:26:39
Dr. Shah: I didn't want to say that
1:26:41
Dr. Shah: Our county leadership got that. So that right before March one was when this pandemic kit, obviously, in full force. But over the last two budget cycles, our local budget went up 15 million
1:26:56
Dr. Shah: And that's amazing and our FB budget has now increase Dr. Shah: Or epi sizes has quadrupled from 25 to 100 plus and we just received approval for 300 contact tracers yesterday with 43 new full time positions at local resources. Dr. Shah: And on that will not stay low. Yeah.
1:27:17
Dr. Perez: That's where it's coming from. Dr. Shaw. So let me just close by saying, you know, we heard a lot on this conversation about the structural barriers that exacerbate a disparities issues of food deserts and insurance of, you know, Dr. Quinn spoke about the importance of focusing on
1:27:40
Dr. Perez: Community Engagement Dr Wallach spoke about the importance of understanding a movement that is localized. And of course, Dr. Shaw just highlighting again the importance of local a strong local public health, you know, I would be remiss if I did not mention the impact of
1:28:00
Dr. Perez: In higher education where I sit as senior vice president at soon as University, all of these issues that we talked about today are magnified. Dr. Perez: In colleges and universities across the country, especially for for low income students, you know, the issue of xenophobia and anti Asian especially anti Chinese harassment that has been happening. Dr. Perez: If you go to our website simmons.edu you'll find a resource list of all the information gathered around this anti Asian
1:28:32
Dr. Perez: Racism and issues and in a statement that we we we drafted.
1:28:37
Dr. Perez: To to show support for, you know, eliminating this kind of ridiculous xenophobia.
1:28:46
Dr. Perez: I know that foundations like the bar Foundation has have signed on to stand against anti Asian
1:28:55
Dr. Perez: Xenophobia during the pandemic, you know, everything from xenophobia and its impact on Asian Americans the vulnerability of our LGBT q plus students who may be less supportive environments that are hospital and unsafe.
1:29:10
Dr. Perez: Not having the social support that they used to have mental health issues with regard to being isolated. Dr. Perez: The potential for exacerbating that isolation. If this contact tracing leads to, you know, apps that identify you know you're within five feet of someone who Dr. Perez: tested positive, we have to really think of the implications of technology.
1:29:32
Dr. Perez: On on worsening, some of the things that we're seeing manifest first generation students who you know personally experienced job loss and their families housing insecurity. Dr. Perez: You know, the strategy at the end of the day, the solution is put together an equity team demand access
1:29:48
Dr. Perez: To data, analyze that data for equitable treatment and and the protocols, we need programs like you know the masters in public health and health equity program as soon as University has an explicit problem. Dr. Perez: Focus on undoing racism, you know, foundations are doing great work before foundation and their emergency funding for the pandemic Robert Wood Johnson Andy Casey's color foundation
1:30:12
Dr. Perez: All with explicit strategies and fundings emergency relief focused on equity issues. Dr. Perez: That concludes our webinar of reminder that today's webinar has been approved for continuing education credits. Dr. Perez: You will receive an email in a few days from CPD at compacts with information on planting credits.
1:30:30
Dr. Perez: Our next webinar will take place in two weeks. On May 30 at 5pm Eastern everyone who's registered for today's webinar will receive an invitation to that webinar. Dr. Perez: This webinar has been recorded and the recording transcript and slide presentation will be available. I want to thank again all our panelists has been amazing.
1:30:49
Dr. Perez: And my thanks to the American Public Health Association, the National Academy of Science of medicine for sponsoring this webinar series. And thanks to you our listeners for joining us today. Thank you so much. Be well
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