 Okay, this short video is to explain why individual behavior alone is not enough and why when you're focusing on population changes, you have to go beyond changing individual behavior directly. The health disparities that exists in the African American community and in other communities. It is based more on what is called the social determinants of health. The health of African Americans is based more on the social determinants of health because the choices that people make are guided by the circumstances under which they live. Saying that people can make different choices such as they can move ignores the difficulty if not impossibility of changing your geographic area because of jobs because of family and because of a sense of wanting to stay where you are. And other individual and social factors. So let's go into this for a second. So we've already, I just want to briefly review the statistics just so that people will understand that there is a health gap. And depending on which year you calculated it, the excess deaths are anywhere between 87,000 to 100,000 per year. That would be the that would be like loading up a jumbo jet full of black people and having one plane crash every day. This is this statistic is based on this is a 2008 statistic that's based on the World Health Organization and the Health United States that is put out by the federal government. So we also see that life expectancy is very different that black Americans, both male and female have significantly shorter lives than white Americans who, by the way, are not all that healthy, given the amount of money, giving the richness of our society. Perhaps one of the most significant areas is maternal death. maternal deaths are considered preventable deaths. And so the quality of health of health that a person of society has is can is based can be looked at in terms of the number maternal deaths. Let me go back to the life expectancy for a minute. A recent quote by the CIA on their website says that the quality of life of a citizenship of a citizenry can be measured by the life expectancy. The proxy for the quality of life is the life expectancy. So what this says is that despite all our money, we don't have the best quality of life in the in the world and I mean white Americans don't have the best quality of life in the world. Furthermore, black Americans quality of life is worse than many poor predominantly black countries. I want to move on quickly because I really want this to be about the stress that undergoes. Now, people continuously make the mistake of confusing race with the class. And I sometimes I wonder if it's because people want to deny the existence of race and so focusing on class is the way to do that. First of all, race is a social construction that has biological consequences. That is being black in America affects your health. But being black isn't the reason why that isn't the biological reason why you're unhealthy. If we want to discover whether race is an issue or class is an issue, you have to control for other factors. So the other competing factors, you can never control for all factors, but you control for other competing factors. So if you believe that class is the factor, then you have to control for race by comparing people the same race, but different class. If you believe that race is the dominant factor, then you have to control for class by comparing people of the same class, but different race. Study after study after study. So this is not. I know that we live in a fact free world where people believe that they get to interpret the facts the way they want to interpret the facts. But it's not true. And the fact is low income whites live longer than low income blacks, middle income whites live longer than middle income blacks. And that even when you look at low birth weight, what you see is yes, that there is a difference based on if you use education as a proxy for class. Then people with less than 12 years of education have more low birth weight than people with 13 years or more education. You see that blacks 15.4 13 years of education 12.4 white 7.3 13 education 6.5. So there's clearly a class difference. Class makes a difference, but there's also a race difference so that black people have with less than 15.4 years of education. I mean, sorry, less than 12 years of education have more low birth weight than whites with the same amount of education and the same is true for 13 years of education. What's striking here is that whites with less than 12 years of education. So let's say poor whites have fewer low birth weight babies than blacks, let's say middle class blacks with 12.4 education. That is race is such a powerful problem issue here that even poor whites are doing better than middle class blacks. Now that's not always that particular comparison is not true on every statistic, but it is true that middle class whites on every statistic is doing better than middle class. So the question becomes why and to understand that you have to begin to understand why focusing on individual behavior and choices alone is not enough. So what we have here with this chart and this is a chart that I developed to try to show the inner in this middle, we have a person who has health that is based on both their genetics and their biochemistry. They have both mental and physical health and so their health is being impacted by the choices they make. No doubt, no doubt, no one can argue that and the choices they make our impact impacts the choices they can make. But what we fail to understand is that those choice it's it's those choices are influenced by structures outside of their control. Wealth and income, education, criminal justice environment, health care housing, the targeting by a tobacco guns, alcohol and drugs, employment availability, food and water and the stress of racism. And those social determinants are impacted by embedded social racial inequalities that are embedded in the society that causes discrimination and inequalities in all of these areas, regardless of the individual choice. So when you talk about people ought to eat right, then you have to talk about food deserts and how people live in food deserts and don't have fresh food, fresh vegetables and fresh meat of readily available to them. I live in a food desert. I live in a food desert. The town that I live in has over 100,000 people inside the city limits and inside the city limits. There are only two grocery stores. What we have in replace of grocery store is fast foods and dollar general. Dollar general stores are now becoming de facto grocery stores. Only problem is that they don't carry fresh products. So there's a dollar general store almost every half a mile to every mile. You can find a dollar general store within walking distance of your home. You can find a dollar general store. But if you go in there, there you can find all kinds of cans and processed foods. Another problem, even the grocery stores are making choices that makes it difficult for a person who is trying to eat healthy to do that. For instance, I have hypertension and I'm supposed to eat a low sodium diet and I'm very good about this diet. So I do all the things that I don't cook with salt. I don't eat it. I don't eat out often. And when I do, I control my sodium intake. And one of the things I do is I read labels and I avoid high sodium food. Recently in the last year, all of the few grocery stores that we have in town have stopped carrying fresh meat that is unsalted in salt solution. All the pork, which I have to eat because I have gout, I can't eat beef. So all the pork is soaked in a 14% salt solution. They call it tender and juicy. They don't put this readily on the label and they don't tell you, even when you read that 14%, what they don't tell you is that it triples the amount of sodium in a serving. So that you go from a 75 milligrams of sodium in a serving size to 350 milligrams of sodium in a serving size. So people who are, and it's expensive, so people who are trying to eat healthy can't. These are the kinds of structural issues that the law can do something about. No one is denying that individual choice in behavior is important. What we're saying is that we have to assure that as we talk about individual behavior and choices, that we also assure that the structures in which people live will allow them to make that individual choice. One of the things I want to talk about, because I think that stress is the difference between why black Americans and other groups, I think chronic stress is the reason. Whether or not you recognize it or want to admit to it that people undergo stress for a lot of reasons, chronic stress. So my view is that what is the difference between a poor white and a poor black person? Not the poverty, not the lack of resources, not the lack of food, the lack of grocery stores, not the lack of sidewalks and parks. Not all of these things that could make their lives, their living situations are similar and their behaviors are similar. What is the difference? It's the added stress of racism. It's the cultural racism. When you watch television and you have to constantly, you cannot watch a television show that doesn't make racial innuendos based on stereotypes. I grew up waiting for the day when the only black person in the film would not be the first black person killed. And similar kinds of stereotypes are broadcast throughout all our system on a daily basis. Recently I had an incident happen to me where I went into Bob Evans and the young lady called me girl, which I don't like. I'm over 65 and so I usually tell people, you know, I prefer not to be called girl and she got an attitude and decided not to serve us. Who knows why she got that attitude? But the reality is, is I have to think, is it because of my race? And then I have to do, I have to say, I have to, when I complain, I have to be careful how I complain because people will get upset and think that I'm charging racism. I can't make a complaint against a white person about being treated differently without being, well, without people becoming defensive about racism. So that's a stress, that's a stress. And these kinds of stresses, they're called micro inequities. If you, if you, if you're interested in looking at doing some research on them, these kind of micro inequities occur throughout the day, throughout your life. So what happens, your blood pressure goes up, all of these, excuse me, all of these biological reactions happen and your body is in a constant state. You don't come down from it. You, when you come home, you don't come out down from it because generally you spend a lot of your time at home rehashing the kind of racialized behavior that has occurred to you. That day are dealing with the racialized behavior that has occurred to your significant other, are your children, are your family. So that chronic stress of living in a racialized society, I think is the difference between, between poor blacks and poor whites, middle class blacks and middle class whites. And I think this is worn out by studies that look at recent immigrants. What they find is that recent immigrants usually have better health for at least the first group has better health. Then the, then, then, then the similar groups. So after Africans have better health than African Americans, Mexican immigrants have better health than Mexican Americans. Japanese immigrants have better health than Japanese immigrants. I mean, Japanese, yes, Japanese immigrants have better health. Japanese America, so forth. Okay, but that, that, that, that, that cushion that better health is gone within the next generation, that second generation people look just like the group that they are identified with in terms of health. And so infant mortality rate is one way to, to look at this in turn, another way. Okay, so, so one thing is stressor. Another thing is a generational impact for health and infant mortality and low birth weight is that is, is a way to understand that. And that the reason is, is because in health, it's common to say that the health of the mother is impact. I mean, excuse me, it is common in health to note that the health of the child is impacted by the health of the mother. So this is kind of my family history. So what this says, I have twin grandsons, this is kind of old now, but I have twin shocker Randall, who's a law professor now has twin grandsons, has twin sons. So his health was impacted by my health. My health was impacted by my mother's health. My mother's health was impacted by her mother's health. Her mother's health was impacted by her grandmother's health so forth and on. So, so what you have is this generational impact. But be more than that is there's beginning to be studies and this goes back to the issue of stress. There's they're beginning not not studies related to African Americans, but studies related to Vietnam era veteran children. What they're finding is that genes is like a switchboard that while everyone has the same genes, there are a number of switches that have to be turned on and off within the genes. And that stress can turn a gene all for one and that that then impacts your health. So that is at a certain level, it's not about being genetically different in terms of being human. It's about having your genes operate differently because stress has triggered a switch to be turned on and off. That's called transgenic mutation and they've known about it for years and studied it in plants, but they've never actually studied it in humans. And they have began to study it because they were finding children of Vietnam era veteran to be sicker than children of children that didn't have children who did not go to Vietnam. And when they looked at it, what they found is that there was no sort of a cultural reason for this difference. But what they began, they then began to look at the genes and what they found is that genes had been switched on and off and had not turned back on and off in the next generation. In fact, what they're finding is that when those genes get switched inappropriately by stress, that it can take up to two to three generations for the gene to revert back to its normal setting. Now think about that what that means for African Americans because we have never been not under the stress of racism. So if, and this is hypothesis because no one is studying it, if slavery, which would be a stress cuts turns gene switches off and on, then you're talking about a couple of generations, which would be Cora. So manless was a slave. Narcissus was a slave. And a couple of generations would actually be my dad. Okay, so you would bet expect to switch to be on with earnest to be turned on off with earnest turned back to its normal setting with earnest. Problem is that Tom and Cora grew up doing Jim Crow, which was stress. And so that would go out to my generation. Problem is, I grew up doing Jim Crow. So that would probably means the stress of Jim Crow. That would mean that any gene genes that are got cut off are switched because of the stress of Jim Crow would be passed on to my grandsons. My view is that we have to deal with institutional and systemic racism. If we want to improve the health of African Americans, because that's the only way to get rid of these factors, including the stress of racism. And that is what I believe is at the core of health disparities. If you have any questions, post them on Moodle.