 Good afternoon, everyone, and welcome to LEAD, Leading Equity and Diversity. I'm Dr. Debbie Willis, pronouns she, her, hers, and I lead the DEI certificate program here at the University of Michigan's Brackham Graduate School. We started this series because scholars wanted to hear from real people their experiences leading equity, diversity, and social justice efforts. Thank you all for joining us today. Given all this going on in the world right now, we appreciate your presence and your willingness to be here with us. Before we get started, please note that you can enable the live closed captioning by clicking the CC button on your screen. Though your audio and visual are muted, we encourage you to engage in a conversation through the question and answer portal. We'd love to bring your voices into the conversation. If you see a question that interests you, please like or upvote that question, as we will ask questions with the broadest interest first. Before submitting your question, we ask that you consider how your words might impact others. We also ask that you are patient with us. As hundreds of you registered for today's webinar and we received many questions at registration, we will not get to them all in an hour. However, we are committed to continue these conversations. So last year on May 29, 2020, amid racial unrest and seeing the disproportionate impact of COVID-19 on communities of color, we dedicated this lead webinar series to address racial equity for an entire year. And this webinar fulfills that year-long commitment. We invited you all to join us each month for a conversation on anti-racism and racial equity. Each month, hundreds of you joined us for 12 months straight. So thank you for being with us along this journey. We also invited you to join us for your own one-month commitment because we just talked about the same commitment and not letting just the moment go. 600 of you opted in to get monthly emails and an opportunity to reflect on your commitment. So we applaud you for that. Today's conversation will address how racism is a public health crisis. And we have two phenomenal guests with us to lead this conversation, Dr. Enrique Neblett and Dr. Chiquita Collins. Let's start with brief introductions. Chiquita, can you tell us a little bit about yourself and your journey as a leader and advocate in the space of equity, diversity, and inclusion? Well, thank you, Dr. Willis. And I want to say I appreciate the invitation to come join and speak on this timely topic. And so where should I start? So currently I am the inaugural vice dean for inclusion and diversity at the Joe R. and Teresa Lasana Long School of Medicine here in San Antonio. I'm also the associate vice president for inclusive excellence and health equity at the UT Health University. And I am the associate professor of population health sciences. So my background is demography. And so native of Chicago come from a large family, Catholic family, matriculated in I would say in terms of Catholic schools in Chicago. So I had a very good educational foundation, went to Lane Tech, which I didn't know until later on in my adult years, that it is the only high school in the country that has produced the highest number of PhDs. And so from there, I matriculated to the University of Illinois at Chicago, was torn between, I always had interest in medicine. So I majored in biology. And given that I was working full-time as well as having a full-time course load and a lot of first generation students can relate to this, realize that college wasn't meant for me. Dropped out, I see we don't share our failures in terms of our success stories. And that only lasted for one semester. And so like many, I decided on either psychology or sociology and by the luck of the draw, pursue sociology. Falker team members saw potential in me and inspired me to, encouraged me to pursue graduate studies. I applied to three schools, only one application made it into the mailbox. And that was the University of Michigan, go blue. And so from there was awarded a merit scholarship. And I tell you, Michigan was a fantastic experience. We had the critical mass of faculty members who invested and were committed to our success. Worked with David Williams, who was now at Harvard University. We pursued seminal pieces of research as pertains to social determinants of health, decided to pursue the traditional academic route was on faculty for many institutions. In fact, many people think I'm in the military in terms of the many moves I've made. I went back to my alma mater in terms of University of Illinois, Chicago, taught at Georgia Tech, pursued a postdoc with the Robert Wood Johnson Foundation as a health policy scholar, landed at UC Berkeley, got back on the market, secured a job at UT Texas, go long horns and decided academia was not for me, pursued a job that was looking for a diversity officer negotiated because Michigan teaches us very well in terms of how to negotiate. And so became the assistant dean of diversity and cultural competence at Johns Hopkins University School of Medicine was promoted within six months to become the associate dean of cultural competency and diversity. And in five years, opportunity knocked and I landed this job. And so that's a short brief abbreviated journey. And again, I think it's important for people to share their journeys because sometimes people only see the outcome of our success and that the path in which we had pursued to get there. Thank you, Tequita. Enrique. Well, good afternoon everyone. I'm delighted to be here. Thank you for the invitation to be a part of this presentation. And I'm in awe and just honored to be sharing the space today with Dr. Collins. So really looking forward to our conversation. I'm a professor here at the School of Public Health, professor of health behavior and health education. This is my second year back at Michigan. I'll get to that in a second. I also serve as the associate director of the Detroit Community Academic Urban Research Center or the Detroit URC, as we call it. And I'm also the associate faculty lead of DEI for the School of Public Health. In terms of my background, I'm a second generation black American. I grew up in East Orange, New Jersey, which is a suburb of Newark, New Jersey to immigrant parents, as you can tell. So my mom's from Guyana, South America and my dad is Panamanian. And so that's a part of my background and lineage. I did my training here like Dr. Collins, my graduate training at least in psychology, where I worked under the tutelage and wise mentorship of Robert Sellers. It's interesting that Dr. Collins mentions David Williams, David is one of my academic idols and also was a member of my dissertation committee. So I work closely with David as well and I'm a big fan. In terms of my diversity trajectory, it's hard to say when that exactly started. Formally, I would say once I became tenured in 2014, was at UNC for 11 years in psychology and neuroscience. And at that time, right after we became tenured, they had a formal faculty fellowship program. It was diversity and education research faculty fellowship program for faculty who were interested in being a part of leadership in diversity initiatives. And so I did that, they assigned you to a couple of committees. I was a part of learning what goes into a university wide survey climate. I also led a learning committee on faculty and student diversity with some colleagues there at UNC. And that kind of opened the door for me. I served on provost committee of inclusive excellence in diversity and then went on in my own department to be appointed director of diversity initiatives where I led the diversity committee in our department and also went on to serve on a number of diversity related committees at the university. So that's a little bit of my background, just kind of starting off in the diversity space but really looking forward to growing in that area. I've learned so much even in the new role in the past year about how diversity efforts and initiatives actually work quite different than how you think they work once you actually get into it. And so I'm really excited to be continuing to do that work. I kind of left out, many people know that my area of research is in the area of racism and health primarily with young black Americans although that has expanded with time. I'm glad to be here. Thank you. Thank you so much. So another thing that the three of us have in comment is that David Williams was on all of our dissedation committees. How cool is that? Okay. So the first question, we'll start very broad in general. Why is racism a public health problem? Like, what does that mean to you? And Enrique, we can start with you. Sure. You know, I think there are a couple of different ways to answer that question. I think I'll start with the obvious way and that it's a public health problem because it concerns the longevity, the sort of life expectancy of people. And we know that there are disparities in population groups that not everyone enjoys the same time on this planet, not everyone enjoys the same quality of health. And racism is a system that sort of shapes how long you live, how ill you are, access to vaccines, so on and so forth. So obviously a problem in that regard. We have certainly for a long time talked about discrepancies in terms of life expectancy, 14 years in some places, right? Between blacks and whites and many of you probably saw the data that came out, I think earlier this year or late last year about kind of the life expectancy shortening, maybe eight tenths of a year for whites in the first half of 2020 as a function of the pandemic, but three years for black folks. So racism is a problem for that reason. I am trained in mental health, so it's a problem to me because it not only influences physical health, but psychological distress. And that is sort of turns into problems in terms of physical illness. Even though the epidemiology rates are similar for mental health, we know that blacks and other groups have more severe psychological distress and issues of mental health access are a problem. So these are some reasons. I think in terms of another way that I would think about this question is that racism is a problem because we don't want to talk about it all the time. A lot of us are selective. It's really funny in these conversations. The things that we're saying now are things that people have been saying for a long time. David was saying them a long time ago, people before David were saying them. And look what it took for us to start having a national conversation about it again. It took someone being murdered. It took a global pandemic. And so I think that's a problem. The last thing I'll say in terms of why this is a problem is that it's a very personal one for me. Just seeing the number of people who have died prematurely in my life. And even just in the past year, losing an anticovid, having a brother who was hospitalized for COVID, this is a problem where people are dying and we need to take stock and figure out how to finally make some progress in this area. Yeah, Shakita. Well, I would like to add, Enrique made a very eloquent response to that question. We haven't talked about it. We've been walking on AXLs and we look at even the literature and the research on social determinants of health. We've been doing it for over 50 years. Although we didn't have that terminology, we have been reporting the discrepancies or disparities that are so pervasive, primarily among the BIPOC community, blacks and indigenous and people of color. And so I would say that we are now in this racial reckoning to really articulate. And in academic medicine, we are now understanding the value and the challenges that exist in terms of addressing it as we teach our next generation of physicians and clinicians and scientists. And so although when we look at racism, many people only think about it from the perspective of interpersonal relationships, but racism is systemic to various social structures, right? So it's not only medicine, it's not only education, it's real estate, employment. And so a paper that we did many years ago really shed light on understanding the fundamental root of racism really is pertain to racial segregation, residential segregation, right? That's one of many. But if you look at it, even though it has been unconstitutional back in 1968, right, we still live in a segregated country, right? You talk about South Africa in terms of apartheid, but I tell you, economists have shared that if we reach a certain tipping point in terms of communities becoming integrated, it only reaches like 4%. And we see this phenomenon in terms of people leaving communities because they believe in these negative stereotypes that poverty values are going to plummet. Blacks and other minority groups are gonna bring in a criminal element and all these negative types of assumptions that are made. And so we have to continually, I would say, challenge those stereotypes and I know we're gonna talk about solutions. It's not just reporting the problems, but I am pleased in terms of we're not at a point where we are having these, I would say courageous conversations because it takes that in order for us to learn from each other and to move beyond just, leaning on scholars who've been doing it for many years. Yeah, thank you, thank you so much. So the next question talks a little bit about some of the solutions perhaps, but the question is, how does increasing the pipeline of the BIPOC population into public health and the medical fields address racism in public health? And we'll start with you, Chiquita. Okay, is my mic on? All right, so although we've made some inroads, primarily as pertains to women, we've reached gender parity in terms of our medical schools, primarily across the country. We still have work to do in terms of diversifying our student population in terms of medical students. In fact, you may have heard black men tend to be our biggest challenges. Reports have indicated, for example, that the number of black matriculants in medical school in terms of black men have remained stagnant for almost 40 years, 1978, right? And so there is a now, I think we have pivoted in terms of understanding that we have to really rev up our energies in addressing this population. And so I would say, this will require even more in-depth conversation. It's not to the point where we're reaching and trying to recruit them when they are completing college. We have to really start at younger ages when we talk about the pipeline. There are many programs that exist for high school students, post-baccalaureate programs that exist, and they have been successful. However, scholarship has shown that we have to reach at the age or at the grade of third grade when students are deciding on in terms of careers and really introducing them to STEM, science, technology, and math courses. That's the instrumental point by which we really have to target our energies and to invest in them longitudinally, not just at one point time period. We have to invest, we have to follow them, we have to provide opportunity. So I would say greater investment is needed in recruitment, mentoring and retaining medical students and across the medical education as well, not just at that time point, but also when they advance and become residents, fellows, and then become practicing physicians, some of which will decide on returning into academic medicine. And so we have to make sure that we do our due diligence at all those important stages or phases in their career so that we can see change. Otherwise we're going to be right where we are today, 10 years from now. So true investment requires commitment and being intentional in our efforts and really doing our due diligence at those pivotal stages and phases. Yeah, thank you. Enrique, would you like to add from the public health standpoint or outside of the medical field in psychology? Yeah, I mean, I guess I'll just comment that the pipeline obviously is critical. I really enjoyed reading about some of the work that Dr. Collins has done in this area which have been groundbreaking and she's really been a leader in this area. I guess more so than answering the question in terms of public health or psychology, I'll just make a comment. And that is that the progression that we are seeing in terms of racism being a more prominent part of discussion in terms of models of social determinants of health, I think is a direct result of more students who are in the pipeline that we wanna bring into public health and medicine coming into the field. I think that these conversations and the awareness is more likely to occur when these folks that we're talking about, these very talented students, our leaders are the people who are the presidents of public health associations. And so for me, another reason why this is really critical in terms of addressing racism as a public health crisis is that the more folks that we can bring in who have lived experience with racism and who are in these types of not just getting through the door but leadership opportunities and who are sitting at the table to inform the conversations and discussion, I think that takes us a step closer to addressing racism as a crisis. Yeah, thanks so much. So just in speaking of health outcomes, Black people and the question says Black people but many people of color have much lower health outcomes across all health categories. What factors in society contribute to lower health outcomes for people of color and what can we do to combat or reverse this? Very complex, very challenging, back to the point of understanding the root causes. Sometimes we use this behavioral modeling as if it is the onus is on the person. They choose to engage in poor health behavior, but we're not understanding the social context by which these behaviors occur. And so growing up in Chicago, I live in close proximity to the notorious Cabrini Green Housing Project. And so we excribe certain behaviors because we make assumptions about people, right? And we don't necessarily look at the billboards that are advertising alcohol. We don't necessarily talk about the lack of grocery stores. We talk about food deserts or the neighborhood grocery store that sells poor vegetables and fruits, but more inclined to see junk food that has high incidence of calories and so forth. So even learning from those who are in marketing and advertising, food placement in grocery stores makes a huge impact in terms of what people purchase. The affordability of good quality foods is very limited in marginalized communities. And so we have to take all those things in consideration. We talk about the social determinants of health. You say I need to engage in physical activity where if I am in a situation in which there are no sidewalks, there's no neighborhood parks and facilities for my children to engage in any type of activity, it makes it very difficult, right? So we have to make sure that we take the social context into consideration. And so there's been a lot of debate and I would say to include all the various types of social services that will lead to a better health outcome. It's not just the onus on public health experts, it's not the onus only on health and medical doctors and physicians, but we also have to engage the community, those who invest in areas. And so that's just a tip of understanding why people engage in certain behaviors. And we haven't even discussed in terms of the level of distress and mistrust that certain communities have towards the health community. And we have a long history in terms of legacy. And in addition to current, I would say, realities by which people are hesitant to even engage in getting the COVID-19 vaccine because of our history. So I'll leave it and have Enrique share in terms of his point of view as well. Yeah, I think some of the factors that I've been thinking about that contribute to this problem. I mean, the list is so long at this point, right? So Dr. Collins really, I think spoke to issues around food security and built environments, which are critical social determinants of health. As someone that is interested in young people, we know that early traumatic childhood experiences are important to consider, that these things have been linked with increase in stress hormones and subsequent difficulties in terms of health outcomes later in life. We know that poor education is certainly a part of a conversation that kind of sets the stage for your income, economic stability, how you're gonna be able to afford health insurance, access to quality healthcare, those kinds of things. In addition to, when I think about food, there's also housing, there's the social community. There are lots of different factors and some newer ones that I've been thinking about. I just taught a course on population health determinants. We have to be talking about incarceration as a social determinant of health. Obviously, we have to be talking about police violence is certainly relevant to health outcomes. Even the digital divide and access to who has internet access has implications for who has access to knowledge and those things can shape health outcomes. So all of those things are important. I think one of the things that was interesting to me when the pandemic started and we saw these disparities, people were like, oh, it's poverty, it's economic inequality. And people always talk about social determinants of health as the root of the root, the fundamental causes. And in a lot of these conversations, people were not talking about racism. But going back to the first question, all of these things that Dr. Collins has mentioned and that I've also mentioned are shaped, are structured by racism. And so I was puzzled as to why we were having these conversations. I actually have people say, oh, it's not poverty. Can you show me that? Or it's not racism. This is all about poverty. We've heard this conversation over and over, but these are the kinds of things. We can look at the long list. I'm a racism scholar, so I'm a little bit biased, but I think that racism is at the root of rollback poverty. How do we get to poverty? How do we get to these inequalities? How do we get to incarceration? So on and so forth. In terms of what we do, I mean, we could be here for a very long time in any of the sort of areas that I gave. There's policies that people are talking about in order to address these sorts of issues. So we're even right now debating the George Floyd Police Act, right? And we've seen specific initiatives in terms of if we wanna just pick one of them around economic instability, people have been talking about baby bonds, the child tax credit that we saw earlier this year, and other sorts of things. These are all things, I think part of our conversation today is about anti-racism. For me, the broad answer to the question is that it's all about policies and programs and practices that are gonna reduce the inequity. And so anything that does that to me is a way that we move forward on this question. Yeah, thanks so much. I do wanna read, I think you both have kind of addressed this question, this and our question and answer, but I'm gonna read it and then you can decide whether we should spend any more time on it. But it says, you can easily understand how racism is a public health crisis among low income with limited access to public, with limited access to education for minority groups. Yet, can we still easily say that racism is a public health issue among high income, highly educated minorities? The first thing that comes to mind is mental health. Are there any other impacts? Can we say that high education and good income is your shield toward any public health disparities, even if you come from a minority group and it's constantly subject to discrimination? So I'll begin. You may remember in terms of the seminal report that came out by the Institute of Medicine back in 2002, unequal treatment. And it highlighted at least 500 studies to document even after statistically controlling for all those things, income, education, you would think that those disparities will disappear, but those who are coming from even, I would say affluent statuses still experience racism. And you asked earlier on in terms of, yes, we can talk about the studies, but also in terms of our own personal experiences. As the child growing up in Chicago, my parents grew up in the deep South and when they migrated to Chicago, they still knew certain tricks of the trade. I had to get dressed up to go to the mall because my parents felt that we will be treated differently if we wore our everyday clothing. That doesn't prevent you. You've heard of stories of Oprah Winfrey trying to get into a upscale boutique in New York, right? And they didn't recognize who she was and you had to be buzzed in and they didn't buzz her in. You hear countless stories, anecdotal stories as well as stories that have been documented in research. And so that does not give us any type of access or privilege just because of our titles, just because of where we live, just because of our income. We experience the same amount of racial discrimination because of who we are and how people perceive us. And so there is much work to be done and it should not fall on the owners of those who are of those ascribed identities. It really is gonna take a village. And I mean in terms of a collective effort and investment, true commitment. And we need to hold institutions accountable because we've been dealing with this for many years and for us to expect our students to... We talk about resilience. We have been resilient for many decades. And so as a matter of, again, institutions taking accountability to eradicate those environments in which we have to our face with so that we can be successful and thrive. And so I am very hopeful and optimistic that we're at this point and we're having these conversations that we haven't had in the past. And so I'll leave it as that and Rikki. Yeah, so I have two responses to the question. I agree with Chiquita, we know from research that even when you take into account socioeconomic status, you still see some of these disparities, right? And as she pointed out, there've been numerous examples anecdotal and otherwise that suggests even if you're Serena Williams, for example, that doesn't protect you. But I think I would throw a lot of question back to the person who posed this question. And I would say, let's look at the life expectancy of college educated blacks, for example. Even with a college educated degree, people have discussed the fact that those folks still, I get the exact numbers next up, but are not living as long as whites who have lesser, I'm sorry, I'm flipping it around, but you understand what I'm saying here that even if you have a higher education, higher degree, you still may not live as long as someone who's white who has less education. And so to me, that sort of suggests that education is not a panacea, it's not the end all, it's important, but it doesn't eliminate the inequity that exists in health outcomes. So there's that. The second thing that I would say is from our own research. So we did a study a few years back where we were interested in a link between racial discrimination experiences and psychological distress. And we were interested in the role that gender identity plays and also socioeconomic status. And we went in and we thought, okay, we expected that the men, these were young adults, that the men would have a stronger association between discrimination and poor mental health. We also expected that folks who were from lower socioeconomic backgrounds also would have a stronger association. The findings of the study actually surprised us. The group that was most effective were black women, so these were all black young adults, from higher SES backgrounds. So the more education that their parents had had, and they were women, this was not the same for the men in the study who were from higher SES backgrounds, but there was something about the intersection of gender and class that played a role where they have the highest levels of psychological distress and the relationship between discrimination and poor health was strongest. And so that really got us thinking about, no, it's not just an issue of having higher SES. In fact, the unique combination of being a black woman with higher socioeconomic or SES attainment introduces an additional burden and additional stressors that that group has to deal with, carrying additional burden in terms of these sorts of things. So I think that to me speaks to this issue of does class kind of eliminated, the answer is no. Yeah, yeah. Can I just tell them that? Yes, in terms of this whole notion of double and triple jeopardy, even our Latino women, right? We speak a different language. And so right now we are now addressing what Kimberly Crenshaw, who's a League of Scholar in terms of this intersectionality, which bore out of the double sexism and racism of which black women experience. And so now we're throwing all marginalized groups in terms of many experiences that they also report in terms of how do we address intersectionality and its multiple, I would say, extension of the spectrum that we are including nowadays. So I agree with you totally, yes. Yeah, thank you so much. I mean, in this whole accumulation of racial stress that the whole weathering hypothesis is so interesting when you add all of those things together, like you said, intersectionality, it all plays such an important role. And I'm sure like Enrique, you study mental health, it all plays an important role on all of these things. So the next question is, declaring racism as a public health crisis is a necessary step to ensure greater awareness and allocation of resources. What are some strategies that communities and organizations can implement to reduce the health disparities, but also to make sure those resources are allocated for this type of study? You wanna start Enrique? Sure, happy to do that. I think it's hard to say what communities should do or can do, I tend to think of the community as the experts and they're already doing some of the work in this regard and they know probably more so than I do in terms of what's important. But that said, I do think that the things that communities are already doing are advocating for their citizens, trying to get them resources, some of the partners that we have in Detroit during the pandemic, we're like trying to figure out, how do we get food to the folks who need it most? How do we advocate for people who don't have internet and who aren't having access to the information about how to protect themselves in the context of COVID-19? So I think that's one very sort of tangible thing, just the day-to-day things that directors of these organizations are doing. I think something we've been trying to be a part of in the work of the Detroit URC is thinking about capacity building and making connections between organizations. So one of the things that some of our partners have noted is that people are doing different things in different parts of the city, but in terms of just what are the challenges that we're all facing and kind of having a collective brainstorming around how do we deal with those issues? That's one thing that they said would be really helpful. So how can we come together? How can we talk about lessons learned? How can we kind of go through this together? And so I think one thing that communities and organizations can be doing is sort of linking up with one another. I think as academics, or it's from where I sit anyway, we can be a part of not telling communities what to do or how to do that, but offering to provide resources that would help to kind of build this capacity and try to identify opportunities for funding. A lot of the organizations have talked about how there's a lot of money that's earmarked for like this specific thing, but it would be helpful to have kind of unrestricted money to be able to do all of the different things that they've been being pulled in all these directions. Can you be a community clinic? Can you feed the people who need it? Can you get people on the internet? Can you call the utility company? So I think that these are some ways that communities can move forward and partner with us. So just to dovetail on that, we have the establishment of private and public partnerships where we are tapping into those who've been in the business for a long time, such as the Kellogg Foundation, the Robert Wood Johnson Foundation and others and really partnering with organizations. I would also add that when we engage the community, that they are participating at the onset, right? I mean, you have stellar scholars in the School of Public Health who have really been trailblazers in this effort, right? So it's not a matter of we are bringing resources to you and to your point, Erike, they are scholars within their own right. And so they have wealth of information which we can learn from them. And we have to make sure that we ensure that they are at the table at the beginning and throughout so that they are not only I would say providing insight in terms of ways in which we can eradicate a given problem or at least mitigate a given problem, but also in terms of seeing it sustained over time, let them be the owners of that. When they feel empowered, you're gonna see even greater returns on your investment versus sometimes we have good intentions and they fall short because we have not included the community. Yeah, it's so important to recognize the wisdom in the community and what they know about their own people. I just like to add one other thing about allocations when you talked about policies that is very important and just thinking about how there was this recent study that came out from one of our researchers at the University of Michigan and a variety of other people about how NIA grants are, you know, African Americans are half as likely to be able to get a grant funded than others. So like kind of working at things at the systemic structural kind of policy level is important for us to advocate for that as well. So our next, oh, go ahead. I can jump in. I remember this point and particularly for this audience, I think it's important and it connects back to some of the issues of pipeline that were mentioned earlier. So I sit on an NIH study section and I have recently, people are probably tired of me telling the story, but during the last term, there was a grant that received a very poor score and this was an investigator who was well established. So I looked over the grant and I was puzzled as to why it received the list score. So I said, let's discuss it. And the lead reviewer on it, you know, sort of said the study has, you know, it's all black people. There's no comparison or control group. And so I'm not sure this is good science. Okay, we could have a long debate about those comments, but what was interesting about that is, you know, this was 2020 and these sorts of conversations that we might laugh about and think like nobody still says that, like they're still happening in the places where the decisions are being made about, you know, allocation of funds. And it's part of the reason why we need more people, you know, to train and bring them. I often imagine, just as I am like, oh, what are these study sections for another, you know, I'm tired. But I often imagine if, you know, we were not in the room, those grants would not receive the attention, right? And then the flip side of that is if there's a small percentage of people who are stretched between all these things, trying to be everything and everyone, that's the reason we're dying earlier, right? So, you know, it's a complex sort of issue here, but I wanted to raise that in terms of the NIH piece. Yeah, I appreciate you telling that story. None of us had heard it. So, and I think it is so helpful to think about those things and why it's so important to have a variety of people at the table, like you were saying as well, Shakita. So we have the next question says, COVID-19 made the general public more aware about the healthcare crisis in the United States. Do you think this will lead to reform, actual reform in healthcare? And how can we keep that window of opportunity open? You wanna start, Shakita? I have to remain optimistic. I think, again, it has opened the eyes of those who were unaware because it did impact them directly. And many people say this has been the perfect storm, you know, the COVID-19 in conjunction with the racial reckoning that has occurred in our country since last spring. And so it has brought to light, you know, many scholars who have been in the field as pertains to social determinants of health and understanding, you know, it's not necessarily in terms of who you are, it's where you are, where you live and the inaccessibility to healthcare and lacking health insurance and all of these factors that have already been discussed. So I think with the current federal administration has already created a COVID-19 task force and you have in the lead Dr. Smith from Yale University who is part of that. And it's a quite diverse, robust, you know, composition of folks who bring different lens and different expertise. And so that is a huge start. And so, you know, again, you know, it's requiring, you know, all of those factors and I remain very hopeful and optimistic that we're moving in that direction. So I would say, yes, I see that it is changing its course but health, I would say teaching hospitals, healthcare organizations, all of which now have, you know, leads who are pursuing efforts as pertains to understanding social returns of health as well as, you know, I would say really looking at ways in which we can change the ways in which we've been teaching our future physicians and scientists. Thank you. So the next question, Enrique, maybe you can jump in here. It's about mental health awareness and how it has become salient during the pandemic. Can you speak a little bit to how racism affects the mental health of people of color, especially among our youth? Yeah, absolutely. So, you know, I often tell people that if you think of a mental health outcome, there's probably a study linking it with racism that shows that, you know, discrimination racism leads to poor health outcomes. So or poor mental health outcomes so depression, anxiety, PTSD, you name it, disruptive behavior, there's probably a study showing that it's problematic. And some studies that we've done with youth, you know, they talk about feelings of being hurt, sadness, they talk about feeling angry, but they also talk about, you know, you know, sort of just being tired, psychologically tired. There's this quote I remember from a photo voice project that we did where a young woman said, being woke is being tired and kind of talking about just the psychological vigilance that is necessary. And studies we've done with younger adults, the youth has said, you know, they feel more like they have to be kind of on edge. And we actually found in some work at UNC that the more people were, you know, sort of saw black as being a central part of their identity, they felt more anxiety distress, more depression, et cetera, which is the opposite of what we've typically found. And one of the reasons we suspected that was the case was because of the context of UNC. We were having discussions about Confederate statue, we had the KKK on campus, that were buildings named after, you know, KKK, the Grand Wizards, you know, so if I'm in a context where being black is a part of my central identity, and I'm in this thing where I have to kind of be on edge and, you know, nervous about what's gonna happen when I leave my dorm room, that's an issue. So I'll say that really quickly, we know that, I think Dr. Collins made this point earlier, it's not just about individual experiences of discrimination, so all of those social determinants of health that we mentioned, those have implications for mental health. If I'm, you know, have to stand in a line at a food shelter, for example, just about all of the social determinants of health that has been studied linked directly to mental health as well. So it's not just the individual instances or microaggressions. Great. So I'll bring in a question from the participants. It says, how do you reconcile interventions that address coping strategies to deal with the effects of racism and the conversation about placing the burden of alleviating health disparities on the individual rather than the problematic system? Tequila, do you wanna take that? I think it's a combination of the two. I don't think you can put all your eggs in one bucket, as they say, you know, it's going to require both, you know, so we have to do some self-reflection, you know, and that's where, you know, we really take a hard assessment in terms of who you are, right? And don't expect to do that on your own. You know, I would say, you know, obviously there are a lot of programs and workshops that are now, you know, coming out of the woodwork, you know, that you can take advantage of, you know? So self-reflection is first and foremost, you know, in terms of awareness is first and then to do a deeper dive in terms of who you are and how you can change as well as, you know, having conversations where you can differ in opinion, but you just ensure that you respect the other persons, you know, convictions and narratives. Because again, it's like you have to be authentic, right? And I think we've kind of turned a blind eye and have said, you know, well, that's something of the past. We're no longer a racist society. Well, we've never really had those, as I say, you know, courageous conversations, you know? We've had laws that have been passed, but the reality is that we still have not necessarily taken the next step in engaging with people who are different from ourselves. And so it's a constant process, you know? So it's not something which you can take one workshop and say, now I'm bona fide, certified. You have to be invested in it and I tell, you know, even myself, you know, I look at my inner circle, my network, right? And so I want my children to be exposed to people from all walks of life and to respect what people bring to their lives, you know? And that's how we become, you know, richer in who we are and more accepting of those who are different. And, you know, you come to find out that we have more things in common than you would ever believe, you know? I remember when I was in the classroom and I was teaching at UT Austin, for example, one of the prime, they had to choose, but they had to do this as a group. They had to subject themselves into an environment which they typically wouldn't, right? And I'm not saying going to a Chinese restaurant, I'm saying where you are the numerical minority and they will come back and say, at first they will have anxiety, right? Because they do it with either another person or with a small group, but they will come back. And I would tell you, they would say, oh, you know, it wasn't as bad as I thought it was, you know, in fact, you know, I made a connection, you know, so again, we have to remove ourselves from our comfort zone and take a chance, you know, and that requires courage. That requires that I want to be different. I want to, you know, improve in advance as a society. It takes all of us to do that. And so you look at your neighborhood. Nowadays, we don't even know who our next door neighbor is. You know, we may say pleasantries, but dude, we really get to know who people are. And again, you cannot negate the fact that's how we're going to move forward. Otherwise, you know, institutions are made of people and people live in terms of wearing the respective communities. We have to do better because we want better for those who are coming after us. I comment on this one briefly. I know we're getting close to time. I agree wholeheartedly with Shakita's points here. I think it has to be a both and perspective. We can't just, you know, put all the eggs in the dismantle white supremacy basket and or all of that, you know, and coping. When I write academic papers, there's always a line towards the end of the paper that says, even though I'm talking about what we can do now, recognize that we need to dismantle racism and white supremacy. So I think that's important to bring it. Well, bring it home is not the right expression, but people are struggling. There is a lot of stress. There's a, you know, David Williams wrote about it, a stress pandemic and people need things now, right? So people, unfortunately, in youth populations, some of the ways that people are choosing to cope and it's not just youth, are using substances, you know? And so if we don't, you know, sort of think about alternatives to helping people cope right now with things that have implications for health, that's gonna be a problem. We can go, you know, protest and, you know, whatever, which is very important, but we can't just, you know, allow in the meantime people to, you know, be engaging in these other things that are not health-promoting. Yeah. Yeah, thank you for adding that. So the last question we'll have is what curricular changes do you think are needed in health science education as we're talking about the pipeline? And what role does critical race theory play in systemic racism and how that's perpetuated in our institutional and social fabrics? So I'll jump in. So right now across the country, I'm the current chair elect for the Association of American Medical Colleges the Group on Diversity and Inclusion. And we're taking a broad brush in terms of ways in which we can provide guidance to our teaching hospitals and medical schools and really doing a deep dive in terms of their medical education curriculum. And that's across the board, not just medical students, also our residents and our fellows, right? And we have to also ensure that we teach our clinical faculty who are teaching our students because we can't just assume they have the wherewithal and the skills and the training to do so. And so I always advocate that, you know, medicine, we don't have to do this alone, you know, in fact, given that I'm a social scientist, we can lean on those who have been doing it for many years. Some of us are not independent academic health centers. We have, we are under the rubric or the governance of a traditional academic university. And so we have social scientists, we have public health experts, we have, you know, those that we can tap into. So we shouldn't do this in a silo effect. We should build bridges and tap into partners who can assist us in doing that. So I would say we're doing a deep dive in our curriculum. We're shifting and understanding historical context because there are some things in which we have kind of perpetuated, you know, in terms of blacks being treated with more pain as you had asked, you know, and other things that we're changing those things. And so I'm just happy that again, you know, we're coming from a global perspective and we're providing guidance to those who are in the business and training our next generation of physicians and scientists. So I think in terms of the curriculum, there's some very specific things that can be done in terms of what studied, what courses are available, you know, who's represented, you know, what models are represented on the syllabi and then the courses and in the curriculum that people are studying. In the past year, so many physicians have, you know, come knocking at the door and say, look, you know, we really don't talk a lot about the social determinants of health in our training. Can you help us think a little bit about this or can you, you know, what do we do about this? And in my own experience, I found that this is a generalization, but unless physicians have had the opportunity to pursue some public health courses or, you know, have an MPH, they're thinking it's very different than the folks who have not had an opportunity to kind of be exposed to those kinds of courses. So I think that infusing more of that public health perspectives into the curriculum is important, but I will also say to Chiquita's point that it's important, when you think about a problem like racism, racism's not just a medical problem, it's not just a public health problem. Racism is a problem that involves urban planning, engineering, law, sociology, economics, et cetera, et cetera. And so if we really wanna think about the curriculum, we need to train the next generation of students to be able to be adept at, you know, sort of being able to speak different languages and converse with the people who are from different disciplines to solve a problem like racism, which is so multi-pronged and multidimensional, it's not gonna help if we, you know, with all due respect, it's important to have medical conversations, it's important to have public health conversations, but there needs to be more cross-fertilization and more conversations. In addition to that, we've gotta train our students so that as they become the next leaders, they are adept at being able to, you know, kind of problem solve and build teams that are not just unidisciplinary, if that makes sense. Yeah. So as always, the time goes so fast, and so now we're at the hour. I loved how we end on that note, right? So what can we all do, actually? It's not just a medical problem or a public health problem, it's a problem across board. What can we all do, and especially as scholars and as trainers, like you were saying, Enrique, of upcoming leaders of all things. So it's just as important for them to have this professional development around diversity, equity and inclusion, social justice, microaggressions, et cetera, because they are going out into the world. So it's just as important as their kind of content expertise. So thank you both so much for joining me today. I know you're so busy and I appreciate your wisdom and experience that you share with everyone. I wanna take the opportunity to thank all of the participants on the call for joining us and the leaders at Rackham Graduate School, Mike Solomon, who joins every month as well. And I wanna encourage everybody to keep in the fight, keep everything going, keep the window of opportunity open. Like we said today, we have to have hope and optimism and we all can do something, all of us. If you're coming from a place of privilege, it's sometimes hard to see what's needed and necessary. So keep your eyes, stay in the curiosity and keep moving forward. Thank you so much, everyone and have a good day. Thank you. Thank you. Go blue. Go blue, right? All of them, I love it. Take care. Bye-bye. All right, take care, everyone. Take care, Rikki. Good to see you. Bye-bye. Yeah, likewise. Take care, Shakita.