 Good morning, good afternoon, good evening, hello Wonka world. I am so very happy to be here with you today, starting our second series of Wonka webinars. And today we have an amazing panel on health equity in across nations. We are live streaming on Wonka's favorite page and you could actually ask questions through the Facebook page and on the chat. We are also recording the webinar and we'll make it available soon after it ends on our YouTube channel and on Youku for the Chinese colleagues. Our panelists will be monitoring the discussions on Zoom chat and Facebook and we will respond to some of your questions after the presentations. Here with me today I have Dr. Kim Yu, Chair of the Interest Group on Health Equity, Dr. Maria Pilar Astier-Peña, Chair of the Working Party on Quality and Safety, Dr. Victor Nung, Chair of the SIG on Emergency Medicine, and Dr. Premendra Pasad, Chair of the Working Party on eHealth. Welcome everybody and Dr. Yu for you to start. Actually, we're starting with Dr. Donald Lee welcoming everybody. Good morning, afternoon, evening. Thank you for taking time during your busy schedule to attend the second series of Wonka webinars. Family doctors around the world have risen to the challenge of this awful pandemic. In the midst of the massively increased workload for family doctors, I'm proud of the level of support and collegiality displayed within and across our member organizations and from region to region. It is heartening indeed. Indeed, the COVID-19 pandemic is bringing a lot of changes to our professional and personal lives. We are slowly adapting to the use of technology to overcome barriers and challenges created by the pandemic. We are getting used to meet virtually and using the cyberspace like what we're doing now. Colleagues are disseminating scientific advice, clinical updates, reflective messages, and professional support through their social media links and connections. They're keeping in touch with each other regularly, like family members, relaying information, urging courage in these extraordinary times. I think all those who participated or listened in our various webinars held in June and July will agree they have been well received and appreciated by family doctors around the world. I'm really looking forward to the next series of webinars which will include presentations from our working party and special interest groups on health equity, women and family medicine, e-health, aging and health, complexities, mental health, palliative care, adolescent and young adults, as well as the environment. Before I hand it over to the convener of this sub-webinar, I would like to say that unfortunately this is a pandemic with an unknown end game. I wish each and every one of our family doctors well during this time. Use the best advice available, work collaboratively with your teams, do the best you can for your patients. You should stand proud of your contributions in facing the world crisis. No one knows what will be ahead of us in the weeks, but everybody knows enough to understand the COVID-19 will test our capacities to be kind and generous and to see beyond ourselves and our interests. Our task now is to bring the best of who we are and what we do to a world that is more complex and more confused than any of us would like it to be. May we all proceed with Winston and Grace. Thank you. Thank you so much to Dr. Lee for these remarks. And now I invite Dr. Kim Yeo to start our presentation. Thank you so much Dr. Martinez Bianchi. Thank you to Wonka again for hosting this webinar Health Equity Across Nations during COVID-19. I am so pleased that we are able to bring this presentation to you, to all the family doctors around the world, and to all who are listening in today. Our agenda today, we will talk about definitions and also health equity across different regions during these COVID times. We will highlight the work done by family doctors in emergency medicine and in primary care and the use of e-health with patient safety and quality considerations. We will share tips with for health equity and also the need for advocacy and the need for collaborations. And then we'll have a panel discussion where we invite you to ask your questions. So the definition of health equity, Healthy People 2020 defines it as the attainment of the highest level of health for all people. And that it achieves and really requires us valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. I have here four different definitions for health disparity, health inequity, social determinants of health and health equity, because it's important that we are very specific when we talk about these. Sometimes in conversations with others, I will hear people use these terms and mix them up a little bit. And we have to be very, very clear about what we're talking about, whether it's disparities or inequity. Is it social determinants itself? Or what is it that we're actually talking about? And for each and every one of you in your region, in your country, in your city, in your community, think about what the health disparities are. Where are the inequalities? What are the social determinants of health that really matter and where we can bring health equity to our communities? Here you can see the statistics of COVID from the Johns Hopkins University website. We are over 30 million global cases with over 6.7 in the United States alone and 5.3 million in India. And as you can see all the numbers below, just below, with nearly a million deaths, like 953,000 deaths. This is a sobering, devastating, terrible slide to look at. But when I look at this slide, I think of not only all the people and communities that we serve, but I think of all the family doctors throughout the world and the impact that we are making, taking care of patients in their communities, right where they are. I'm going to pass this time over to Dr. Viviana Martinez Bianchi to talk about the global disparities in COVID. Thank you, Dr. Yu. The pandemic has exposed the weaknesses and inequities that were already existing around the world. The UN policy brief discusses disparities in the impact of COVID-19, according to age, gender, sexual orientation, ethnicity and migration and refugee status, with increasing stigma, discrimination and hate speech, targeting minorities, and those suspected of carrying the virus and even healthcare personnel. Next slide. People of African descent who are 21% of the regions of the Americas population are disproportionately affected, owing to worse socioeconomic conditions compared to the rest of the population, limited access to social protection and high levels of discrimination in the labor market. Next slide. A recent BMJ article highlighted deep inequities for migrant workers in many countries in Asia. So Mali's suffering 10 times higher infection rates than the national average in Norway and a disproportionate proportion of cases in Sweden. Asian migrant workers are also disproportionately seeing high rates of COVID-19 infections accounting for 70 to 80% of all new cases in Saudi Arabia. The World Bank has warned that the virus could push between 40 and 60 million into extreme poverty this year, with sub-Saharan Africa and South Asia hardest hit. The ILO International Labor Organization estimates that half of working people could lose their jobs within the next few months and the virus could cost a global economy $10 trillion. The World Food Program says that 265 million people will face crisis critical levels of hunger unless direct action is taken. Next slide. Women making a big part of the healthcare workforce are particularly exposed and we will hear about these inequities from the working party on women in family medicine on our next week to September 27th. People from Asian and Black groups are at markedly increased risk in hospital deaths from COVID-19 also in the UK. Blacks are more than four times more likely to die from COVID-19 and individuals of Bangladeshi, Pakistani, Chinese and Miss ethnic groups are about 1.8 times more likely to die from the pandemic in the UK. Next slide. COVID has shown significant disparities in the US with Blacks dying as twice the rate as whites and Latino Blacks and American Native communities being hospitalized at a rate more than four times higher than the white population. Next slide. Why are we seeing these numbers? Let's have a reminder. I love this graph from the WHO showing us the factors that lead to increased vulnerability. I like this graph because it proposes who do you need to look out for in times of emergency management and preparation. Look at populations with lack of clean water or sanitation, those with poor access to healthcare and basic services. Who has food insecurity and malnutrition in the community? Who is marginalized or underserved? Who has difficulty with language? Who works or lives in overcrowded or within sufficient infrastructure? Which are the communities in your, which are the populations in the community that are highly dependent on informal economy and daily wages? What is the system of health, social and governance for those communities? And definitely this has worsened the conditions for those living in armed conflict and violence. Next slide. At the core of the inequities is the concept of intersectionality. This is a way to identify advantages and disadvantages that are felt by people due to the combination of the factors that I discussed before. And also including what happens when racism, ethnophobia, homophobia or phobias of the poor to mention a few of those get in the way of health. Next slide. Back to Dr. Kim. This slide is the health equity lens slide and it talks about when you think of how you view your population and your patients, think about this health equity lens. How do you view things? And so in terms of people, place, process and power. How do you view in people? It says how do you positively, who are the people who are positively and negatively affected by this issue? And how do people perceive those barriers? Who are the people in my community? And what are the contextual effects of the physical, spiritual, emotional related to those issues? In place, what kind of positive place are we creating? What kind of negative place are we creating? And how are those resources and investments distributed? How are you thinking about environmental justice and impacts? In process, we think of how are we meaningfully including or excluding populations and people, whether it be refugees, minority communities, disabled, the rural, who are really affected? And what are the clinic processes and policies in place at your practice in your organization that contribute to the exclusion of communities most affected by inequalities? What empowering process can we initiate? And then think about power. What are the barriers to doing equity work where you are? And what are the benefits and burdens? And who really is accountable? Are you the person that's in power? Or is it someone else? Who do you need to talk to? Thinking about health equity, now that we've heard from Viviana about disparities, we want to really look and focus on different parts of the world that are doing really, really important work. And this is a report from several of our family doctor friends from around the world and healthcare professionals who wrote this article, Health Equity and COVID-19 Global Perspectives. In this article, they mentioned 13 countries and I really invite each and every one of you, we have the references at the end, to read this article because it talks about the different things that have been mentioned previously, but also things that countries have been doing. And I'm going to share a few of those with you. So for example, in Hong Kong and in China, this is a picture of Dr. Loretta Chan, one of our general practice friends in Hong Kong. They've been doing outreach to the elderly proactively, especially during this recent third wave of COVID-19, where they've seen increasing cases in nursing homes. So they're going to nursing homes. And I know many of you are doing that also in your country and in your community, where you outreach to the elderly, where we know that they are having a preponderance of COVID-19. They have active contact tracing and testing of high-risk groups with free screening, including those who work in supermarkets, transportation, taxi drivers, public bus drivers, the elderly, all the high-risk groups. That require extra screening. And then you see here, public health measures, the social distancing measures, the fever clinics, the temporary hospitals that have been put in place to support the infrastructure and ensure better health for all in their communities. In Australia, they have done outreach to First Nations people and where they've reached out to First Nations people and had pandemic plans developed and implemented with them, where the First Nations people are leading the advisory group on COVID-19 in their community. This has led to shared decision-making, two-way communication and empowerment and leadership for their communities, and it's really helped decrease the rates of COVID-19 in those areas, despite the difficulties with health equity that remain in that area. They were also the first ones to get rapid PCR tests that were deployed to those regional areas and remote communities. And this is data. It's a little old. I was trying to find more recent data, but was unable. But this is as of late July. They only had 60 cases in the First Nations community, which is only 0.7% of all cases, but they make up 3% of the population. It should have been like 215 cases. They only had 60. They've had no deaths. Decrease morbidity, decrease mortality because of increased outreach to the communities that need it. In Peru, the family doctors in Peru are working in a hospital home program. And this is something that is from Dr. Rafferty in Peru. And she says, I'm a family doctor in Peru and every day I go to the homes of people with COVID or suspected of having it. I work in a home care service called Hospital at Home. Until before the COVID pandemic, we only saw elderly patients and with reduced mobility who needed emergency medical attention, home hospitalization and palliative care at home. Currently, we see all those who need medical attention, especially cases of people with COVID-19, we evaluate them, manage them, treat them and refer serious cases. So by doing this, they really are decreasing the spread, but also increasing the care for those patients in their homes, directly where they are. In Zambia, family doctors, clinical officers and village health workers are educating about masks. They have a no mask, no entry wherever you may be to ensure that the COVID-19 doesn't spread. They're teaching the ladies in the village to make masks, which helps provide income for their families. And they're also going to schools to teach in the schools about all the different public health measures that are necessary and triaging patients so that they get patients that need care to further services. The Ministry of Health in Zambia has done an amazing job with case detection and contact tracing, which has resulted in a population of 18 million having a lower case rate than South Dakota or a state in the USA who has 885,000 people. So you can see that with limited resources, with good public health measures, with the community physicians that are out there and the healthcare workers that are out there, there's able to be significant outcomes and improvements in COVID cases, number of cases. So we've talked about enhancing the health equity lens for primary care. And one way you can do that is by using health equity data tools to inform your decisions about that. So there are population health mapping tools during COVID from most countries that will show graphs and examples of resources. There was also surveillance data and mortality data and hospital data that will help as well inform your decisions about what may need to be done in your community. Here's a resource that was developed by the American Academy of Family Physicians called Health Landscape, and in it you're able to put your zip code and pull up all the different demographic information about your area. So the unhealthy behaviors like how many people smoke, the percentage obesity, the health outcomes, how many percentage of people in that community have high blood pressure. Here you can see 48%. The rates of diabetes, how many have had a stroke, how many have lost all their teeth. Here it says 33%. And then the preventative care that's been given as well. These resources like this will help inform your practice to know what it is that I need to reach out to my patients about. If I've got patients that have a high preponderance of food insecurity, then I need to provide resources for those patients. And this is another resource available and you can see the link right there where you can also put your zip code, the neighborhood navigator, that will show you all the different resources available for food, for housing, transit, etc. These programs are really wonderful resources for your patients to help them in improving the social determinants among your patients. Here you can see an area called Aragon Region which is divided into basic health zones. Each one has a health center with family doctors who serve the population. The family doctors register health and social issues from patients in their EMR in the EHR electronic health record and their COVID data from their EHR also is shown on the map. As you can see in this picture, the dark areas are the increased risk of those with COVID-19 rates. And in those areas, there are more seasonal workers for fruit and meat enterprises who live in crowded conditions. So you're able and in this particular area in that large bubble you can see opened up into the health center area of Zaragoza where some of the family doctors are able to look and see what this is the community that we need to outreach to. I'm going to pass this time over now to Dr. Victor who will talk about the Special Interest Group in Emergency Medicine. Thank you very much Kim and welcome to you all from countries around the world. So the Wonka Special Interest Group on Emergency Medicine was first established in 2016 and we have well over 150 members from around the world. And really the aim of the group is to support family doctors that provide urgent and emergency care to their communities as really part of their role as family practitioners. If you could go to the Wonka website please join our Special Interest Group if you are interested in joining. Next slide please Kim. Referring back to what Kim was alluding to in the paper that she presented of health equity and COVID global perspectives. I think in many ways the emergency department where we intersect with health equity is that we really show inequities within the health system. In many countries around the world the emergency department is really the gateway into secondary and tertiary care and also paternity care. And if you look at how the emergency department is dealing with COVID and other diseases you really get a good glimpse of how the system itself is staring. So as an example some of the statistics from that paper that Kim alluded to looking at for example in Brazil we see that there's more ICU beds in richer regions within Brazil compared to poor regions. And almost double the amount. And you can also see that there's a higher rate of hospitalization amongst racialized populations in Brazil compared to non-racialized populations. The other example in Sub-Saharan Africa is that the majority of the people that are employed in precarious work with no access to social services. These are also the patients who also have lived in potentially slums and poor ability to have physical distance. So these are all elements in which we can see inequities within the system. And these are inequities that are very apparent to us for those of us who work in either family practice clinics or in the emergency department as we'll be seeing these people as patients. Next slide Kim. Looking at my local area this is a map of the city of Toronto. And as you can see the darker areas are the areas where there's a higher rate of COVID infections. And you'll see that the areas with the darker color is also those areas where there's a lower socioeconomic status. And we can see that this fits in with the rest of the world data where those with lower socioeconomic status are those at higher risk of contracting COVID-19. Next slide Kim. And similarly we know this again from data from around the world. This is data from Toronto, which shows that the quintile of income is in verse beat related to the number of COVID infections. So that's similar from around the world data as well. And like I mentioned previously you know the emergency department is valuable in the sense that it's essentially the canary in the coal mine for the system. The canary in the coal mine you'll remember that in coal miners the canary will be in the coal mine and often with gases such as carbon monoxide it is often the canary unfortunately that would die. And that's when the coal miners know that there's something troublesome and the coal miners leave the mine. And that's similar as we look at the health system is that when we see that there's a disproportionate burden on the emergency department we know that the rest of the system is strained. Next slide. And I'll give you a personal example of a story of Mrs. A which has been a patient of mine previously and I can think of many other Mrs. A patients and I'm sure all of you who are listening can think of similar patients as that. Recent immigrant from West Africa which we have quite a few in Toronto, the knowledge of the system and I mean the health system is poor. Their primary language is not English. She's a mother of multiple children and multiple demands. She may have children with dietary restrictions and in this case she has two of them. Her husband is actually back in Africa working and providing money to support the family in Canada but unable to provide social support. She works at a fast food restaurant which is precarious work. So she doesn't always have hours to work and therefore her income is not predictable from week to week. Canada as many of you know is a large country and some parts are not have adequate access to public transportation. So the lack of a vehicle really limits her ability to get around. And finally the perspective of the social housing which she's in also makes it hard for her to physical distance. And if you look at each one of those factors you can see from a systems perspective from the emergency department we have to navigate all of these. So in the ED it's often a very fast moving dynamic place in the hospital where there's many patients, multiple demands, lots of people. So for somebody who doesn't speak the language and also doesn't know the system you can imagine for her to be able to express herself, get her story accurately to her providers becomes very, very difficult. And if you look at the fact that she has precarious work and she doesn't have the income to provide for her children, especially those with dietary restrictions and we know even without COVID healthy foods is much more expensive than unhealthy foods. So this provides another barrier to her for essentially healthy living. And then of course lack of a vehicle, many of our health systems is organized that it's not all in one location. And we might actually have clinics from around the country, around the city. And for someone who doesn't have a vehicle, unpredictable work hours, being able to take her children and herself from clinic to clinic to have follow-up appointments is very, very difficult. And all of these issues are definitely there pre-COVID. But certainly with COVID you can imagine that it brings out these inequities even more pronounced. Next slide, Kim. And I'll move on to Dr. Pramandar Prasad for his presentation. Thank you, Victor. So I'm going to talk on e-health and health equity. So first of all, I will briefly define what digital health is. It is the field of knowledge and practice associated with the development and use of digital technologies to improve health. It's really quite simple. It's a healthcare through technology to both patient and medical professionals, simplified as it can so be. It actually covers a growing field of science from variables to patient data, robots and genomics. During the COVID-19 public health crisis, two modes of digital health have been commonly used and that are virtual healthcare or televideo-enabled interactions between health providers and patients and health information that is accessed online or via mobile apps. As we all know, COVID-19 has no boundaries. It can infect rich and poor, young and old. However, this uncritical perspective misses the systemic factors that impact outcome of illness and create inequities between outcome of illness and create health inequities between communities and across the life course of individuals. The COVID-19 pandemic has far greater associated with morbidity and mortality in racialized groups that struggle with poverty and poor access to healthcare. That's why we suggest the health equity factors like it has to be equal access to digital healthcare and equal outcomes from digital healthcare irrespective of age, gender, ethnicity, income and geography. The health providers with competencies training to provide equitable digital healthcare and necessary adaptations. There has to be measurements and quality improvements to improve access and outcomes and involvement of people from vulnerable groups in leadership, health professions, code sign and data stewardship. Next slide. Although e-health has great potential, but it, we have some great disparities also. And the disparities are like we have technical barriers, patient barriers and system barriers. In technical barriers, there are limited internet access and broadband connectivity in rural areas, limited access to smartphones, webcams, laptops by vulnerable populations and remote patient monitoring equipment required internet access or Bluetooth connectivity to smart device. Whereas from the patient barriers, there are limited digital literacy by vulnerable populations and lack of trust by patient of sharing data over the internet. And the system barriers that includes confusion over complexity of building requirements, increased disparity between private practice and health centers and role of data collection. So I'd like to hand over to Maria Pilar. Thank you. Thank you very much. From Wonka Quality and Safety in Family Medicine, it's really a pleasure to participate in this webinar to share ideas with other working parties and special interest groups. And to give some tips to ensure quality and safety during COVID pandemic. Next slide, please. Safe and equitable are two crucial or cross cutting healthcare quality dimensions. We cannot provide a safer healthcare if we do not guarantee equity. And at the same time, looking at our daily practice through the lens of equity, we are then implemented a safe practice to reduce harm in our societies in our patients. Next slide, please. There is a big safety concern about coronavirus and society because pandemic is a society question is a high risk situation and we have to do a risk management. We know that we have a lack of scientific evidence evidences about medications and the way we provide care is different, mainly through telemedicine and with a lot of protections when we do face-to-face consultations. And it's a hard moment for the community as well due to confinement and these social distances. Next slide, please. Health equity is like quality can be separated from patient safety, as I said before, because pandemic is a public health issue, a community issue and needs a community answer. But the whole community should participate. Family doctors are leaders, are health leaders in the communities and its essential family doctors is community healthcare access as a safety way. Health equity and safety are these two dimensions that will ensure no harm to the community. We have to pay attention to vulnerable social groups as Dr. Du and Dr. Martini Bianchi have said before, patient safety incidents in healthcare increases particularly in women, minority groups, migrants, homelands, prisoners or other different populations. So many scientific reviews as Dr. Kim do show us and said that we have to make these lenses in our daily practice. Next slide, please. Regarding emergency medicine, we have to consider every day some safe practices. Family doctors, we will be safe themselves as there were health organizations in their 17 September world patient safety days. The safer, the professional, the safer the patients. So doing and doffing PPE is the way we have to work. We have to offer patients these PPEs and encourage them to use and never forget patient identification. And their name and their age. We have to short and to make visit with short and added values. Deciding if we need to transfer or to stay at home. And if in the case we have to transfer the patient, we have to guarantee the condition of transferring. Making always a list of relevant clinical information and medication the patient is daily taken. Next slide, please. So there are some tips to be in mind. Enhancing family doctors awareness on these inequities is a necessary first step to tackle them and improve patient safety for all patients during COVID pandemic. We have to be proactive. There are some proactive activities to be taken. First, to contact vulnerable patients. Some of them may not have possibility to contact with the practices. To work in collaboration with other professionals as social workers in community agents to deal with social determinants of health in your community to reduce COVID-19 impact. Family practice may build a map to identify at risk population that mainly will be vulnerable people and those who have chronic conditions and work actively with them. Next slide, please. Considering the use of digital health, the eHealth, we have to guarantee patient identification with the correct name, spelling, considering different cultures when we call patients. And when calling the patients, we have to guarantee at the same time the confidentiality of our encounter because sometimes we phone people and they are in the supermarket or they are in streets or they are in a very crowded living room. So we have to be flexible and make a new call just to guarantee the confidentiality and the best encounter as possible. And always register in your electronical medical record. The most important information from patients, the most important information we have agreed to guarantee the continuity of the patient journey through the health system. When we have already written, other professionals can read and act in consequence. Next slide, please. In each phone call, we recommend to talk about patients' medications as well because sometimes they come from the hospital, they have been discharged from COVID disease or other disease and some medications can be changes. So we have to talk with them how about their medication, how do you use them and if they adhere to the medication. Consider as well the living conditions, if they work or do not work, if they earn a salary, how is the house and if they have family or relative support to deal with the confinement, to deal with the isolation or to deal with the disease. And as well, assess any contact with COVID-19. We have to organize information to isolations, to do PCRs, to reinfer frequent hand washing and using face masks and social distance when going abroad. Next slide, please. I give the words to Dr. Yu. Oh, Dr. Mantine Bianchi. Okay, sorry. That's right. So advocacy in health equity. Advocacy is an activity by an individual or a group which aims to influence decisions within political, economical and social systems and institutions. Advocacy can include many activities that a personal organization undertakes, including media campaigns. Think about a lot of what you have already done about what has been done in regards to this COVID pandemic. It includes public speaking, commissioning and publishing research or conducting exit polls or the filing of an amicus brief or a letter to advocate for the issues that matter to your community. I see family doctors as some of the best advocates in the world and really wonka world as a vehicle for health equity around the world. Next slide. We have the opportunity to utilize ICD-10 to coding, use it to code when we're seeing patients having factors of vulnerability and be able to research into our data to then look at how those factors have intersected with health and health outcomes. Look at, for example, Z65, problems related to education and literacy. Z56, problems related to employment and unemployment. Z59, problems related to housing and economic circumstances and all of the different subcodes from Z59 that we can see such as extreme poverty or low income or insufficient social insurance and welfare support. Z60, problems related to social environments such as adjustment to life cycle and transitions or to living alone or a culturation difficulty if you're working with immigrant communities. Z63, other problems related to primary support group including family circumstances. Think about using this ICD-10 codes so that you can later figure out what, how has COVID impacted your patients or any other situations in health. Next slide, please. You also, as a family doctor, had the opportunity to create multi-sector partnerships to combat the epidemic. This slide here illustrates a group called the advocacy team, the Latinx advocacy team and interdisciplinary network for COVID-19 that I co-founded when we started being confronted with the significant inequities suffered by Latino, by members of the Latino community of Hispanic origin in the United States. And in this interdisciplinary network brings together representation from community activists, our Duke health organizations, multiple NGOs, schools, city, county, state government, face-based organizations, human and immigration rights lowers. We all learn a lot and we really become more powerful from our ability to work together. Next slide. You can also advocate if you look at your map. This is the map of my county and where our health system, not driven by family doctors, but in general, how our health system plays testing away from where Black, Asian, Black and Hispanic communities live in our county. So one of the issues that we saw here was they need to really advocate for testing sites for COVID to be placed where the more vulnerable communities exist. In this map and here you can see all of the white community tends to live on the west side of town where most of the testing sites were located. And then we advocated and I haven't put the start in there yet, but we advocated and now there is a testing site in the middle of where Black and Hispanic communities live. So I invite you to look at those data and the sites in your community and see what you can do about them. Next slide please. You can also get involved to create policy change. Think about this. Lack of documentation should never be a barrier to the highest quality of care. COVID-19 care should be provided free of charge to those who cannot afford payments or who do not have health insurance. COVID information should be made available in the languages of local minority populations. Nutrition and access to food should be a priority and should not depend on economic status. And we need to penalize when denial of service occurs to those people from underserved communities or vulnerable and marginalized communities when they are rejected from coming to healthcare. This picture on the bottom of the slide shows what we do when people come through our drive-through testing is we open the trunk of their cars and put food enough for 14 days of quarantine so that they will be able to quarantine at the time of their testing. Next slide. I also invite you to review maps of COVID numbers in your territory. We were speaking when we were getting together and I was talking with our colleague from Nepal and I was very curious to understand why we're such different in concentration of COVID in this map of Nepal. And I wanted to understand the reasons that he was able to give me the reasons. What I invite you to do is to look at COVID maps from your area of influence and where your community is and see if you can see what is happening. And if not, get curious to find out what is going on and then see what your health system, what your clinic or your family doctor organization can do to really become an advocate to improve health outcomes for COVID in your community. Next slide and I think is Dr. Kim you're going next. Thank you so much Viviana. I think what you highlight so well is the need and here's one of our tips for advancing health equity is the need for collaborations. And how it is so important that we have those collaborations both whether it's in our one co-working parties and special interest groups like right now or whether the health department or hospitals or different family doctor organizations or other organizations outside of family medicine that we need to collaborate. Here I mentioned the health equity network for the Americas who's doing amazing work in the Americas to gather stakeholders to really work on equity and especially during this time of COVID. But at the heart of this and at the beginning, maybe we should have had this at the beginning, but at the beginning of any health equity work, it really requires us to acknowledge the power and privilege of being able to be in health equity work and really to look at some ground roles. I think this is really vital for every organization, every practice everywhere that you are to have these ground roles. This is taken from family medicine for America's health tactic team. Several of us were on that tactic team and we really had to create these ground roles to really ensure that we created a safe and respectful environment for everyone to contribute their stories, their feelings and perspectives in the way that they needed to to build on those personal narratives in a safe way. To really build on the contributions of each member and to really address all the differences intentionally to work to understand these intentions to respond effectively to the microaggressions and the triggers and to respect each other's time during that. All of these things, you may read it and say, that looks nice. That looks good. But I really challenge you to really take this on and really have these as it moves forward in health equity wherever you may be. When you look at populations that risk of vulnerability, you must ensure that they are heard included engaged and supported by an environment that promotes engagement between healthcare systems and people. This is taken from the ADA model, which has these five steps. You can see the community participation in the center, but the five steps are that you assess, inquire, deliver, educate, and then respond in this continuous monitoring process, which we as family doctors can really implement. So really making sure that you include here, engage and support. So I'm going to share with you some advocacy and action around the globe and so ways that family doctors have helped advance health equity. Here you see Dr. Gobeth Ratnam, a family doctor from Sri Lanka, who's also on our executive council for the rural Ronca. And he's been making PPE and helping provide PPE, giving face masks and face shields to essential workers. And for many family doctors around the globe, they are spreading PPE wherever they're at, wherever they can be, whether it be food industry workers, shelters, prisons, nursing homes, whether it be wearing a mask campaigns, or whether it might be like this T-shirt. I even have a T-shirt and maybe my green screen will allow, but you know here it's got, you know, contact spread virus, mass spread love, you know. You can do these campaigns to help educate and inform your patients, your communities, wherever you may be, and to provide PPE wherever you can. Another place where advocacy and action is happening is in Australia where they're setting up respiratory clinics in rural Australia to ensure the care is continued, COVID care is continued in the rural areas. And here we have Dr. Ewan McPhee, who's the president of the Australian College of Rural and Remote Medicine, with some of his staff who are leading in these respiratory clinics that are like little mobile units that have been placed in different parts of Australia to help improve the care and the commitment of the government to provide telehealth and telemedicine and funding for that is tremendous. I mean, to be able to continue to have care for patients wherever they may be. Another place is in terms of patient education via social media. Here we have Dr. Joy Mogambi, who's our secretary general for Wonka Africa in Kenya. And we've seen her and others making videos for their patients in their own language to ensure that education about COVID and safety about COVID and how to protect themselves from COVID come through to all patients in the communities. And they're also providing testing, as we've mentioned early for special populations, but also providing it free. I've seen this in multiple areas of the world where people will put on their Facebook. We're providing free COVID testing. Come and get it. And this is one way that we can really advocate for our communities in need. Also, in terms of care for migrants and refugees in camps and whether it be in clinics themselves, whether you might be a city where you're accepting refugees. You are so vital for these communities to ensure that they're getting the care that they need and the protections that they need. At the end of it, we really need to address racism. And you can see here I say racism is a pandemic. In some ways, the pandemic has shown us that racism is a pandemic. And that all of us really need to stand and be anti-racist. We need to address racism wherever we may be as family doctors to ensure that our patients are getting the care that they need. So you see here, COVID-19 does not discriminate. And this graphic here you can see shows the network where we as doctors and where COVID is the intersection and all the little web that you see here of healthcare where racism and implicit bias really rears its ugly head. So we as doctors, as family doctors, as people who are in the communities serving the patients that we have really need to have that health equity lens to really ensure that all are taken care of and that at the center you see the patient right there. So right now, maybe you're feeling, I really want to get involved in health equity. I really want to know more. So please join our special interest group in health equity. It's a little plug for the group. We started in 2014. We have over 250 members and we really need your experience and skills. So please, please, please scan the QR code here. Go to the Wonka website, join the group so that we may continue this conversation. I will put some references here and we'll have them for review later. And now we're going to spend some time in discussion. I'm going to pass this time back to Dr. Martinez Bianchi. Stop sharing them. All right, I see some questions coming up in our, in our both on Facebook and on the chat. And I'm going to start with, there is a first question for Dr. Maria Pilar Astier-Peña. The question is Pilar, doctor, how could I deal with medical colleagues that refuse over years of tentative dialogue to make a proper registration of consultations in a rural urgent care facility? Again, I do agree that to be registered is a question of safety for doctors and for society. So we have to try to involve both doctor and society. We need to transmit society. They need accredited services and they need quality and safety services. So the registration of doctors will help to provide a safer care. And on the other hand, to doctors that are reluctant to be registered, that many colleges and medical associations can help them to improve their practices, particularly during the COVID-19 pandemic, can help them to maintain their practices, to give advice and support and have as well a network to talk and work with. And I think both sides will be benefit from this. So I encourage perhaps to have a discussion to try to, as Kim showed us, the president of the family medicine rural areas in Australia, Binder in the front line, helping doctors and showing up. We are here to help you and support you. That could be an idea and opportunity to be implemented. Thank you, Pilar. I have another question coming from Luis Andrés Jimeno-Feliu to our panelists. He says, many measures that have been taken to curb the COVID-19 pandemic, mobility limitations, confinements, quarantines, impact very negatively on the most impoverished populations. What advocacy measures could we do to prevent the economic crisis from doing more harm to these populations than the COVID? Kim? That's quite a long question. But I think that what I'm hearing is that what can we do? And as we shared in this presentation, there is much that we can do to help find resources for our patients. And so really reaching out to neighborhood collaborations and organizations that might have the things that your patients might need. So really start with identifying what the needs are in your community, finding out whether if it's food, if it's financial issues, you know, trying to reach those needs first. Because, you know, if people can't find food, it's very hard for them to say, I'm going to find money for my insulin, right? If you're able to find ways and means like in Zambia where they're helping, you know, provide income by having people make masks, like maybe that's something that could be done in that community. So really finding ways and means for your patients to be able to meet their financial needs is so very vital. And then ensuring that there is a way for them to have access to free or reduced cost healthcare to ensure that they have free COVID testing and treatment is so important and advocating for that. Because without advocacy, maybe they won't have the means to be able to have that. I just want to add that to be beside World Health Organization who is trying to improve universal health coverage and is doing a lot to move governments to guarantee free access to healthcare, a basic free access to healthcare. And Family Doctors will advocate as well for this program, the universal health coverage, and it can help as well. Because I think it's a multifactorial problem, so we have to push all together from different sides. And we have to recognize Family Doctors are leaders in the community, so we have to be more committed to and more involved in reaching this universal health coverage, mainly through primary care. Thank you. Thank you. Next question or comment from Richard Botello. How can we innovate in developing more effective learning processes, platforms, systems of facilitation through leadership? Through the leadership development needed to reduce inequities and to address the injustices of isms. How can we innovate in developing more effective learning processes, platforms, systems of facilitating through leadership development needed to reduce inequities and to address the injustice of isms? I think there's many ways that we can really innovate our technology, like using this webinar. You know, as an example, we have seen Zoom learning for so many communities around the world and eHealth has taken a lead in that. And so ensuring that our organizations and educational institutions, our medical schools, our residency programs connect together is very important to be able to move the need on health equity. The issue is that for many curriculum in different organizations for medical schools and residency programs, health equity may just be a half day once a year or even once in the whole program. And so how do we ensure that every program has adequate information about health equity and training, which I think is so vital as Family Doctors to ensure. So it really requires necessary implementation and advocacy and movement from education, you know, the educational organizations and forces that be in every single country to really ensure that the isms are taught, that the isms are really addressed. And that workforce diversity is important, that the people who are teaching look like the people in the community. Right. The people that are in the residency programs and in leadership also represent the community. So I think it's important on multiple facets of ensuring the diversity of your medical school or residency program or hospital or practice wherever you might be in a community to ensuring that the educational needs are being met and that we're ensuring that this issue of health equity is really addressed. Thank you. My next question is to Dr. Prasad. Access to digital medicine depends on IT provision, coverage, speed and facility with IT use. What is your prediction for the future and what is going to happen for eHealth? You're muted. Can I have a question again? Sure. Access to digital medicine depends on IT provision, coverage, speed, facility with IT use. What is your prediction of what can happen in the future for IT health and what can we do from Wonka to improve that? Most of the countries the government has already is like they are providing the internet facility to all the healthcare centers and even they are trying to provide the internet facility to the general population also in a cheaper way. So I think that most of the people can use that the internet facilities, the net coverage and the healthcare center like they can start all those like eLearning facilities, the teleconsultation facilities with the patients so that they can easily use that facility for in a healthcare. Thank you. I see another, there was one other question. I think there is a question about the prediction for the future for everybody. I'm going to ask everyone to see what is your prediction for the future? What is your prediction for the next years in particular? And how is this, I will say how is this COVID pandemic is going to affect and then challenges of what we can do? Victor? Sure, thanks Viviana. So I mean, I think it's, you know, just like in Dr. Lee's welcome message, I think, you know, the path down COVID is certainly uncertain. I think, you know, throughout the last few months we've had multiple webinars and we've been engaged with each other. I think part of the strength that family medicine brings is the power of conversation because we in many ways we're a community based discipline and not only are we skilled clinicians as doctors, we also exist within the community. So we're actually able to provide a much more community specific view and lens to the problems that we face. And I think that the important aspect that we bring and we really need to advocate is the science and the evidence behind what we do. And I think as family doctors we understand the evidence and we understand the scientific basis. And as we continue the discussions and conversations amongst, you know, whether it's our state or provincial or national legislators and authority bodies, we need to ensure that we maintain that what we do is based on science and that it's community oriented. So those are, I guess, some of the comments that I would provide. But I mean, I think in many ways, you know, I'm quite optimistic despite, you know, the second wave that's probably coming in many of our societies, I think, you know, we continue to strive to be kind to one another to collaborate, and also to to essentially not lose hope in that we together as human beings can get through yet another crisis. Kim. I think the future for the next year as we see it really will depend on each individual country's response to the pandemic and the ability to be able to have strong public health measures. For example, the social distancing the masking all of that that that really is going to play a big part into how each country's future may be. We know that with flu season approaching that without those public health measures flu and COVID it's going to be so hard to distinguish. It's going to be very difficult in many family doctors practices, unless you have really adequate ways of having, you know, sick side, well side or fever clinics or respiratory clinics to be able to separate those patients out and so right now we know that the value of family medicine is that, as Victor has said, you know, being part of the community and seeing where the front line. We've shown that we are the frontline and in many communities and areas. We are able to span not only in the family practice office but in the emergency room in the hospital. You know, on all over going into the homes right so seeing I think the future really shows the depth and breadth and scope of family medicine and primary care and general practice and what family doctors can do. That's, that's how I see our future. I also think that telehealth and telemedicine digital health will play a major role in the next year. I mean right now we know that in some countries it may be up to 20 30% of the country may be on telehealth maybe even more. We've seen in parts of the United States, we went up to 80 90% at some points of the public health emergency but you know we need to really think hard about how to take care of patients, whether in person or virtually. And so that's going to take a lot of education, a lot of input from government to be able to get the resources available as mentioned before to make sure that we have the infrastructure to be able to support that. And I think we're going to have to really prepare for the third, fourth, fifth, sixth wave of COVID. And I know, and I'm hopeful that with all of us together, we are definitely stronger together, and that we'll be able to make it through this. Pilar. Okay, thank you. Well, as a patient safety working party. I would like to introduce the error analysis of the cheese mobile and explaining that pandemic is a big risk for the society. As you see in the cheese slide, every cheese slide is a barrier. And if we consider several barriers, for example, health organization, well organized health organization will be a barrier, or social services, proper social services will be a barrier, and promotion and health equity will be a barrier as well. And welfare for the whole population will be another barrier. All those barriers we know are imperfect. So pandemic has show up in such a way that all the holes of the cheese. So we have many things to learn. And the hope, the hope is how we are going to learn from them. I think there are three key issues. The health is global. So, and the economy is linked to the health. So if we do not succeed together, we will be in this situation for many years. So we have to make a plan to make a plan considering these three values for all. That's right that when we were answering questions, and there were some questions about the second pandemic that won't be COVID will be delayed diagnosis, chronic conditions that get worse, etc. So really we have to make, we have to act locally as family doctors because family doctors, we are leaders in our community. So we can avoid to make advocacy and to work in the community. But we have to think globally and push harder governments to think these new paradigms, health, globalization and economy. And if we do not succeed together, the future won't be so blissful in such a way. Thank you. Thank you. I don't see any new questions. So I'm going to share my screen, if Harris, to just kind of go through my, through some, are you seeing my presentation? Yes. Yes, perfect. Okay. And so you might be thinking where to start. It can be overwhelming and can feel like it's a really, really high going up stair of where do I start and how do I make a difference with this. Well, you can start small. No, it's not advancing. Sorry. I'm really sure why I'm having trouble advancing my slides. Sorry about this. For some reason. I can take over and share slides. Oh, you got it. Yes. So you can start small. You can start by maybe looking in your community and seeing which organizations, which restaurants are owned by immigrants in your community, but those who are suffering the more difficult inequities. You can get on Twitter and start tweeting about issues of health equity or on Facebook and really share knowledge about what you know and engaging others who might not be involving health equity to start becoming activated and become really engage in fighting for equity. You can go to a medium level and create educational opportunities to understand the health inequities in your community or in your county, in your state, or in your country, depending on your level in your organization. You want to be curious, looking at those maps, looking at what is happening in your community when it relates to health inequities and what can you do to improve the outcomes of the people in your community. You can share your concerns, share them professionally, share them with colleagues, share them with those who might have not understood, or maybe with those who have the ability and the power to make a bigger difference. You can go big. As family physicians, we are leaders. We are researchers. We are advocates. We want to participate. We want to become administrative champions. We want to become leaders of inclusive policies that actually augment the voice of those communities. Here, you know, communities don't have a voice. Communities have a voice. The issue is who is actually listening, and are we as family doctors, vehicles to get communities that are not being heard well enough. If you are working in a community with bilingual or people with other languages, higher bilingual and bicultural people, learn the language of a community that is suffering most of the disparities in your town. What is racial and ethnic health equity training? What is going on when there is a minority that is underrepresented or having severe inequities? What can you do about that? Change the way we do research. So we really include the communities that are really often not counted in data to really highlight what is going on with them. Do warm hands-offs to community services? If you are identifying that members of your community are having difficulty being able to access food, are there organizations that you can actually refer them directly? Not just tell the person, go to that other center, but actually can you get in touch with those organizations and do a warm hand-off? Can you promote resources, give resources to your patients? Can you prescribe the food? If you are a leader and your organization's leadership structure is very, is non-diverse, are you including women? Are you including those who are different, those who speak another language, those who are currently not represented in the community? You will learn so much if you hear and learn and listen to those voices who are representing the lives of communities different from your own or different from the leadership in your organization. I want to thank you all for being healthcare heroes. And heroes, for me, you are because you not only represent your communities because you work really hard for the communities you serve and because you're making a difference every day to make someone feel better from the moment they're born to the moment they're ready to die. And thank you so much for the tremendous work you're doing during this pandemic. Don't forget that next week the working party on women and family medicine will have a webinar on what is going on with women with the pandemic. We have some special speakers, including our past president Amanda Howe. I cannot wait to listen to this webinar that will be directed by Aileen Spina and members and our president-elect as well. And now I want to thank everybody in the panel, Maria Pilar, Kim, Pramendra, and Victor, and Haris Ligidakis in the background for a successful webinar and for everybody who listened today. Thank you so much, everybody. And we will see you. Thank you. Thank you to you, Vivi, as well. Thank you very much for contacting so nicely this webinar. Muchas gracias. Mucho obrigado. Pramendra, is there another language we can say thank you in? Thank you.