 Welcome everyone to the session, Defining Health Beyond Clinical Care. This is a case study of community building activities to address the social determinants of health. I'm your chair for today, Sam Osoro. And before I introduce the presenters, I would just like to give a quick introduction to this very interesting topic. This is not only relevant to how practitioners, this is also relevant for every individual in our society. So SDOH, or social determinants of health, is identifying someone's health status by connecting social factors that may influence their health status. This is also interesting for anyone exposed to the institute process, obviously, because we'll go into how the two can, the three can actually connect. So the presenters for today, I'll start with Dr. Sharzad Shariran, who works as a practitioner position at Golden Gate Community Health Center. She also serves as director of primary care scholars and family medicine clerkship in the Department of Family, Community, and Preventative Medicine at the University of Arizona College of Medicine in Phoenix. The co-facilitator is Farzad Fani Marasasti, who serves as director of public health prevention and health promotion, and is also the associate professor at the University of Arizona College of Medicine, and he oversees the culinary medicine program and the social determinants of health curriculum. So I'll turn it over to you. Welcome everyone again. Thank you, Sam, for the introduction. Welcome everyone. We all learned so much in the past two weeks from remarkable work that has been done to advance the current discourse on various topics and fields of study and so relevant to the current discourse on social justice. This pandemic has unveiled our system failures, health inequities, and social issues. Some of you may be currently part of a Health ABS working group in the past several years. A diverse group of health professionals has done great amount of work on advancing the discourse on health, drawing from current scientific understanding on health and Bahá'u'lláh's divine revelation, and translating this knowledge into an emerging conceptual framework on health. Some of this work was presented at the ABS conference a few years ago. Rashid and I wanted to explore this emerging conceptual framework further by translating some of its critical concepts into the field of service through constructive engagement locally at a community health center in the Phoenix metropolitan area. There's so much to learn and we're hoping and eager to increase collaboration and research in this area of work. In this session, we will briefly explore the definition of health and social determinants of health from a scientific and spiritual perspective. We will describe the role of the institute process in community building activities in addressing social determinants of health. We will share an example of a case at a community health center. So what is the purpose of health? The Bahá'í writing state that the purpose of health is to serve. The body should be a servant of the soul, never its master. We may have two intentions for health. One can be to satisfy our personal wishes or another be serving humanity. And of course, the latter is more commendable. How do we define health? The World Health Organization in 1943 defined health as a state of complete physical, mental, and social wellbeing, and not just the absence of sickness and frailty. Since then, the definition of health evolved into a more holistic definition, such as a dynamic state of physical, mental, emotional, social, cultural, and spiritual wellbeing and balance in all aspects of life, not merely the absence of sickness or disease. This is an important investment in our perspective on health. So health in the broader sense is affected by the balance of all the components of one's body. Each of us as individuals, together as a community, are institutions that set policies, the relationship from the cellular to the societal, from micro to macro, from local to global. This is also in line with the concept of complex adaptive system that Dr. Tahiri described in her presentation last week. Shoghi Effendi, the guardian of the Baha'i Faith says, we cannot segregate the human heart from the environment outside of us and say that once one of these is reformed, everything will be improved. Man is organic with the world. His inner life molds the environment as in itself, also deeply affected by it. The one acts upon the other in every abiding change in life and the life of man is the result of these mutual reactions. So this is an important concept in the Baha'i Faith that you will see applies when we look at the determinants of health in our efforts with community-building activities. In the current scientific and medical understanding of health, we recognize that there are several factors that determine our health. A number of studies have attempted to assess the impact of social factors on health. A more recent review estimated that medical care was responsible for only 10 to 15% of preventable mortality in the US. Studies suggest that health behaviors, such as smoking, diet and exercise and social and economic factors are the primary drivers of health outcomes and social and economic factors can shape individuals' health behaviors. So what are social determinants of health? They are the conditions in which people live, work, play and grow up that can have a significant impact on health outcomes. These complex social structures and economic systems are responsible for most health inequities. So here are examples of social determinants of health. Our economic stability, our income and how much financial support we have. The neighborhood we live in, the safety of our physical environment, can we safely go out for walks? Are there parks around or transportation? Our education and literacy level, access to early childhood education, access to food, healthy, nutritious food. Our community and social context, how socially integrated we are or social support and of course health care access and quality of care. So a few words on food insecurity. The statistics on food insecurity refer to the very low insecurity, which is someone who basically doesn't have enough food. However, we know that a much greater percentage of Americans have low food insecurity and unable to get quality nutritious food daily. In 2014, 17.4 million US households were food insecure during the year and that's again the very low food insecure. In 2016, 31.6 of low income households were food insecure. Black households are twice more likely to be food insecure than national average. Hispanics are at higher risk. Our high risk populations are unemployed individuals, non-white and individuals with disability. A food desert is an area that has limited access to fresh fruit, vegetables and other healthy foods. Predominantly in lower socioeconomic neighborhoods, black and Hispanic neighborhoods have fewer full service supermarkets than white neighborhoods. So how the city is designed and your access to transportation can impact your access to healthier food. You'll notice that in low socioeconomic neighborhoods in the US there are less grocery stores and more convenient stores that obviously carry less healthy nutritious food. So if you don't have a car or access to good public transportation, this intensifies the problem in those neighborhoods. What we call race-based medicine amplifies and contributes to systemic racism. So as we know, race is a social construct and changes over time. There are no underlying genetic or biological factors that unite their racial category. Race is not an appropriate market for disease state or risk and should not be included in medical diagnosis and treatment. Using race as a surrogate marker increases health disparities. This is part of eliminating systemic racism and healthcare, understanding that we're all one human race. Now, you may have heard that some populations are more greatly affected by COVID-19, such as African-Americans, Native Americans and Hispanics here in the US. There was a cohort population-based study published in the New England Journal of Medicine that examined the role of race in risk of mortality. The study showed that race alone, independent of social factors, such as low income, residents, health insurance status and co-mobilities, the main one being obesity. So when we adjusted for these factors, race was not a factor for mortality. So this study highlights once more the impact of social determinants of health and that race in and itself, it's not a determinant of health. So speaking to race and speaking to racism really as a social determinant of health and as a public health crisis, which now is being declared in a number of places around the country finally, you can think about COVID-19 as a great unveiler. It's really exposed the underlying deficits of our health system as well as our society in terms of the systemic structural racism that exists. So if we look at our black brothers and sisters, for example, these issues, right, they're disproportionately impacted by COVID-19, but this pre-existed COVID-19. COVID-19 is just exposing something that's been in place because of the legacy of 400 years of slavery, because of the anti-blackness as the National Spiritual Assembly of the United States termed in their letter as well as the spirit of white supremacy that permeates our society. And this actually unfortunately really structurally results in real outcomes for real people. So these are just some of the stats. So 60% more likely to be diagnosed with diabetes twice as likely to suffer complications, five year survival rate for breast cancer for black women versus at 86. So it's 71% versus 86% for white women, black men, highest mortality rates for prostate and lung cancer and studies suggest lack of suitable and equitable care compared to white patients in terms of getting that care to access. Other stats add to that cardiovascular disease, another one of our major diseases, African-Americans 50% higher cardiovascular mortality, maternal health, black women are three to four times more likely to experience pregnancy-related death than their white counterparts and black women have the highest rates of depression and suicide, which has increased by 200% for black men in the last 20 years. So these are really so, and only one in three African-Americans who need mental health care actually receive it. So these are very sobering realities of racism in America. The issue here, when we look at it and we talk about segregation, we look at the history of the civil rights movement and we've talked, we've heard about segregation. Well, segregation is not something that's gone away. There was the history with the Jim Crow laws, the redlining, the untold stories of the massacres in Ohio and other places of prosperous black businesses and communities, which just really strike to the core of you when you hear it and you listen to it. We all need to be open to learning and understanding this, but segregation is real and it's still happening. Not everyone has the same opportunity to be healthy and you can see the differences in neighborhoods translating. So segregation, even though America is the most diverse, arguably the most diverse nation on earth, there is segregation. This map basically shows you the density of segregation in a lot of our populous cities like New York, Boston, other places where you have a lot of diversity, but you actually still have a lot of segregation in terms of how the communities and neighborhoods are set up and those communities and neighborhood setups actually contribute to the social determinants of health in terms of poor health outcomes. And this is a quote that many of you have probably been reading and studying because this is the first, at least in North America and the United States, this comes from the first letter from the University of Texas in the last 33 years, directed solely to the United States and the Baha'i community because of the dialogue on race that is finally getting the light of day that it needed to get for so long. Racism is a profound deviation from the standard of true mortality. It deprives a portion of humanity of the opportunity to cultivate and express the full range of their capability and to live a meaningful and flourishing life while blighting the progress of the rest of human kinds. It cannot be rooted out by contest and conflict. It must be supplanted by the establishment of just relationships among individuals, communities and institutions of society that will uplift all and will not designate anyone as other. This is so critical when we think about this because that's what is resulting. When we see the poor health outcomes, for example, when we see among black Americans getting poor health comes even when you control for socioeconomic status factors than a white person coming in to get that same healthcare. The change required is not merely social and economic but above all moral and spiritual. So from a Baha'i perspective, it's not just about numbers, it's not just about material education but it's moral and spiritual. With the context of the framework governing your activities it is necessary to carefully examine the forces unfolding around you to determine where your energies might reinforce the most promising initiatives, what you should avoid and how you might lend a distinctive contribution. It is not possible for you to affect the transformation vision by Baha'u'llah merely by adopting the perspectives, practices, concepts, criticisms and language of contemporary society. So we have to go beyond that. Your approach instead will be distinguished by maintaining a humble posture of learning, weighing alternatives in light of his teachings, consulting to harmonize differing views and shape collective action and marching toward forward with unbreakable unity and sered lines. So much has been said with great talks already during this conference about this critical and most challenging issue. So I'm not gonna talk more about this here because of the focus here but so critical and there's not enough that has been said in terms of what we should be and can't be doing. So racism is one of those determinants of health because it's one of those lifestyle impact factors. And this is a breakdown just to kind of show you that a lot of times we think of genetics biologically as being a big determinant of health but really the majority is whether you have access to care what behaviors we engage in as well as these other social and economic factors which form the social issues of health. And why this is important is that while 80% of medical education is focused on biology, 60% of premature deaths are due to non-biological factors. What that means is they're due to non-biological factors such as behavioral choices, lifestyle, social determinants. And even in graduate medical education 80% of clinical education occurs in inpatient settings yet over 90% of medicine is practiced in outpatient settings. So this actually suggests a lot of reform in terms of how we're educated and training future physicians in healthcare as well based on what's happening. And prevention is really powerful just to drive home the point. 80% of heart attacks, strokes, diabetes and 40% of all cancers can be prevented with diet, exercise and not using tobacco products. And that's a huge and very powerful stat. And unfortunately, because of the social difference of health being in a negative state currently and the standard American diet being sad, 50% of adults do not get their physical activity and fewer than one in 10 adults eat the recommended daily fruits and vegetables. And that's where you see it breaking down at the neighborhood level, right? In terms of what Shaza was mentioning earlier in terms of food deserts, access to healthy food, recreational facilities, the built environment. So it's individual and public health kind of coming together. So recent data has actually been shown that zip code versus genetic code that the 40% is due to genetic early life diseases arrest over 60% is really contributed to by environment social determinants, behavioral lifestyle. So really the zip code in which we grow up has even a more profound effect than we originally anticipated than our genetic code. And to drive this point home, this is just looking at one city in particular Baltimore where you're looking at the connection between life expectancy and poverty. So there's a direct correlation in terms of growing up in poverty and your life expectancy. And obviously that's shaped by access to opportunities, not only for education, but health literacy as well as opportunities for healthy food, physical activity, all the different, and access to healthcare when you need it the most, access to health insurance. This is just to drive it home here in Arizona where Shaza and I are on some of you may have visited the Valley of the Sun in Phoenix, you just travel 10 to 15 miles south and you get a 10 year difference in terms of life expectancy from the North Scottsdale area down to South Phoenix area. And I think another point that needs to be made here, a lot of times people talk about equality, but it's critical to understand the difference between equality and equity. So equality refers to when we talk about getting equal opportunities for everyone, this is how we can address social terms of health. Well, not everyone is coming from the same starting point. Because of the reality, for example, of anti-blackness and white supremacy attitudes that are built into structural racism systemically in our system, we have this disproportionate beginning as inequality. So if you just want to provide equal opportunities to everyone, this is what your results is going to be. You're still going to have this unfair, unjust system set up the way it is. If you really want to go towards equity, you offer varying levels of support depending upon the need to achieve greater fairness for outcomes. So where you're coming from is actually critical to looking at what we're offering. And this is really important when we talk about equality versus equity. Our starting point is important. This is addressing the systemic structural racism and social determinants is critical. And health equity then means giving patients the care they need when they need it. And as defined by the Institute of Medicine, providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or socioeconomic status. And looking at this from the Ottawa Charter on Health Promotion, when we think about transitioning to what do we mean by promoting health, this new definition of health, it's really the process of increasing the ability of people to have control over the determinants of health in their life. And they're not just subject to the whims of a system that is unjust and unfair and against them from the very start but actually building upon policy, strengthening community actions which leads back to the Institute process of community building activities which we're gonna talk a little bit more about here today and developing personal skills, human resources and reorienting towards access to health services. So now I wanna share some interesting findings. Some of you may be familiar with the 80-some year Harvard study of adult development one of the longest studies of adult life which is fascinating because it's very hard to do a longitudinal study that is that long. So 80 years ago, they started following over 268 Harvard sophomore men during the Great Depression. Following them along the years, collecting data on their physical and mental health hoping to get more data on indicators of health outcome. So we are now in the second generation of these families. They expanded their study to include 1300 of their offspring and women and wives were included somewhat later in the study. Over the years, researchers have studied the participants health trajectories and their broader lives including triumphs and failures and careers in marriage. So now they recently administered a survey to the millennials and asked them if you had to invest your time in something that would help you achieve healthier and happier lives, what would that be? And the millennials number one answer was building wealth not surprising. That was the most common answer among the millennials. The second most common answer was fame. And in this 80 some old study showed significant correlation between the quality of our relationships and our health both physical and mental. Not necessarily committed relationships but relationships in which the person felt happy, loved and safe. In fact, if you were in a relationship that was abusive and you couldn't trust the person it had a negative impact on your health. So close, authentic, symmetrical and loving relationships were predictors of health outcomes more than social class, IQ and even genes. The people who were the most satisfied with their relationships at the age of 50 were the healthiest at the age of 80. Those ties protect people from mental and physical decline and are better predictors of longevity. Other interesting studies that highlight some similar finding as the Harvard study of the Sardinian studies. We know that in developed countries women outlive men by many years. However, in this Italian island in the middle of the Mediterranean called Sardinia men live as long as women and far more than other towns. It's a super longevity town. Obviously this is an interesting population to study and there are many studies looking at this population and the role of genetics, diet and lifestyle. We know from multiple studies that 15 to 20% of our health and life expectancy is determined by genetics and 75% by our lifestyle health behaviors and social determinants. They started analyzing observing what is so different about this town. It's architecturally dense town. The streets and alleys are interwoven villagers intersect a lot. There's a lot of social cohesion. Suggesting again the importance of social integration relationships and community. This town has a big sense of community and everyone's really integrated into that community. So being closely involved in community activities help maintain a healthy mental state which is critical to overall wellbeing. The Baha'i writing state. Now if thou wishes to know the divine remedy which will heal man from all sickness and will give him the health of the divine kingdom. Know that it is in a precepts and teachings of God. Guard them secretly. What's the purpose of religion? Baha'u'llah says the fundamental purpose animating the faith of God and his religion is to safeguard the interest and promote the unity of the human race and to foster the spirit of love and fellowship amongst men. In essence, the purpose of religion is to help us have happier and healthier lives as individuals and communities and bring about unity. As Baha'is, it's important to understand the difference between an ideology and true meaning of religion as Baha'u'llah defines it and not how society may perceive it to be. Ideology is a set of ideas, principle values that are considered greater than humans. This doesn't mean that there isn't a difference in the value of ideas you can have. Obviously they're good ones and bad ones, but when we believe that those set of ideas are greater than humans, then we can justify sacrificing humans for the set of ideas themselves. This is how we can justify honor killing, terrorism in the name of God. These are obvious extreme examples, but we can have long discussions surrounding capitalism, liberalism and other forms of ideologies as well. Shoghi Effendi states, if certain social assumptions and religious formula have ceased to promote the welfare of the generality of mankind, if they no longer minister to the needs of a continually evolving humanity, let them be swept away. For legal standards, political and economic theories are solely designed to safeguard the interests of humanity as a whole and not humanity to be crucified for the preservation of the integrity of any particular law or doctrine. This is so powerful. It's powerful quote from Shoghi Effendi, especially in the midst of COVID and the decisions we are making on a political level. So Baha'is believe that true religion is not an ideology. The laws of God are there to help humans and their preservation, not to sacrifice the human for the preservation of a set of ideas. The Universalist Justice in its January 2019 letter state that our challenge is that humanity is gripped by a crisis of identity as various peoples and groups struggle to define themselves, their place in the world and how they should act. Without a vision of shared identity and common purpose, they fall into competing ideologies and power struggles. So we need a shared common vision. Shoghi Effendi states that the chief reason for the evils now rampant in society is the lack of spirituality. The materialistic civilization of our age has so much absorbed the energy and interests of mankind that people in general no longer feel the necessity of raising themselves above the forces and conditions of their daily material existence. There is not sufficient demand for things that we call spiritual to differentiate them from the needs and requirements of our physical existence. Even in global health, we have come to realize and accept that there's an increasing need for moral leadership as Dr. Tarey spoke about based on the World Health Report over the last decade. Man's merit, life and service in virtue, Baha'u'llah states and not in the pageantry of wealth and riches. And further, he says, dissipate not the wealth of your precious lives and the pursuit of evil and corrupt affection nor let your endeavors be spent in promoting your personal interests by concentrating oneself to the service of others. One finds meaning and purpose in life and contributes to the upliftment of society itself. Therefore, we know that we need a common vision, a shared purpose. We know that the chief reasons for the evils in society is lack of spirituality and our merit, lives and service in virtue. And in essence, the purpose of our faith is to establish unity through meaningful symmetrical just authentic loving relationships in communities as we develop a foundation toward achieving true unity. The way we do that is by the divine plan by walking together on a path of service by building capacity, by engaging the process that the Universal House of Justice has laid out for us. And this idea of service, Abdu'l-Baha says service to humanity is service to God. How that manifests itself is by creating these symmetric, authentic, meaningful relationships at a core level, starting with the family and building out in the community so that individuals are not isolated and that they're members of a purposeful community that is global in scope pursuing a bold spiritual mission. The framework that this provides promotes the transformation of the individual in conjunction with social transformation as two inseparable processes. So we can see how this now connects with what we were talking about before. The social determinants of health. The overall direction and process of learning that the Bahá'í community is pursuing since the Universal House of Justice is really toward capacity building. That is the watchword. The whole collective effort that we're all engaged in together is to strengthen the spiritual foundations of villages and neighborhoods to address certain of their social and economic needs and to contribute to the discourses prevalent in society, all while maintaining the necessary coherence in methods and approaches. This in essence is addressing the social determinants of health. So when we're actually engaging in the divine plan, engaging in the community building process, we are building those authentic meaningful relationships that contribute to healthy outcomes and we are directly engaging in modifying, elevating and enhancing and improving the social determinants of health for those communities that we're working with. We can see this breaking down and evolving in different parts of the world where you see the natural outcome of the rise in both resources and consciousness of the revelation and the impact it has on the life of the population. This is where we get to the point, as we know in terms of the process of social action. And not infrequently, we can see that initiatives of this kind emerge organically out of the core activities like the Junior Youth Spiritual Empowerment Program or prompted by consultations about local conditions that occur at community gatherings. For example, developing tutorial assistance for children, projects to better the physical environment, activities to improve health and prevent disease. These are just some initiatives that become sustained and gradually grow in various places to found a community school. For example, it's all dependent on what the environment is and what the needs are in those environments. And so this is all different ways of learning how to apply the revelation of Bahá'u'lláh to manifold the dimensions of social existence as Universalists of Justice says. And it plays out in every community, every village, in every city, in every town. And we're directly impacting those social determinants of health. Thought this was interesting is from a message dated January 2001 to the Conference of Continental Boards of Counselors where they talked about the main sequence can be likened to the trunk of a tree which supports other courses branching out from it. And each branch addresses some specific area of action. For example, a set of health materials being developed in Africa offers a good illustration of a few features of such courses branching out from the trunk, which is the main sequence of the institute process. Following years of training, community health workers in the late 1980s and early 1990s, several Bahá'u'lláh agencies decided to elaborate a series of modules aimed at preparing individuals to deal with progressively more complex health issues at the local level. By the time the first module began to be used in its initial form, the institute process had gained in strength and it became evident that those who had studied books one and two of the Ruhi instant suit were better prepared to visit members of their extended families and friends and speak on health related subjects. This is community health workers in the Hispanic community where we work, they're known as promotoras that promote the health and wellbeing their peers in the community. The design of modules was modified so that they could constitute a branch after book two, which participants study while they continue along in the main sequence. Efforts in this direction have met with definite success. This example illustrates that branch courses are not a disconnected collection of materials randomly placed at various points. Rather, they must emerge out of actual experience and adhere to a certain logic both internally and in the context of the overall institute program if they are to be pedagogically sound. In other words, as we're struggling and challenged in different communities, we need to get in the field and we need to learn by doing in the field. And the hope here is that the development of such courses to address specific needs, in this case, social health needs, right? Social determinants of health with community health workers defined by action on the ground will be a natural consequence of the endeavors of burgeoning communities, which are avidly striving to translate into reality the teachings of Baha'u'llah and to use training materials as a means of systematizing their experience and sharing with increasing numbers the insights they gain. So this is something that we're looking forward with this talk with others that are talking about this, the working groups that Shahrz had mentioned, that we were participating in, that everyone we work and we learn from each other. This is what is evolving around the world and I think everyone has probably had great stories to share. So just to drive the point home, each book gives a lesson, right? Where we gain a life skill. With these skills, we build community and improve our individual and collective health. When we are community building, we are actually setting up the social determinants to achieve optimal health in all aspects of life. We're strengthening the core of each of us and each of our neighborhoods to maintain our wellbeing and thrive. We are changing culture. This is what's happening with the institute process. So social action and change in culture. So as we get to this level of social action, we enter the realm of culture and social action can become an occasion to raise collective consciousness of such vital principles as oneness, justice, equality of women and men, to promote an environment distinguished by traits such as truthfulness, equity, trustworthiness and generation, right? To combat racism, to combat anti-blackness, for example. This demonstrates the value of cooperation and ultimately leads the emergence of a prosperous global civilization to be addressed at the level of culture. So community building and change in culture, the University of the House of Justice says qualities of mutual support, reciprocity and service to one another begin to stand out as features of an emerging vibrant culture among those involved in the activities. And I'm sure all of us can testify to personal experiences as we've gone into the field to learn by doing and being involved in the imperatives that are there with our plan. So ultimately, just to bring it back full circle, these lead to the undoing of racism. The activities of the core of our community life are profound for general great societal change, right? And they basically are embracing larger and larger multiples of people. In these activities, people are not segregated, right? People are to be brought together, right? In the form of these activities that we grow together in the community where we will eventually help to weaken and eventually uproot prejudice-tainted notions underlying our present social order and can begin to undo racism to our side. It's not that simple. It's gonna take time, a lot of effort. And putting it together, the data that shows how social determinants of health are so critical for wellbeing makes the divine plan even more timely now as we're learning the role that all these factors have determined to your health all the stats that we quoted earlier in terms of science, it's advancing how critical these factors are and the fact that the plan, the divine plan is directly impacting this. So it's really important for us to move beyond the limited concept of what health is and embrace this wider concept which also includes the spiritual dimensions of life. And this is how we get towards authenticity and health. Charles is gonna talk a little bit about how we are learning about applying it. So how do we translate this knowledge that we've been talking about? Scientific knowledge and obviously drawing from the divine revelation of the Ha'Allah and the institute process, the current divine plan. How do we translate this knowledge into reality? How can we test this emerging conceptual framework on health? So as physicians and health professionals our area of interest is to begin working toward a model of care and an eventual so-called complex adaptive system addressing the social determinants of health informed and guided by the divine plan. The setting in which I currently work in is a community health center in South and Central West Phoenix which intuitively seems like it would be an ideal setting. It serves an underprivileged underserved population with social determinants of health impacting their health outcomes. What we are hoping to do is establish community building activities through the institute process and bridge the gap between the health center and the community center and the community at large. Next slide. We are hoping to be able to measure health outcomes as a result of community building activities to help guide a potential model of care addressing social determinants of health and really eager to collaborate with others in working groups as well and do more scholarly work in this area. Just to speak to the community, this particular community, the Wesley Community Health Centers and the Golden Gate Community Center. This is a community that is in Southwest Central Phoenix. It serves folks who are mostly Hispanic although we have a number of immigrant populations from Africa as well as Asia. Mostly Hispanic though, a big number of folks are undocumented and underserved in terms of having access to resources. The mission of the community center is actually to provide programs and services to improve the quality of life for these children who are challenged by the social determinants of health and their neighborhoods. And in fact, both of the centers are not just clinics. Actually they started out as community centers in the 1950s. One of them was relocated. There's a whole history there when the airport was expanding. But basically have more than just a clinic there. There's a gymnasium, there's afterschool programs and this clinic piece basically connected with an existing community center when there was a federally qualified grant to become a federally qualified health centers and those of you in healthcare kind of know what that is. And they built up partnerships with the universities in our area here, a number of the institutions listed here. So actually from the beginning, when the clinic formed versus a volunteer clinic to serve the neighborhood, you had residents and medical students involved and it's evolved since then to like a federally qualified health center. But the dynamics that are different here is that this clinic, most federally qualified health centers, they serve obviously at risk and underserved communities, but they have about 17% who are uninsured. At this community center, about 70% are uninsured. So just to give you the proportion impact in terms of social determinants and a number of them undocumented, but very culturally rich community as I mentioned. This is a picture of one of the community centers. Like I said, there's a gymnasium, there's afterschool programs for kids. Seniors gather there to do bingo, they do different things they do. Recently we did a grant work with them to actually build a commercial kitchen to help with the afterschool program. There's a summer camp, involvement of youth that they already have. They're coming in every year, the summer camp and the summer afterschool program is highly subsidized in terms of it's like 10 to $15 a week. So really helping those youth who volunteer, they're engaged. This is really right there where they're doing great things in the community. And a number of our medical students have been involved in getting credit by doing actually service learning in the community. Whether it's activities in terms of access to fresh produce and doing cooking programs to other health literacy and education tutoring programs. They have a reading initiative from programs for children and the youth as well. And most recently they've been disproportionately impacted by COVID-19. And so doing more there in terms of reaching these families has been something that's been a focus of the community center. So we began our efforts by developing a new class of friends and collaborators from physicians behind that resides in that community living close to the community center and youth that are willing to serve as animators. And then as collaborators, we had also a community center program coordinator who was very receptive to our involvement because of our built rapport with her and a leadership role as physicians at the center. We had regular teaching meetings, parade reflected, consulted and developed actionable plans like any neighborhood where we're starting to establish core activities. So our initial plan coming into this project was to form a junior youth group. And there are a lot of many youth volunteers that Farshad mentioned. In fact, there's a high school in that neighborhood that's a satellite school that collaborates a lot with the Golden Gate Community Center and they send many youth volunteers to us. Also out of the efforts of a few Baha'is in that area, several of these youth have entered the institute process in our junior youth animators already. So there's a lot of potential and synergy between these two efforts. The Golden Gate Community is a natural place for the youth to serve. But in reading the reality of that neighborhood, that community center and population with over 50 children in after-school program, it became evident that establishing a children's class first make the most sense. So next slide. I'll show the pictures. So here, just quickly running out of time, some pictures of children's classes and you see that there's great diversity. We have Hispanics and African Americans and underprivileged children that are part of these children's classes. Next slide. And as Fashion mentioned, we do have a lot of pre-med students and med students volunteering in the health center. And for us, it's a great teachable moment to bring into this understanding that most of health actually happens in the community. So we always encourage those youth and students to volunteer in the community as well. Next slide. The children themselves have started a community garden. You can see here. So already towards social action and obviously it became really important for us. All the nucleus of friends and collaborators to be really involved and integrated into that community by participating in their family events and festival and really getting to know all those families of the children that we serve. Next. So after a few months of establishing those children's classes, we started doing a home visit and outreach to get a better pulse of the community surrounding the Golden Gate Community Center. And it also to help support those children's classes. Most of the children live around that community center. So we started off by visiting the neighbors of Martina who was one of our teachers that reside in that community and established neighborhood devotionals. During those home visit, we had great opportunity to start addressing social determinants of health to have conversations surrounding health and social action. Many of them did not know about the health center and the services that were offered in different programs. So it was just the beginning of those conversations. It's just a quick picture of Martina's devotional table. She was very excited and it was really the first milestone. All right, thanks. So in terms of next steps and challenges, like many of you that are laboring in the field of service and developing some neighborhoods and communities, sustainability and building capacity and getting some of our youth into that institute process is our really next step and challenge. We have some of those youth that are volunteering from that high school that are helping and assisting in the children's classes but really starting those conversations and getting them in the institute process is really the next step. And obviously in light of COVID, like many of you, it presents challenges and we haven't been able to figure out a creative way to continue with our children's classes right now, although we have ongoing discussion with the program coordinator there. However, as Fashad said, this community has been the most affected by COVID-19. As you know, Arizona has been a hotspot over the past month and a half and this community at some point had a rate of positivity of 50%. So huge prevalence of COVID in that community and our focus has really been to screen for COVID in that community, offer services and address social determinants of health related currently to COVID and access to care. Can go. So yeah, so just sort of wrap it up because I wanna have time for a question. So yeah, so recently the community health center started doing intake form on social determinants of health, including food insecurity. Number of our students are participating in that, the primary care scholar students that Shazad mentors one study looking at food insecurity and diabetes. But the bottom line for all of this stuff is, you know, we're healing ourselves with a service and just to leave us all with this quote from Sharia Fendi, the more we search for ourselves, the less likely we are to find ourselves and the more we search for God and to serve our fellow men, the more profoundly we will become acquainted with ourselves and the more inwardly assured this is one of the great spiritual laws of life. With that we will and leave it there. We can open it up to questions. Okay, thanks. That was a great presentation, very much in depth. And I'm pretty sure these questions will be a continuation. We have about 10 minutes. So let's see what we can get through. So one question is, could Bahá'í community core activities becomes nods for collecting health and wellness data for a big data study of the impact of Bahá'í activities on health? Absolutely, as I was saying, they're really looking at this data and first establishing this model of care in a community health center and doing pre and post, you can call it intervention in the scholarly world. And there's a lot of work to be done there when we're thinking about scholarly work that hasn't been done yet. So I know that there are many health groups and we're eager to collaborate with many of the other health working groups. I know that there's a health seminar coming up soon for those of you who did not know who are in a health professional. That's next week addressing a lot of the topics that we were talking about today. If you're interested, you can email me later on and I can give you information to register to that seminar as well. Yeah, and just to chime in, I think as big data evolves in terms of what we understand, the impact of the data that we're collecting from wearables to information that you get from your phone, I think understanding and looking at the impact of the institute process in each community and how they directly connect with social determinants of health will definitely be a great opportunity for integrating that in terms of interventions that we're gonna do at the community level, both clinically and community-based. So yeah, I totally agree. Thanks. So another question, on one of the graphs, you showed that a large percentage of health problems is a result of genetics and behavioral issues. That was the pie chart. Can you please elaborate further on this observation? So we mentioned that in the last 15 to 20% of mortality was we are health access or the medical care that we receive is responsible, can impact 15 to 20% of mortality. So the rest really is behavioral and what we call our social determinants of health. Yeah, so I think it just changes the whole scope of how we look at things, right? In terms of, a lot of times people think, well, things are just genetic, it's out of my control, but the reality is there's much more in our control, both individually as well as collectively in terms of society setting up the system in a way to incentivize health or incentivize disease. So right now, things are set up very much so to incentivize the chronic illnesses that we have and the disparities. We have enough time for a few more questions and you're open to sharing your slides with the group. Yeah, we're happy to share the slides. Okay, great. So I have a question, just maybe even the role of animators in the community. And the role of animators is also even to analyze the negative and the positive forces in their communities. When you talk of health, how do you talk about the negative forces as well as the constructive forces? Let's say, for example, spoiled food in the neighborhood or the impact that liquor stores have on the neighborhood and how that obviously affects the health status of the community. Yeah, absolutely. Chauza, do you wanna stress that or? No, I mean, I think that I was talking about home visits and just even the youth that are volunteering at our community center, really there's so much opportunity to, as we're on that path of service with them to have these conversations. We're not, we haven't established yet a junior youth group but we already have animators from a satellite high school that are eager to serve. And those conversations happen naturally because we serve at the health center and we're physicians. So, the youth really enter those conversations naturally with us and it's an opportunity just looking at the after school program and when we first started working there what the children were eating and what children are offered in cafeterias in school but also at this community center. So those conversations occurred and understanding that how that impacts their health. And since then with the implementation of the teaching kitchen we've had volunteer chefs who come and prepare healthy, nutritious food and snacks for our children and for the community. So those were just like direct results of conversations. Yeah, and as you get to know obviously everyone as an animator knows you get to know the youth and then you get to know the families. It's important to be able to ask other questions. You get to know like diabetes runs their family or they have this challenge in terms of getting access to healthcare, their health literacy and then the different projects that people do. A number of them can actually be directly connected with addressing health education and powering them. That's great. So another question, how could research be conducted presenting correlations between improved health outcomes and strength of community building processes through the Ruhi Institute? That's a great question. I think that would be one of the things that I'd love to see if we could add to our dialogue with one of the working groups, the working group on health and maybe we can all collaborate together. People want to kind of email us and we'd love to talk about that because I think there's more that can be done specifically looking at it. So for example, if you're looking at like I'm living Phoenix in the Creighton neighborhood and in our neighborhood, there is definitely like any other where we have a stronger Hispanic community, we have some immigrants from Africa, there's access to care issues, there's diabetes, understanding kind of looking at what people's knowledge and understanding of this is, connecting them with health services and then maybe even teaming up with the health center and looking at what you can do in terms of knowing what the health outcomes are, what their baseline is going into it before we're kind of building out our activities and then kind of looking at it just like anyone who's listening knows who does clinical research would know. We have to ask those hypothesis driven questions, collect some data and then we can kind of assess it. So I think that's something that I'd really be interested in collaborating and learning from. It's a broad topic. I think there's so much to look at even within our community building activities. And so there's a lot of opportunity. I mean, we can think about preventable diseases and screening, cancer screening. During our home visits, the Golden Gate Community Center offered, had a funding to offer free breast cancer screening for patients who don't have insurance. So in those conversations, there's opportunity to improve access to those services. And so you can just see, looking at the impact of home visits in best practices such as screening for either colorectal cancer or breast cancer, there's just so many opportunities. Totally. We have enough time for one more question. So how well received as your model researching the relationship between community building activities and social change and health with community organizations and funding sources? So there's a question, how well received is the model? Well, I mean, we're learning about it. And I think that's the whole point. It seems to be receptive for the members of the community, as Trouser just mentioned, in terms of connecting them to services when things come up in those discussions and those activities. But I think formalizing that, I mean, there's a lot of different organizations that are out there doing a lot of good things, but we have to kind of connect the dots. And I think we're trying to figure out how to connect those dots. And that's why we're sharing this as a case study here today and hoping that that'll generate further discussion and hearing from other people who are doing it and maybe further along when we are as we continue to evolve and understanding it. I think we currently are very well placed because we have a great relationship with the program coordinator and a lot of the leadership at that community health center, which places us in a great, gives us probably more opportunity for collaborations and the children's classes have been so well received by the staff and the families. And so I foresee other opportunities, even if it would be for grants or other opportunities like that. Great, so we wanna thank the attendees for listening and hopefully continuing this conversation. Like you said, any last minute thoughts before we close? As I mentioned, I think there's a, for those of you who are in the health professional, there's a seminar coming up next week and we're hoping to be able to continue this dialogue. And I know that Sam has shared those, our emails, so feel free to email us for further information. Yeah, I hope we can stay connected and talk and learn from each other because if we don't talk to each other, then we can't learn and grow, so thanks everybody. So thanks everyone and thanks, thank you to the presenters. And this is the last day of ABS and there are a few more presentations left. And hopefully everyone can attend those ones. And thank you everyone again.