 Good afternoon. My name is Molly Martin and I'm the director of New America Indianapolis. New America is a non-partisan non-profit think tank based out of DC But I work here in Indianapolis where I've lived for 20 years and focus my work on the Midwest the rust belt in the upper south I'm really pleased to be here today with my co-leads and partners at the Indianapolis recorder for the third in a series on COVID in the black community today we'll be talking about something incredibly timely pressing and And certainly sad frankly that black Americans and black Hoosiers are seeing Disproportionately poor outcomes from COVID-19 and there are systemic reasons and social reasons And we're going to talk a little bit about that today And I know that dr Kane's office is joining us and we're very excited to see the county folks and I'll introduce the rest of our panelists in a moment But I do want to start quickly by acknowledging that when New America Indianapolis talks about issues related to race And issues related to the black community. We have some principles that we share First black voices are critical to everything we do solutions design Obviously black forces are a leading part of our community as they are in any community We also acknowledge the systemic racism and biases impact every aspect of our social economic and cultural lives Black lives matter race and ethnicity are not the same The black community is not a monolith And as talking about in talking about health care and the economy and the COVID-19 outbreak the word vulnerable tends to come up a lot Sometimes we mean vulnerable economically. Sometimes we mean vulnerable in terms of social determinants of health Due to systemic biases due to history of marginalization So just keep in mind that when we say vulnerable we kind of mean a myriad of things now that i've said that I'd like to introduce our panelists and then i'll i'll hand it over to my wonderful co-moderator Today joining us. We have Dr. Virginia Cain the director of the maryham county public health department Mr. Carl Ellison the president and ceo of indiana minority health coalition Ms. Antoinette Holt office of minority health at the indiana state department of health Dr. Erica Hubble stint of community health network Dr. Woody Myers a physician of a the owner of mires ventures and the former state health commissioner of the state of indiana And dr. Jennifer Sullivan the secretary of the family and social service administration for the state of indiana We're so glad to have you here today. We're so glad to have all of you across the country joining us for the conversation This will be a bit of a round table format. So, uh, thank you in advance for submitting your questions and keeping those coming I'd like to turn it over to my co-moderator extraordinaire Oshea Boyd the editor of the indianapolis recorder our partners in this project. Oshea. I'll hand it over to you Thank you so much molly. Um, as you said, this is a very important discussion We have a panel full of doctors. I feel a little intimidated because I don't have doctor next to my name So, um, we're going to try to make sure that we get some of these important questions answered that we talk about some very We talk about some very important aspects of cova 19 are affecting the black community statewide indianapolis and nationwide I want to get started With some data that we just learned recently the state of indiana released data on friday And I know this is an ongoing Thing that we're going to keep doing is releasing data. But for the first time we release data on friday about indian statistics when it comes to black americans black hoosiers The initial data 18.5 cases are african-american 19.2 death rate for african-americans That is very disheartening when you think about the numbers We only make up 9.8 of the state's population So, uh, those numbers are They're not indianapolis local numbers are statewide Um, but i'm just imagining that we can expect to see the same in indianapolis We can expect to see the same as we're seeing in chicago We're setting percent of cova 19 deaths are african-american milwaukey 81 Again, disheartening numbers Residents i've been reading reading up one as i prepare for this uh panel discussion Residents of majority black counties have three times the rate of infection And almost six times the rate of deaths As residents in majority white counties. So this is why this panel this discussion is so important We are talking about something that deeply affects our community and when you said vulnerable This definitely shows how vulnerable we really are and truly are to not just cova 19 But many health disparities but how this affects those other co-morbidities we have so Thank you. So I like to get started first with you dr. Erica huddleson. How are you doing today? I think you need to unmute yourself. There we go. Doing well. Thank you This is this is tricky when you're when you're going back and forth doing this. How are you doing? Doing well. Thank you Good. That's good. So I don't Want to um hit you with tough ones just yet But I want to ask you what a few weeks ago. There's a lot of information circulating Social media here say people talking there seems to be less misinformation today than it was before But what do in your opinion do people need to know do black people need to know about cova 19 I think understanding just the basics of the virus. I mean, it's a respiratory virus It's going to be spread by a sneeze or cough and those droplets are what are carrying the virus You can Contract the virus if it's on surfaces and you end up touching your eyes nose or mouth That's not the most common way that it's contracted though And this is a virus that in many people it doesn't have a lot of side effects or symptoms But those who are at increased risk or who have underlying health conditions They're the population at risk and we have to take that in mind Moving forward When you say underlying risk, what is that because I know some people may have asthma But they're pretty healthy. They exercise they do a lot of things and they don't really necessarily consider themselves unhealthy So when we say underlying risk, what does that mean? Sure. So these chronic health conditions Things like heart disease lung disease diabetes obesity severe asthma These conditions are all going to predispose you to being at more risk if you are Around the virus or contracted because your immune system is already stressed from dealing with these day to day chronic conditions so the virus poses more of a stress on your body and It overwhelms it in a sense That's something I think people don't think about so stress your body is already under When you have a condition that your body's already working hard to keep you healthy And then you add something else on top of that that is a respiratory illness I think people may not be aware of that or they have that type of mind now Recently the u.s. Surgeon general Jerome Adams He discussed the things you're talking about health conditions that people already have asthma Heart condition high blood pressure prediabetes And he called this a legacy of growing up poor in black in america Which when I read those words I just had to stop and just think for a minute like wow that's something that is so profound and so deep When we talk about the legacy of growing up poor in black in america and then you have covet 19 on top of that what Are the impacts that we can people can expect From this illness if you already have something are you is it going to be that you is going to Disaspirate your other illnesses as well or is just totally respiratory and that's all it is So this is a multifaceted question because it depends on what underlying factors you have definitely Yes, it can predispose you to having a more severe reaction to the virus So in some people say oh, I just had cough and cold and I got over rather quickly Other people you hear they end up in the icu on a ventilator and so it does affect People differently based on their underlying kind of basis of health and their chronic conditions overall Unfortunately, we see a higher concentration of these kind of chronic diseases in our black and brown communities And does that affect your ability to bounce back to when you have an underlying condition exactly? Okay, so I read I did a little bit of research on you and on your youtube page You made a statement on your profile about about who you are as a doctor And one of the things you want to do is create the bond and trust with your patients And I'm imagining I don't know you I'm imagining that part of the reason why you feel like that is so important Is because you understand as a black woman that distrust that We tend to have when it comes to people in the medical community. Can you expand a little bit on why that's so important to you? Definitely Yes, definitely coming from a black community and growing up right here on the east side of Indianapolis I've been blessed to actually have had wonderful doctors and healthcare providers In my life, but I know a lot of people have had very disheartening Situations and things that they've come across Sometimes they feel like they're not heard by their doctors or their providers And that overall will affect how often they come see their doctor We've noticed people don't schedule regular appointments if they're not comfortable with the provider that they're they're linked up with So just taking that time to establish care with a primary care provider not an emergency department You want to make sure you have a primary care doctor or provider? Who knows you one-on-one who knows your medical background and your history? And over time you're going to build trust just from showing up for those annual health visits and exams and Those check-ins with your provider on a regular basis How do you help your fellow colleagues understand this? I see a smile. I see a little How do you help your fellow colleagues understand this distrust and how important it is to build their trust? I think starting with a baseline of do you want to be healthy and how can I help you in your journey? Because you do have to take some personal responsibility for your own health But once you have decided to make that change and journey We're here for you and I make sure my patients understand that I am there to help guide them through All the ups and downs of chronic care management even if you're healthy you still need to see your doctor At least once a year So it's important to kind of establish that baseline so they know moving forward You've always got your provider there to discuss or chat with if you've got questions or concerns and That's really what I'd like them to know Well, and you mentioned something that I think when we talk about health We always want to have personal accountability We always want to make sure that we we recognize that we do have some ownership of our own health But so many times when it comes to talking about black americans We are blamed for situations that for systemic Challenges that we have nothing to do with that we can't control. We know that many times when you go to When you're in pain you go to the hospital You're you're kind of like that. Oh, you're not as much pain as you say you just want drugs, you know It's those kind of things that we often battle So when we're talking about how do we How do we battle this? How do we advocate for ourselves? um In the system that sometimes doesn't believe what we're saying Sure And I think that goes back to establishing a relationship with a primary care provider Who can then Be an advocate for you speak to your specialists and other caregivers that are helping to manage your health It's interesting that you bring that up because community did receive a grant from centers for Medicaid and Medicare services To address specific unmet health related needs and these things like the food Interpersonal violence Transportation issues these were all addressed during this Grant and now we are able to screen some of our high-risk patients right when they come in the office Identify what needs they have that may impact their health and then we connect them with the appropriate resources during their office visit That is okay. You said you connect them with their resources often we um Don't know the resources and in primary care So it sounds like that we need to have a primary care provider To advocate for us to know what's going on with us and that primary care provider can help us navigate the web of Of medical professionals out there because just me as oh shia. I get online. I try to find a doctor I may not find the right doctor the one the doctor I need, but if I talk to my primary care provider You're saying that will help me find the doctor I need And when it comes to um COVID-19 though when we are so one thing I've been concerned about is life has not stopped People are still getting sick with other things. Um, I just remember who Who was chopping something and cut his hand? So it's those kind of things that are still happening every single day How do we as we're worried about? Um COVID-19, how do we also make sure we're not inundating you guys? All right, this is a something that you've been talking about You look like this is somebody you've been talking about. How do we make sure we're not inundating you guys? and and with with different things and worry But if you can still do your jobs effectively Or you know, and that's one of the biggest concerns Our health care provider team our nurses our doctors our medical staff in the hospital and outpatient We were all concerned. How do we manage? This in a time where everything this is all new So what we are Asking is that you continue social distancing that truly is helping to Decrease the amount of people who are exposed to the virus Which in turn flattens that curve that a lot of people have been talking about And that curve is really what we want to flatten so that we don't overwhelm the health care system Because you're right people are still getting sick and this is in addition to all of the new covid cases that are being admitted So we at community are providing virtual visits So you can talk to your doctor any day of the week or most and We have also created a few Hope sites. So we have consolidated our med checks Our family medicine pediatric and internal medicine teams into one location in different areas of the city So that we can divert all of our normal resources Inpatient to the hospital where they need it more And this is still allowing poor patients to get regular care and access You can still have video visits with your specialist or your provider Or even phone visits and we also have a phone Call team of providers who are on every night of the week to help feel some of these questions and guide care So it sounds like that You guys are being created too in the way that you offer care to people because the The idea is that you want to you want to take care of the patients Who may have COVID-19 but you also want to stop the spread Of COVID-19 and you also want to keep yourselves healthy Right So that you can keep on practicing and helping other people Women as as an as an african-american woman when you see the numbers of for of Infections and and a death rate for other african-americans for our community as a doctor What do you think that we need to do is As a community also in the medical community. What what do you think needs to happen? You know, it's devastating looking at these numbers because these are friends and family and people within our community that We could potentially have prevented from getting this disease I think it's so important for us to realize social distancing Although it's uncomfortable and it's unusual it is helping and it needs to be continued Until further notice. I would say listen to what the CDC guidelines are putting out there And make sure that you are hand sanitizing sterilizing And think about things that you wouldn't normally sterilize and sanitize like your cell phones We don't realize how often we touch our phones and then touch our faces Pins light switches doorknobs Just things that you can do more regularly to prevent spread of disease Um wearing a mask if you're out in public and you do have a cough That's important to prevent others from exposure to yourself Because we have found that there are asymptomatic COVID cases a lot of people carrying COVID who don't know that they have it And so they're fine, but a cough or sneeze from someone who's a carrier Could infect that person standing next to you who can't fight the disease off as well as you might be able to You said a couple key things there social distancing. I know for many Black people it's been hard to social distance We are a communal people. We like to gather. It's been some nice days out there. We want to barbecue We want to you know have we want to get together. We had Easter. It was hard not getting with family for Easter But you said something that you may be asymptomatic right And that's something I think we may not think about is that we may be asymptomatic But you call for sneeze And you may infect someone who will not be asymptomatic Who will have who can have an underlying condition who could be older and more susceptible How do we kind of hit that message? To make people who are a little bit. I don't want to say hard had it But who are having a hard time understanding Why it's not affecting me But how it could you could spare someone in your community from from having such an illness I think if you think about that person standing next to you It might be a stranger But if you put a face on that person and you're considering that A member of your family, you know a community member someone who you may not have met but Knowing that you could save their life by staying at home by wearing appropriate precautions by washing your hands By limiting your groups to 10 or fewer people at a time If that could save that person standing next to you. I think that really has to be A factor Thank you very much. Dr. Huddleston. I'm going to pass it back to you Molly Thank you so much. Dr. Huddleston and We start the conversation in that very important way understanding the basics about the disease Your insights as a patient as a provider as an Indianapolis resident And we're moving now to kind of build on that and understand from minority health advocates and providers and marrying county and state wide To take a grassroots perspective and an advocacy perspective and really understand what the data gaps are what the trends are And our experts in this part of the conversation will be dr. Virginia kane the director of the marrying county health public health department Mr. Carl ellison the ceo of the indiana minority health coalition Dr. Jennifer Sullivan the secretary of family and social services here in the state of indiana and miss antonette holt Who runs the minority health division of the indiana state department of health and antonette? I hope I didn't ruin your title there. I apologize I want to kick off It is minority health month. So it's an important time to be having this conversation COVID-19 or not and dr. Kane. I'm going to come to you first And ask you um, and I do want to clarify because we have people from across the country that you are The lead of the marrying county public health department marrying county is home to indianapolis right here center correct, uh When you think about minority health month and the messaging Opportunities and challenges you have in reaching different parts of marrying county Have you found any messaging difficulty around COVID-19 and the local black community or has it all just kind of been one blanket message? So no, I think that uh based on the different Patient populations and our different racial and ethnic populations A lot of times what age has to do with it Uh, some people in anna city area may think this is a conspiracy that it's out to Use this disease to get rid of them. So they may not always trust the government Uh, and we have to look at for a younger generation. So like our young teenagers or young adults They may feel more invincible And feel that this doesn't Apply to them. So we have to look at using different messengers And different modes of how we get the message out. I may be an older person. I love the radio And I don't watch television as as much And we may have individuals who don't watch radio or television They don't have access to a computer or they don't really utilize computers So we have to look at how do we reach those individuals, but if you don't mind I want to go back a little bit to our prior speaker because I'm really concerned that if we really want to change the paradigm of how some of our Positions who may not be of african-american Background and interacting with their patients. How do we change them? Well, it's going to take more than a patient talking to the physician to change their attitudes Because a lot of them may have unintended biases or unintended implicit biases that they're not even aware of And so they need training And we need to hold them accountable All hospitals that have providers all academic centers that are doing training How they had to training so they understand When they may be insulting so on just recently I had some and it's the young generation providers that are training that we're graduating But we got to get them where they need to be I had them insult one of our black patients who's got a master's degree Ran a very huge organization for the state And yet acting like they only have like a third and fourth grade education And trying to explain things to them And saying wow, you know, do you know the definition of this? Because they didn't bother to read the medical chart before going into a room and saw it because they saw an african-american Patient just assume their third fourth grader reading level And i'm having a conversation with you now if it had been the ceo of lily pharmaceutical companies There i guarantee you they would have read the medical charts before going into the room So we gotta have these folks accountable To change the paradigms about how they are managing and treating our african-american patients, Hispanics or any other racial group that may be vulnerable and burdened as a related to this issue Thank you. Dr. Cain. It's a really powerful message about differentiated messaging and also a powerful message about Saying what we mean and meaning what we say, you know, which patients are we talking about? Who are we talking to and when we see wrong things? calling them out One of the Challenges and the sad part is they don't even they they don't mean any harm. Some of them. They just really don't know They've never been educated. They don't even realize that they may be insulting Of patients. So this is why it's so critical that we've got to have them required to do some training We've got to have special requirements of all providers related to this issue and especially our young generation That's a great point and I know that one of our audience members pointed out that the training has to be continual Uh, this is not one and done maintaining and in learning and building cultural competence Especially for public health emergencies is something we have to keep doing Yes, absolutely constantly and dr. King We will be back to you in a minute here But I would like to hear from mr. Ellison on the point you just made So carl, could you tell us a little bit about the indiana minority health coalition? And reflect a little on the advocacy the face of advocacy when you hear a story like dr. Cain's when you hear that people are still being greeted with inadequate access Or poor treatment from from health care establishment So start with telling us about yourself and then respond to dr. Cain if you would sure The indiana minority health coalition. We've been around for about 25 years We exist to eliminate health disparities and operate through a statewide network Of about 22 entities So we are around the state primarily in the larger metropolitan areas Where our service area covers about we're 95 of the black latino minority populations are in this state So think of us as sort of a local anchor a local Point of service a local point of hearing What's happened within the communities now in our approach to eliminate health disparities We tried over time to educate our way out of this. We do a lot of evidence-based education where it's sort of a Save one soul at a time so to speak But and but beyond that we've found the need to have a larger megaphone So we put significant emphasis on advocacy over the last several years What the presumption is that you can't really address health inequities if you don't understand it You can't really have a strategic way of approaching if you if you don't have the data So we have been largely Focused on making sure our legislators understand public policy issues. So there's a significant advocacy presence at the legislature every day We spend a great deal of time looking at Proposed bills looking at policies providing some input the legislators to try to help cultivate a sort of a more strategic a more Tested way of addressing issues that we face And we've also tried to focus on specific minority health topics Now, of course since health disparities exist across the board, you can choose cancer heart disease No, but you can choose any in any health condition And we can find some way to address that from a minority health concern We have typically tried to isolate at least one or more Minority health conditions doing minority health month to bring attention to this But the sad reality is that Most of us or at least you know many policy makers cannot cite specific disparities if you ask them They might be able to cite for example Infra-mortality because we've made it a practice of the last several years to Put a great deal emphasis on that particularly from our our governor and our legislative leaders And we now talk about not infra-mortality rates, but how many babies are those? Well, if if if I were to ask someone, do you know how many what the disproportionate rate is among cancer? Survivors or even cancer people die from cancer. Mostly just can't tell you that So as we go forward, we're gonna have to change the paradigm where when we routinely talk health We have to talk disparity. We have to make health disparity data information more evident more sort of a top of the mind It should begin health discussions Typically if we're going to address an area of health equity, we don't do that in a more specific Targeted manner so people can understand it at the local level So for example, if I were to look at the state health plan and say, okay What's the plan in st. Joseph county to reduce health disparities to health equity? There's no such document. So so we go about health equities in a way into blind It's more a work of faith Not a work of strategic thinking not a not a work of data gathering. So we've got a on the go forward basis Not just for with respect to nobody but with respect to addressing health equities in general We've got to be much more specific much more willing to articulate The differences and to make sure that's part of the conversation upfront and that we include communities with college in this conversation I've really been trying to do this for 25 years We just now see an urgency To engage the policy makers and others in a more strategic discussion to make sure we're always at the table Always helping to assure that the health disparity agenda is top of the mind as we discuss policies resource allocation and all the various things that we can and should do To achieve greater health outcomes for the state and nation Obviously unless we can do that Our productivity as a nation will decline. So it's kind of in everybody's interest now To be more conversative health disparities Thank you. Mr. Ellison that's so helpful And I think what you point out and what dr. Cain pointed out get to the heart of this program It's very important to talk to talk about and understand kovat 19 And disparities and outcomes and access related to kovat 19 But what this crisis has done is put in stark relief something that everyone on this call has known for a long time That these disparities exist and existed before You talk a little bit about kind of the state approach and and we think in indiana Especially for those on the phone who who don't live here We think of marion county in indianapolis as having kind of the lion's share of the state's black population But that's not entirely true. There are black Hoosiers across the state There are black Hoosiers in rural areas in our larger towns Fort wane south bend certainly lake county up in the region So i'd actually like to come i'll come back to you mr. Ellison, but i'd like to go to our friends from the state And miss holton and dr. Sullivan and hear a little bit about state data And state impact of she had introduced some some of the data on rates of infection and rate of hospitalizations For black Hoosiers. What are things looking like statewide right now in relation to kovat 19? Um, actually, I know that you guys work as a team. I'm going to come to mishold first and then go to dr. Sullivan I was hoping that you go to dr. Sullivan first and they come back to me She got the data data We can certainly flip flop if you like She said no go ahead. Okay Um, I think it's important while talking about data that we explain in regards to because there's been a lot of questions as to Why it takes so long for data data gaps and different things. So dressing that real quick. Um Usually on average when we would collect data It would take a process of a couple of weeks or different things because we would clean the data We would make sure it's accurate. We would make sure that we were inclusive Of of everything and so now we are being put in a situation where we have to turn data around in a 24-hour period So you're going to see numbers fluctuate It's also important that we note that we it's important imperative that we are collecting racial ethnic data So then we can understand the populations that we need to serve Especially those most vulnerable and then how to address those populations I think people uh, certain people have already talked to talked about the importance of making sure That we are inclusive of the target populations that we have that they're at the table in the beginning and not an afterthought It's very important. Um That advocates that are on this panel and beyond are part of the solution Because again, you know, if you're not at the table, you're being served for lunch. So We don't want that. We want to make sure that we are being inclusive of that. Um Data gaps. I know that we have been working on in regards to making sure that we get that because we have No set standardization as far as reporting There's some guides and guidelines in regards to reporting, but there's no set overall or agencies Nationwide different things as far as here's the set measure as far as reporting And so then that can make it difficult in regards to reporting numbers and things too um, and so We are constantly trying to work and improve on our ways that we collect our data Um, and how to make it I think we need to address. I think dr. King You know, I was like, wow, dr. King taking all my notes. Um We we need to address systematic and structural barriers And that does involve class standards A culturally ghostly appropriate services. We need to make sure that the people That are on the front line are asking these questions as far as race and ethnicity because That's a process too And then also we need to make sure that people understand the importance of why we collect racial ethnic data Sometimes people are apprehensive with someone asked them their race and ethnicity to give it to them But it's just like the census. I would I would dare to say how many people filled out their census because it was due this month But that information really does help us in regards to when we have to Figure out programming when we have to do different things like that. So it really assists us in that and so The set numbers that we presently have that you can find on the website or dr. Sullivan would talk about Um allows you just to kind of see where we're at in the state So thank you so much. Uh, first of all for um having me on today Um, I worked at the indiana state department of health as the deputy health commissioner for two years and with antonette And she is just one of my favorite people Um, and and so many other folks on the screen are as well. So thank you And you might wonder why the family and social services administration would have anything to do With this public health response social services and health care delivery often don't Factor in when we talk about public health responses, but from the outset Of indiana's global pandemic response. Um, the family and social services administration has been tasked with some big I think really critical and important jobs Uh, we deliver health care and social services to about one in five Hoosiers during normal times And we knew that that number was going to increase Potentially dramatically and it has uh during this pandemic And we have a special relationship at fssa with group We may have lost dr. Sullivan for a minute Oh, there she is Meeting unmet social needs So our our early big projects were um building out snap tanaf medicaid and child care development fund access to individuals In addition, we launched operation food with community networks and the national guard Quickly producing a map that shows in real time where Hoosiers can find food near them We also facilitated safe recovery sites for individuals experiencing homelessness and worked closely with individuals and families With aging loved ones and individuals with disabilities as well And we bolstered access to mental health services along with Non-emergent non-pandemic medical care through the convenience and safety of telemedicine and medicaid And in these efforts, uh, we also knew the gaps in indiana's health outcomes that predated this pandemic Would be even more exposed now than they were before So health disparities or differences in health outcomes for different groups are not new to indiana and are a top priority for both health care public health and social services Dr. Cain and and and mr. Ellison Talked about infant mortality our obi navigator project With many of the partners on the phone here, for example, is based on blending what we know works in health care And public health to improve infant and maternal maternal mortality with a community level social determinants of health approach for groups who Continue to have Disproportionately poor outcomes and our black mortality infant mortality rate is starting to improve because of this collaborative approach But in addition to health disparity, we also have to address health inequity Which is harder to talk about because it means that health disparities are happening because our systems have design flaws that cause harm And this is the inherent and often not recognized bias that happens in our communities our socioeconomic structure And unfortunately like dr. Cain said even in the halls of medicine That places minority populations at greater risk for poor outcomes than disease qualities would predict alone and we're seeing that exacerbated with this pandemic In indiana's data that antonette talked about suggests that we are no different than other states experiencing these issues in the pandemic And I think this is an ongoing tragedy that is mitigated by a lot of different things But I'd like to suggest and to this this group and and the things that we're thinking about at fsSA that one is acknowledgement Two is partnership to better understand Three is changing our structure to to recognize bias before harm occurs Four is active outreach for groups that have been systematically marginalized And five is comprehensive understanding of the needs of individuals and families Who we are asking to do really difficult strategies like social distancing that may be harmful for them For example, um individuals who have suspected cova that are seen in the emergency department, which is why I'm dressed funny after this I'm heading into my shift Um, we have to ask a few important questions before these folks go home if they're safe to go home One can can you isolate safely? Are you in a safe place? Do you have access to food? Do you have access to cleaning supplies? um Do you have access to The medicines or a way to contact your doctor if you need them and this should be part of all emergency care And the opportunity to do this better now and in the future is not lost on any of us So, you know We believe at the state the local the advocacy the grassroots level that Hooters regardless of race ethnicity gender geography or income Should and will have access to testing and access to high quality care. That's free of bias That is a goal for today not for the future And we have to both acknowledge and seek to reduce health outcome gaps across the state and to do that We have to analyze our data. We have to see what indiana looks like and we have to mitigate those gaps For disparities in this disease process and then continue to educate our essential teams in public safety and health care How to adapt our protocol so that we can care for everyone because that's our calling and that's our duty Thank you so much dr. Sullivan. Dr. Cain dr. Sullivan talked quite a bit about the importance of data as did miss holt Gathering data understanding data disaggregating data by race or ethnicity. So we really know what we're dealing with What is the status of disaggregated data on race and covet in mary in county? So in mary in county, we're going to have a public release sometime this week but I can Tell you that when we look at our deaths right now currently 40 percent of our deaths are carrying them whites But 42 percent of the deaths are carrying an african-americans so that our death rates are more than Twice the number of deaths we're seeing in our white community so definitely We're disproportionately being impacted By our rates and if you you look at it from a rate level What I mean by rate if you had a hundred thousand african-americans How many you're dying out of a hundred thousand? And it's 18 african-americans were 100 thousand But if you were a white patient that number is eight People out of a hundred thousand So you can look at it both ways that you're seeing that african-americans are disproportionately being impacted related To this covet 19 and you know, there are a number of underlying reasons for that Has to do with more african-americans are more likely to have chronic medical conditions Hypertension for example They may have diabetes Their weight may be Higher than our standard weight. We'd like to see that can impact somebody If you're developing pneumonia or respiratory difficulties in asthma or chronic kidney diseases and so because of these Uh different chronic medical illnesses it impacts our immune system all of these chronic medical conditions So your immune system is not as normal As opposed to someone who doesn't have the chronic medical conditions. So it makes you way more vulnerable Uh to developing this infection compared to our other counterparts But let me say one other thing Because of our poverty level that we have in maryon county In the african-american community I may not have a primary care provider So I may get my medical care through the emergency rooms or urgent care So it's intermittent But because of poverty and especially Most of our african-americans are liking the food industry, you know hospitality area and whatever So we've lost a lot of jobs. So I got to figure out how am I going to pay my rent I'm going to pay my food heaven to help me To pay For a doctor's visit. So I'm going to wait until I'm you know, feel I'm real real sick If I go to the doctor So sometimes it may result that by the time they're seeing their doctor They may be way more sicker Than the average person if they had good insurance or they had a primary care provider Where we're gonna have to a lot of money coming out of our pocket They could be seen earlier and my last point before I hard to show You know people assume that with no insurance, why are people not taking their medication? So, you know, we've had people who have the flu We give them a prescription just for a five-day prescription for the flu that will prevent the death In that prescription cost a hundred and twenty five dollars Just for a five-day treatment for the flu But if you got diabetes and you may have hypertension to boot You're paying the full retail cost of that medication Because you're not part of an insurance where you can get a discount where I might be just paying $15 or or 25 dollars They are having to pay 200 dollars for just one medication and may get up as much as 500 because they're paying the full Retail value So it's really scary That people may not be able to stay in good health because they can't afford medications That's a really important point and you know, dr. Kane you and the other panelists have pointed out a lot of the clinical and kind of predisposition issues around heightened rates of poor outcomes for black Americans in this and in other health crises But you've also hit on something really important And I want to nod to to shelby Cummings at local initiative support corporation here in indianapolis who does social determinants of health work She points out in the chat that a lot of poor outcomes for Black Americans are tied to their life outside of the clinical experience their life outside of seeking health care poverty food insecurity High numbers of black Americans who work in front-line work and work in front-line work that is not necessarily protected With gear even though we know we have a gear shortage in health care Whether that is materials moving or working in a grocery store labor economics is a little more my area And so so we know that there are more black workers in maryon county and st. Joseph county up where mr. Ellison is from who work in front-line work and kind of Vulnerable work anyway in retail and they have a lot of contact So when we think about these non-medical reasons for the increase in in coveted and poor outcomes for coveted 19 for black Hoosiers What role do health care Advocates play in raising that that flag mishold. I'd love to start with you since you're with the minority Division minority health division of the state department of health You're a health care public health specialist. You feel like it is also your job to talk about these social Issues that that are compromising black Hoosier health Yes, I think people forget the health income encompasses all aspects of life So it's not just so much how you feel But it's everything from your environment thing that makes that difference And so the office of minority health is constantly trying to make sure That we are collaborating with different communities and populations and organizations to uh To create a support system that's going to be Effective in its approach of eliminating health disparities And we can't do that by By ourselves, you know one can move a lot But when the whole hand is working and the fingers are working we can make a mighty blow And so it's very important that we address Those issues isn't it's important that individuals that are advocates and things are at the table I cannot express that enough. I think it's very important That our leaders understand top down bottom up The importance of supporting not just saying in name health equity But actually supporting in resources and people and things and valuing the importance Of why we need to take care of the people that we serve And not forgetting that and not forgetting those disparate populations That may not have a voice at the table or may not be sounding as loud I think it's very important to empower people to in the community as far as what's going on because the more you know The better you can do you can make choices and different things That hopefully can help you or give them the resources and tools that they need in order to be successful I think we've all kind of mentioned in regards to it's hard to say okay to someone Social distance and you're living five people in your home and your home is a set space I can't and maybe someone in your home is affected with the virus So how do you take care of that? It's hard to tell someone that has to put food on the table Stop working or they've lost their job what they're going to do And so just as dr. King was talking about those that don't have insurance paying them out If you have insurance there are high deductibles that you have to meet Before you can get your drugs and so these necessary drugs that's supposed to help you With the underlying causes that you already have are exorbitant causes like 400 500 dollars So you can't afford to get it and so then you suffer and so then Again, we have to address those biases because then you start to blame the patient or the person to say well You're not listening to what i'm doing. You're not listening what i'm saying, but you're not looking at the whole entire effect So yes, it's important to sound the alarm while we have a chance and opportunity I know that we do that as a state office of minority health Most states have a state office of minority health or a minority health entity That exists So striving these men and women are striving every day to try to incorporate health equity in our policy to make sure that our laws and things are Making sure that we are not forgetting the most vulnerable population. So yes Sounding the alarm making sure that you're part of the solution. And so I think that's how we're going to be effective Mm-hmm So mr. Ellison when you hear misholds call We have to be at the table. You have to have black voices at the table You have to have affected populations at the table black policy makers black epidemiologists What if i'm an activist or i'm just a concerned voter and resident and I want to know how I can hold organizations and government accountable for making sure that there's racial diversity at these policy making tables Where would I even start? Well, you can start anywhere Where whatever table you're at one of the things for example When we engage new organizations, I will often ask what is the race ethnic composition of your board? What is the race ethnic composition of your staff? Do you have dollars in your budget set aside for minority concerns because The budget the composition organization the company trustees is a statement of commitment and a statement of If you will relevance to having minority voices be part of what the entity is doing. So one way just simply just ask Well, secondly though, I think a lot of organizations like ours That have that that are at the table. We collaborate with a lot We're at a crossroads where we may have to become really more social justice organizations Because it doesn't matter how much we do in health education. It doesn't matter how much we do in advocacy Until the society and state fundamentally address the clear economic inequities Which drive adverse health which drive all the things that that we try to fight for after the fact We've got to begin to do and maybe advocate for some very simple things We try to stay in a health lane. So we don't typically say well, you know We ought to raise the minimum wage after 10 or 15 years at $7.50 an hour It's perfectly ludicrous to think that families who have to live on that can somehow make it So we've got to be realistic in terms of our economic policy We cannot look at Talk about the social terms of health if we don't address the social determinants And and from a policy point of view a resource allocation point of view. We don't systemically do that And so unless this state and nation decide to become a more equal society by our commitments by our actions by our knowledge Then we will always be at a disadvantage with respect to creative real change We cannot educate our way. We cannot say it's a personal responsibility to achieve great health If we have a system to stack against poor people, particularly people of color It's time for this nation to make mistake to make a commitment to great equity. I mean we we can measure it We can we can determine whether or not we make any progress there But but but you know for us to worry about can we get uber to take people to appointments for medical services in 2020 It's like come on now. We should have already had that solved and so If this crisis doesn't do anything else Perhaps it will wake everyone up to the notion We simply have to make a decision as a nation state and community change how we've done business And to give greater commitment to assuring that we not only talk about the equity We're not only talk about those terms help, but we really do some about it Thank you, mr. Ellison We will be back with this same crew and also back to dr. Huddleston soon. We have lots of good questions coming in But now that we've heard a little bit about the clinical and non-clinical Reasons that are driving some of these rates. We've heard a little bit about state and local data We'd like to hear a little bit more about the legacy of battling pandemics and epidemics in indiana So we'll be back to the rest of our panelists soon But i'd like to hand back to oshea who is going to interview one of our special guests today oshea Thank you. Thank you so much. Molly Thank you. Dr. Myers. How are you doing today? Pretty good. Thank you So I'd like for you to kind of introduce yourself and Tell a little bit about your expertise My name is woody mires. I'm a third generation Hoosier born and raised here in indianapolis and became a physician years ago specializing in internal medicine critical care medicine Was appointed to be the health commissioner here in indiana Under two governors governor or then governor by Going on to do a lot of other things in health care management and health care leadership uh around the country and in fact around the world have seen a lot of different Health care issues problems uh in just about every aspect of delivery public health research teaching and came back to My my roots and become involved more recently in politics I'm a candidate for office for public office. I'm running for governor here in indiana and in part because I I believe that the problems that are being discussed today The inadequacies in health care have not been well addressed not just across the nation but particularly Here in in my home state One of the things that concerns me the most as we get into this discussion in more depth Is the investment that the state has not yet made in solving the problems that have been very well described by The the panelists this afternoon Indiana has under invested in its public health solutions The the the trust for america's health has ranked indiana number 49 of 50 states In terms of the dollar amounts that that we invest So health care professionals like dr. Sullivan and others can't do their jobs If they don't have sufficient funds in order to to do them We spend 17 dollars and 58 cents a person compared to some states that spend over 60 dollars a person On public health through our tax dollars and that means that our public health infrastructure is far too weak That's one of the reasons I believe that we haven't done as much testing as we should have done or could have done That's one of the reasons why it's taken our state health care professionals More time than i'm sure they would like to get us the numbers that we need because the infrastructure Providing that kind of information is inferior compared to to other states So we have to put our our money where our hearts are and that means that we have to increase by a great amount the investment in public health in indiana Such that the people that that want to do the right thing to understand what we need to do can do their jobs better Thank you. Thank you for that when you talk about The situation we have now this is not new for you. You've seen This issue of disparities for a very long time And now it's playing out in a in a very in a very major way Can you kind of talk about we've heard disparity in equity? Why do we need to know About disparity and what does health equity mean? How do we get there? Is this part of the investing is this part of the investing more money into the health care system in indiana? That is that what gives us to equity? It's part of it. Yes The easiest way to think of disparities are differences and and those differences can have many many different causes One cause is as i've just mentioned the under investment In the system to get the results that we'd like to have But there are other issues as well There are disparities in the amount of research that is being done On some of the for instance the genetic differences We know for instance that that african-americans have higher rates of high blood pressure Then do they do many others and and we understand that in part It's because of how we process certain enzymes in our in our relationship to our kidneys All of that is now being exposed as a potential source for some of the The causes of why a kovat 19 might be disproportionately Affecting the african-american community. So it's it's both access issues And it's a better understanding of the biology So we need research that looks into those i've seen preliminary research that that makes a strong link between What we call the green and angiotensin system in our bodies and and the entrance of the coronavirus And i've also seen and heard today The stories from dr. Cain and others about How we are not getting the right kind of access to the services that do exist And the inappropriate way some of our Our patients are being treated when they when they become part of the system or try to access the system The number of people that have called me with their stories about their inability to get tested or Or the way they were treated when they when they tried to to to get a test All of that suggests that disparities are real Disparities are multifaceted Disparities do have solutions One of those solutions is better investment But another solution is the one that dr. Cain outlined and that's making Understanding of cultural differences a part of the teaching of physicians and nurses in our state And making that far more of a mandatory Experience for our students than an optional experience. And so I think that that's professionals like Dr. Hellison have identified earlier on today that Some of her colleagues perhaps aren't approaching this in the way that she would like to see or that she's doing I I just know we can do a better job if we work together and address all all of these issues that have been brought up Thank you You I kind of want to go back to something mr. Ellison said Accountability, how do we hold our public officials accountable? How do we make sure that people who have a vested interest in black health are Being at the table to hold the public officials accountable when they're talking about health issues that affect our community I think that's also multifaceted Carl Ellison mentioned that that the boardroom is a very important place And that we ought to make sure that that there is equal representation in all the various boardrooms of the companies and the And the not-for-profit entities that are providing health care services that are providing health care products And although that's a little better now than it was 10 20 years ago It's certainly nowhere near where it needs to be And certainly if we were to take a careful look at Who sits on the boards of our major hospitals and health care clinics in our state that there's plenty of room for Improvement and I also obviously believe that there's a route through our political system by electing people To public office at the state level of course the local level and the national level Who not not only care about these issues, but who are competent to do something About them carefully and efficiently with the public's dollars Not wasting money on things that are frivolous or things that are that are fraudulent as we've seen examples of unfortunately here But putting those dollars into places that can do much more good for the people that need that Those services and so I I just know that it's both public and private sector Efforts that can be improved that will get us to where we want to be and that's too equity You mentioned equity is as an as an issue. It certainly should be everyone's goal We we are nowhere near where we would like to be with respect to equity I know that that that I can Advocate from the position. I man as can everybody else That's that's on the panel today But it's going to take much more of this collective effort and forums like this one where we can discuss these problems openly and Proposed solutions and debate the best way to go because I know that if we We bring these problems out of the open and and then talk through the solutions we can do a better job Saying that I had a question you kind of said way to a question I had When do we move though beyond talking and discussing and To it's 2020 So these things are not new when do we see some action? It's it's time for action. It's really Past time for some action When do we Get there? What is it going to take? What are what do we need to do? Do we mobilize? Go down to the state house. What do we need to do to make the action happen? Yes, yes and yes all all of your all of your solutions are Important and I think each one of us is going to have to pick the best route for our own advocacy. I've decided that Given my years in the in the public sector in the private sector That it's it's time for me to to put my hand up with respect to the political Sector, I think that the political decisions that we make how we spend the state's tax dollars What programs get funded what programs don't get funded? What we want our legislators to look at in terms of bills to pass and what What we want our legislators to to stay away from or to change Those are the kinds of political decisions that I think that are most important that that we can make differently So I've chosen to spend this the last part of my career In the political route whereas others especially the the the group that is listening in many of them are younger Can choose other ways all of us need to work together and and do What we think from where we are that go as far as we can as fast as we can To to make these these these changes and yes, we have been talking about Disparities in one way or another now for for many decades. I know that I have Throughout my entire career in health care I've seen them from the time that I was a pre-med student to to today And I just know that although some improvements have been made we can do much better Thank you In any discussion about health Issues we have to talk about health care health insurance that always has to be part of the conversation And mr. Ellison and dr. Cain have have kind of hit on Low-wage jobs how these affect the community in which we serve Um When we talk about access to health care If we are working a job that that does not offer health care or The deductible so high it may as well not offer health care. How does that impact? COVID-19 how does that impact? Getting testing if you can even get tested yet and many of these people are working jobs are On the front lines they are still at the grocery store You know at restaurants delivering the food They're pretty much called essential workers Are they getting are they able to get the test and then how does this been in this situation with a lack of insurance or under? insured impact impact COVID-19 there there are going to be two major effects the direct and the indirect the The individuals that can't get care because they don't have access because they don't have insurance or Or they are not qualified for the the state's rat somewhat restrictive Medicaid program compared to Some other states. Those are the folks that I truly worry about today because when they get ill They often choose to use the emergency room and they choose to use that That route far too late in their illness and and that's bad for them And that's bad for our system, but it's the indirect effects as well this the social isolation that we are now Doing and it's remarkable in my view that we've done it so well and in so many ways Is producing a tremendous hit on our economy here in indiana and around the around the country We are going to clearly have an economic recession There are a lot of folks that don't like to use that our word But I think it's there's no doubt that it's coming the unemployment rate in our state and in the other states It's going to exceed 20 30 probably And it's not going to come back as quickly as I'd like to see it or is that Everyone else would like to see it and and many of the people that are going to be affected by That are going to be in the jobs that you just you just spoke of the the jobs that are in the the front lines with respect to for instance restaurants and and with with respect to The movie theaters and other things that are just not going to bounce back like you you might want them to and So we've got to as a state Come up with creative solutions I I believe that indiana is exceptionally well positioned to become A leader and what we now know is a critical missing element And that's medical supplies that we already do a great deal in health care pharmaceutical products and Devices but we can do much more right. I would love it if we would then dedicate ourselves to becoming the medical supply hub for the For the country producing all the products that are required, especially because I believe it's many others do This is probably not the last Virus that's going to be coming around that it's going to be affecting us Hopefully nowhere near as badly as as this one has but We we know that from the last 20 years or so. We've seen mirrors. We've seen sarge now covid And we have the normal influenza attacks that we have every year We we know that these viruses are hurting us. We are not exceptionally well prepared that this the This pandemic has shown that let's Reverse course and then say hey look next time this comes around We are going to be ready and indiana is going to be the leader in getting us ready and getting the nation ready I I just would hope that that would be one of the things that we could bring to our state to Not only take care of current needs, but take care of future needs And that's one of the reasons I've decided to enter the political arena to try to make that happen I definitely think That people are beginning to realize this could happen more often than not with uh pandemics epidemics pandemics and I and those jobs you mentioned like the movie theaters I definitely think people are going to reef going to take it a little bit so before they just go back Go back to spaces where everyone huge groups of people gather And so that will impact the economy as well. So and that leads me to ask this question Because when we talk about health care and health access and access to health we also it's not just insurance It's about getting to the doctor which has come up a couple of times in this conversation It's about actually getting there. I think mr. Ellison said, you know something about it's 2020 We're talking about taking an uber to your doctor What what can we do to make sure that people Can get to the doctor that is one of the things and for you doctors in in this group You know that many times if a patient is late, you don't play those games You have like 15 minutes in here have to reschedule but for some people There's a barrier to get to the doctor just to get there even if they were 15 minutes late That's the best they could do and to reschedule Creates a whole another issue. So then how do we work with those Patients who are trying to do what we're asking to do. They're trying to be healthy They're trying to come and see their doctor, but they have issues with getting there Well, there's a there's a saying that I like to use if we keep doing what we're doing We're going to keep getting what we're getting and that means we have to change our approach And there are a variety of components to that one is that we need more doctors and more nurses In indiana we need to train more and that's Clearly not something that we have prioritized enough. I would like to get dr. Huddleston more colleagues out there In community and elsewhere around our state so that people have more access to positions and nurses and Advanced practitioners of all kind and I think also We need to be willing to use technology more I believe that the the state is now beginning and dr. Sullivan can correct me to allow More telehealth visits perhaps Hopefully through our our Medicaid and Medicare programs. We we need to make them available, of course in private insurance as well We know that we can get a lot more done on telehealth That we that ever before because all of us are now zoom experts We've been doing zoom now successfully for for a month and a half So we figured that out. We can also do many aspects of health care Remotely with help from professionals There are now devices that you can use to measure blood pressure and so on and report that to your to your physician or your nurse practitioner Remotely all those are the kinds of things that we need to take much more seriously to To put on the agenda to put the policies in place right now so that we can extend The ability of patients to to access the help that they that they need Not just here in indiana, but but around the country So I I think it's time for us to to open up our our minds to new ways to approach old problems And to produce many more people to help the folks that that are are needing help I agree. I think this has opened our eyes to how we can be creative And and in solving some of these issues had it not been for covid 19 Maybe we'll never start thought about using our our technology in this way But it's definitely forced us to use our technology and be creative and and I and I've I've heard about more tele services More people even want to come to mental mental health calling your therapist Uh, having a having a FaceTime chat with your therapist or even you know your doctor just to check in Um and how much that has changed and it's very accessible. It doesn't take too much time To just call up and have a quick conversation. Hey say hey, I don't feel well. Here's my symptoms. What should I do? Versus going to actually when you don't feel well the hardest thing I've always found the hardest thing is to get is to get dressed and get out to the doctor When I don't feel well, so one word of caution though. I don't want us to overdo that and There are going to be in-person visits required We we're we're going to need to be able to have dr. Hullson and dr. Cain they're going to have to examine us at some point and and And take take some blood samples and then get our x-rays and so on so We don't want to over get overly dependent on these tele services, but in certain visits I'm sure they can be much more adequately Are much better used and I would like for us to expand our our menu That is a great caveat because it does need to be a balance. We do need to have a balance here Of in-person versus online or virtual visits I think that is all for now with we can move on to questions molly You'll me take the first question or do you have some questions from the chat? Thank you Yes, thank you, dr. Myers I have a couple questions to kick off with ocean that i'll come right back to you for some more I did want to offer a caveat to all of our audience members and panelists We are getting so many great questions and so many great points These will not be lost even if we don't tackle them here in the last 15 minutes With thanks to our partners at wfyi public broadcasting and side effects public media We will be answering the questions we get and sharing them online through public broadcasting and on the recorder We will make sure especially since some of these are our public health and patient questions Before I cut back to ocea with some more questions. I actually have a burning question for dr. That came on kind of early in the chat And since it's a practitioner question. So we have heard obviously that being asymptomatic It's asymptomatic. You don't know how long do you estimate that someone needs to isolate before they feel safe that they're they're not liable to affect others This is actually changed a bit. Um, if you are a health care or essential care worker, um in the past few weeks However, we have been telling most of our patients if you feel that you may have been exposed You should isolate for 14 days and that's kind of the standard. We've been using on average And when people are out and about even after their isolation, we're being encouraged to wear masks Do you have any recommendations on the quality? Source type of mask that that folks should be seeking out? There's a lot of mixed information about that one too. Um What we have found is that you want to reserve the in 95 the high tech mask the surgical mask Reserve that for the providers that are in the hospital caring for patients Those people who are patient facing. They're the ones who need the in 95s and those um more high tech options If you're just out in public walking around yes, you're basic Surgical masks and they're even recommending that you make masks Just to prevent you from spreading anything you might have From your bodily fluids, uh, so that's a component of barrier protection That's really helpful. Dr. Can you look like you might have an inside and I'm sure you do That's that's you're advising folks on that all the time Oh, just hold one second. We need to unmute you. Okay, sorry Am I I think I'm muted. Oh, you're fine Can you hear me? Yes. Okay. Good. So um, I did want to just emphasize one thing that I didn't mention You know, we have some incredible hospital systems here. I think that's really important to know. We're very fortunate And we have one of the newest public health hospitals as ganazi. That's in the country that um most vulnerable populations are able to go and I'm an infectious disease physician and I'm on the fact that I use school of medicine And I do want to say that all of our medical school faculty Have been undergoing this implicit bias training So we are trying to really focus and emphasize that We have some wonderful federally qualified community health centers. We got like over 24 And they've got a lot of experience dealing with African-americans, Hispanic patients, Burmese populations, you know, they have the cultural staff In the translations in order to address that so people they use a sliding scale You got no money. You don't have to pay So just say that those are some tremendous resources out there I will say though one point I want to emphasize We unfortunately are limited in testing for the COVID-19. This is a question that keeps coming up in the community We just our health department was only able To obtain COVID testing just about 10 days ago And our capacity is just 200 tests a day So that's why we try to focus on those Essential workers our bus drivers, you know, folks who are on the front lines essential services Doing the testing for them While we're trying to get to the point where we can do public testing But we are desperately trying to find new tests new reagents We're told that reagents won't be available for our Our machines that we use in our public health labs until June the 1st. That's just incredible to us The reagents won't even be available to us till June the 1st So we're doing a contract With people that have a lot of expertise in these laboratory tests to try to find someone That we can find some tests Get the reagents early so we can expand To the public and the community to do more broad based testing in these areas So hopefully we may have some wonderful news related to that Within the the week Thank you, dr. Cain Dr. Sullivan, did you have anything you wanted to add about the state's testing capacity or future plans? Well, I certainly did want to echo The sentiments that were Stated kind of throughout First of all, I think one of the biggest highlights that we've seen Of this response was we've been working to enhance and open up telehealth and mental health policy over the last Three years that i've been in this role And then with the opportunity to really open that up at the federal level across the entirety of all of our Medicaid and community mental health center platforms has been extraordinary To watch folks have additional access to health to really decrease those barriers to care that they may have had in the past And that will not go away when this is over. It has been an incredible win That has always been part of the of the growth that we've had And now being able to really accelerate that into Rural areas underserved areas has has been extraordinary and very heartening. Additionally to Carl, you'll be very excited to know that we've brought on those on-demand services for Medicaid members for transportation Just actually just before This pandemic so that access to non-emergency medical transportation continues to grow And really meeting people's needs Where they are so the combination of those two things Will not just during this pandemic but for the future help us to expand services For members and then also, you know for folks that are worried about how they're going to get health access This is what we do, right? This is what we're about our entire job in social services and Medicaid delivery and early childhood education is to make sure that we're addressing those unmet social services needs The healthy indiana plan is our expansion program everything that has been kind of the unique part of indiana's Medicaid expansion is currently on hold. So there's no co-pays There is no cost sharing there. None of those things that are part of hip itself Are in in place right now and no one loses any of their coverage During this pandemic and we will continue to learn from this on how we improve health health outcomes using these programs I also like to really talk about the two-thirds one-third phenomenon when we talk about health outcomes and health disparities In our kind of sister developed nations across the globe If you kind of swirled health care costs and social services cost into one bucket The proportion of those is flipped in the united states We spend about two-thirds of our dollars on health care and one-third on social services and then partner nations it's flipped where we really think about Social services and supports first because they actually are more effective and they're less expensive And so getting those needs met before you're sick Is really critical and we're seeing that in play right now that if we invest in those preemptive social services in public health preparedness That those really expensive Health care needs that we have which are absolutely essential as you see right now having critical care hospitals Like dr. Cain talked about and at eskenazi that can take care of the sickest patients when we most need them Those are important, but having the entire spectrum Shored up and ready to go at a moment's notice is exactly what we're doing And seeing and learning and this collaborative effort to say yeah, this is why We're never going to be the same after this is done bruised and not bruised but not broken is how I describe it to our team And and certainly you know from everything you're seeing on the screen from public health prevention where antenets sits To primary care or dr. Helsen sits to the emergency department where I sit and all of those blended together Makes a three lane highway to health that I think is is where we really need to go Thank you so much. Oh, she I'd like to turn back to you for maybe another question or two Yes, actually this question was asked twice. So I wanted to see if we could get an answer to it Um, do you think the cobit 19 high mortality rates for black americans is due to patients Being sent home and not hospitalized until it's too late So I think um, dr. Cain, this might be a good question for you and maybe dr. Myers could chime in So tell me the question again. I apologize. I was trying to get my call in number For in the patient's to say that they can't access And They can call our call center number and we can assist them Okay, that's what we want that to happen. So we want to assist people So I have a number three one seven two two one 5500 From eight to five monday through friday. You're having difficulty finding a provider We will assist you at our call center to help Related to that. Can you get that number? Dr. Sullivan has uh, They have the state's call center, which is 24 7 I believe and I'm I'm gonna do it for you jennifer, but their numbers eight seven seven eight two six 0011 So in and it's on our website and it's on the state Uh website government site so we can help find your primary care provider if you're having difficulty finding their provider So now what was my Well, thank you so much for that information dr. Cain. It is it is needed sorely needed and very valuable Do you think that covet 19 high mortality rates for black americas is due to black patients being sent home and not hospitalized until it's too late Honestly, no, I don't I honestly don't think that's the case I think our big case is that's number one. We may seek out care a little bit later Uh than our average person. I also think number two Uh, we may have a higher number of patients who don't have a primary care provider and able to Get in early for their care because they're used to doing it. Some of them intermittently through emergency rooms And with this loss of income it puts a huge impact on our patients and so if They're they're not in as good of health for some of them only Um with those co medical conditions It just puts them at a higher risk for contracting the infection Compare it maybe to their white counterparts, but if they get in late And they may have more co more more morbidities multiple medical conditions Uh, it makes them way more vulnerable and a higher risk for dying Then uh, say their white counterparts. So I think it's a combination of factors Thank you. Dr. Cain, uh, dr. Hudson or dr. Myers. Do you guys want to chime in? Well, there you are molly Do you guys have any thoughts you want to add because as we're getting pretty close on time here I would just echo what dr. Cain has said that there are factors that we don't fully understand yet And that is one of the reasons why we've got to continue research In all of the underlying issues surrounding these disparities. I don't want to just make the assumption that it's only access Yes And I do want to make one major point that hasn't been covered in this entire conversation if you don't mind Please do Critical for everybody to know So with all that trillion dollar stimulus package Are people aware That the affirmative action process has been waived by the department of labor when we say this again The department of labor has waived the affirmative action process for all the stimulus package So there's no guidelines on a federal state or local level That they have to use any affirmative Action guidelines as they dispense the stimulus package So we're going to have to look at very carefully in terms of How much of the stimulus package are giving to Racial and ethnic populations We need to know the amount Of money that's given How many vendors May be involved in this process that are of different racial and ethnic populations Because there's no accountability now if the affirmative action Process has been waived by the department of labor So that's something we really need to keep our eyes on Related to that and guys This is our time to raise the living wage for everybody People can help themselves If they can get a decent wage And so that's seven dollars and 25 cents an hour that's been there for 30 years My god, we can do better for the state of indiana and our local communities So that's what we need broad-based support from everybody To get our act together and raise those raises. Well, okay, dr. Kane I don't know if there's a better way to close out on that and I think we have like two more two more shows from that, uh, molly Right and we are coming up on time, but that is a great way to end and and I couldn't I definitely couldn't have said it better So I won't say I couldn't I will say in closing I want to thank all of our panelists. We understand that this is you know, a mighty group This is like the world's smartest dinner party except for me And I'm very honored to have been here We could have spent an hour with each one of you But we do thank you for taking the time to share just a little bit of your expertise And taking the time right now when some of you are frontline Medical responders, all of you are important on the ground activists and now is the time when you are in the most demand Thank you so much to the indianapolis recorder to my amazing co-moderator Oshia and to our wonderful community partners at side effects public media and wfyi Everyone who has been registered everyone in our chat here We'll receive feedback on the questions that have been asked We will share the answers and we will share information through wfyi and the recorders platforms We are so grateful that you continue to participate in the recorder new america series Thank you very much. If you want to check in with us, you can check the twitter Hashtag covet in black indy. You can find us at at indy recorder and at molly g martin mol l y g mar tin So with that I will close out and wrap us up with great Thanks to all of you for being guests and all of you for attending. Have a wonderful day and stay well Thank you you