 So, so welcome everybody. This, as you know is the fourth and actually final culminating event in our month long custody Harvard Medical School series for black history month racism medicine and bioethics. My name is Lachlan Farrow. I'm a doctor centered in the HMS Center for bioethics. And I'm excited that all of you all month. If you haven't seen the other ones, you can see them online. Have, I believe, experienced some of the energy that the test he partners with us have found in reaching across organizations that haven't collaborated in the past, and it is not just been productive. It's been enjoyable, which I think is a metaphor for some of the things that our guests today, Dean Dana bone Matthew is going to say that we need to eliminate the structures of racism, so that we can all thrive together. I think Washington in the first session reviewed the long centuries of racism in medicine that she built on in her book medical apartheid. This is Lily head and Rickens Earl in the second session humanized, what has been labeled as the Tuskegee but actually is the US public health and the syphilis study there. And then last week we heard from Dan Dawes, the head of the Morehouse Satchel leadership Institute about political determinants of health. All of that today will be integrated in a case study with Dean Matthew about the history of structural racism in Charlottesville, legally enforced segregation its impact on health. The point of this month has been to understand history, so that we can make the future healthier and better for all of us. So we look forward for all of you to hearing about any of your ideas on Facebook, YouTube, Twitter, or by email to us because this is just the launching of a lot of wonderful things ahead. I'll not hand it over to my cherished friend partner colleague Dr Ruben Warren, director of the National Center for bioethics at Tuskegee University to take it from here. Ruben. Good evening. And this is another exciting opportunity for us to share I always start by talking about the intergenerational conversation we're having, not only about the past, as we look back, but also about the future. You see over my left shoulder the Sankofa bird is really looking back the African symbol looking back to move forward. So we really are excited about this session. Dr Lachlan has shared we had a, a really good first, second and third start the National Center for bioethics and research and healthcare in Tuskegee, and the Harvard bioethics center are in a very important collaboration. We're committed over the last several months to do something. So we're doing more than talking about something we're going to do something and that's already engaged in this month. This black history month is an example of the doing together. I mentioned it's intergenerational. And that means that we are looking back to work with our colleagues to move forward we have done some good things I think over the years, but there's so much more to do. So we're looking on our junior colleagues and students to listen to what we've experienced, benefit from what we experienced don't repeat the mistakes of the past and carry us into the future. And that regard I'd like to introduce to due to our co moderators, one from Harvard and one from Tuskegee, Miss Lizzie, and Hernandez please give us a little bit about yourself. And my name is busy Hernandez I'm from Queens, New York, and I'm a full time Harvard master of bioethics student. My interests are kind of at the intersection of criminal law and health law and the way that we can understand the carceral system as a public health and bioethics issue. And I'm going to law school this coming fall. Pass it over to Edward. Greetings, everyone. My name is Edward Connick and I'm honored to be a student moderator this year. I attend the historic Tuskegee University where I'm a fourth generation student. I'm a freshman biology major on a pre medical track from Detroit, Michigan, planning to pursue a career in the field of cardiology. My interest in the field of medicine and biological ethics is a story of the great Daniel Hale Williams, his monumental feet performing the first open heart surgery and setting surgical standards that are still followed today have inspired me for as long as I can remember. Additionally, I have the distinct pleasure of introducing our dynamic keynote speaker, Dr. Dana bow and math. Dr. Matthew earned her BA at the Radcliffe Institute of advanced study at Harvard University 1981 her JD at the University of Virginia in 1987 and her PhD at the University of Colorado at Denver in 2018. An individual committed to higher learning. Dr. Matthew currently serves as the Dean and Harold H. Green Professor of law at the George Washington University Law School. Dr. Matthew is a leader in public health and civil rights law who focuses on racial disparities in healthcare. In Matthew also has taken on many public policy rules. In 2013, she co founded the Colorado Health Equity Project, a medical legal partnership incubator aimed at removing barriers to good health for low income clients by providing legal representation, research and policy advocacy. In 2015, she served as a senior advisor to the director of the Office of the Civil Rights for the United States Environmental Protection Agency, where she expedited cases on behalf of historically vulnerable communities besieged by pollution. She then became a became a member of the health policy team for my home state United States Senator Debbie Stabenow of Michigan and worked on public health issues. To top off her many accomplishments. Dr. Matthew is a published author of the book just medicine, a cure for racial inequality in American health care. Please join me in giving her and giving Dr. Dana Bo and Matthew a warm welcome. What a fabulous welcome. And what an honor to be a part of this collaboration, which is a symbol of not only two powerful institutions, uniting of history and forward thinking. And the uniting of two very, very different historical institutions in order to change the future I am grateful and honored to be a part of this conversation and of the series. I am in Washington DC, but in spirit with each of you, even though we are virtual. I'm going to get right to it because as usual I have too many slides, and much to say but I'd much rather lay the table if I will set the table for a conversation, as though we were at dinner together so let me begin by sharing my slides and here's the real rubber will meet the road let's see if I'm going to be able to do this successfully and quickly. If everything goes right because I'm a law professor I'm going to start with a constitutional amendment is everybody able to see my side. Yes. All right. And before I get going let me make sure that I can advance. Can you see my second slide. Yes. If I were in the audience. If I were able to see the audience I would ask you what the purpose of the 13th amendment is the 13th amendment to the Constitution is familiar to us. We certainly learned it by high school. Those of you I heard one of the young women introduce herself is going to go to law school next year. The audience has never heard of the 13th amendment and would immediately recognize it as the amendment that quote unquote freed the slaves. It is the amendment that made it constitutionally impermissible to own people as property. That is true. That is what the amendment says today, but the screen shows the original language, the Collins amendment that was originally introduced to become the original 13th amendment. I don't go into the history in detail, but let me point out the bold language the emboldened language says that Congress will not have the power to abolish or interfere with any states. Use of the institution of slavery slavery in order to hold people in service for their labor without pay. That means that the original 13th amendment the amendment that preceded the one that actually passed Congress said the exact opposite of the amendment that we have in our Constitution today. Now this would be a historical nicety just something to recall quickly and scurry over if it were not for the fact that not only did that original Collins amendment that original 13th amendment Garner two thirds of the required votes in the House of legislative and two thirds at the time of the required votes in the Senate, but our president, the great emancipator spoke with approbation about that amendment in his second inaugural address. He said to the audience there assembled, I have no objection to that original 13th amendment original of course is my insertion, but at the time, the 13th amendment which he had no objection was that one, which would have permanently enslaved African Americans like myself. Indeed, that amendment was ratified by six states, including Virginia, Ohio, West Virginia, and if it had not been for the firing on Fort Sumter that began the Civil War, we do not know whether that amendment would or would not have been the unamendable amendment in the Constitution today so for those lawyers among you go back and look at the language it is not only an amendment that does the opposite of what the 13th amendment did does it was unamendable. Right. So, this is my point. We have a country that at its foundation is ambivalent about the humanity of others. The dehumanization that we saw in Charlottesville, the day that I began my job in Charlottesville, August, the 10 2017 and the political violence that we saw at the capital. If you employ me watch out because I bring this with me it seems the political violence that we saw in the capital on January six. These are echoes of the deeply ambivalent structural history that we have with respect to the humanity or lack there of of African Americans in this country. As a result, I want to talk some about how that structural in humanity what I call dehumanization manifests in law and in health. So I'll start with Thomas Jefferson he wrote a book the first and only published volume, hardcover volume that he wrote was called notes on the slave on the state of Virginia notes on the state of Virginia in notes on the state of Virginia. Thomas Jefferson describes the Negro as he saw the people that he enslaved the things that he said the things that he articulated social psychologists tell us are examples of both blatant and subtle dehumanization. He's blatant in that he said, they are more like the orangutan than like man, they lust after their women. They are not able to feel poetry, like we can, and the physical features don't have the beauty. I'm paraphrasing but only slightly that is blatant dehumanization likening a human to an object or an animal. He also exhibited in notes on the state of Virginia, subtle dehumanization by subtle human dehumanization social psychologists mean, not ascribing the qualities of humanity to an individual or a group of humanities again paraphrasing, Thomas Jefferson's work notes on the state of Virginia, he said there, their griefs are transient. Ah, that was so important because how other could how otherwise could he justify how otherwise could a society justify the cruelty, the hatred, the immorality that was the institution of slavering how indeed it was because the dehumanization was the psychology of the day. It was the understanding that justified ownership that got codified in law. And so when we ask what is structural racism. This is the origin of structural racism structural racism is the opposite of, and is the greatest threat to health equity. That's my thesis. That's the point that the rest of my comments will go to. So let's talk about structural racism from the start structural racism is a form of inequality structural inequality and inequality I suggest is the greatest threat to health equity in America and worldwide we could park here and spend the rest of the day on examples but let me make the case that structural racism is a type of is a sub category of is a powerful example of structural inequality broadly structural inequality is the inverse relationship between the resources needed to be healthy and achieve healthy outcomes and the differences in income between the top and bottom quintile of a society. So let's look at that down structural inequality the two graphs here on the left we see the genie index where OECD nations wealthy nations have an index of their inequality again inequality defined is the difference between the top and bottom quintiles median household income. We see that in the OECD nations the highest level of inequality by the genie index is the United States that's on the left now the graph on the right is intended to show what structural inequality is structural why because the relationship is reliable. It's replicated throughout many societies and the data tells the same story in each of those societies so here you see a study by Pickett and Wilkinson, and what they have done is graphed the relationship between income inequality as measured by the genie index that I've left and an index of health and social outcomes on the y axis and what we see is a straight line relationship that describes the connection between income inequality and health outcomes this is to say that in the bottom left hand corner where we see the the nation of Japan. They have lower income inequality smaller gaps between the upper and lower quintile and better health outcomes, right, so the health outcomes index is better on the bottom and worse on the top, and then compare of course the outlier in the upper right hand corner. The relationship is replicated reliably that what makes that's what makes structural inequality structural. Now, what is structural racism. Well, let's start with a definition that the great Kamara Jones has given us in the American journal, public health journal about what racism is. I want to only put two fine points on it three actually one racism is not an attitude of an individual it is a system. It is a system that is historically maintained point to it is a system that as Dr Jones says divides or hierarchically arranges people by value and by worth in a higher and lower order so racism is a system number one. It ascribes value to people based on this construct that we call race how people look their phenotype, their phenotype and their features, how they look. And the third characteristic of what racism is is that after the system hierarchically arranges people, it then allocates resources, based on those relative status. Are you more or less human, are you more or less valuable in that ordering, you get more or fewer resources, you get more or less power, you get more or less voice. Right, so structural racism revealed is a system of prior injustices that result in ordering a people so that there is divestment or relative investment over the lifespan, whether they get polluted or clean water hospital access or not healthy or unhealthy food, well ordered jobs or not, again, a system that hierarchically arranges people and their resources, this is structural racism, and here I've defined it again. Here, I've diagrammed it. This is the relationship, I suggest that exists between structural racism and health outcomes structural racism at the bottom is a fundamental cause of poor health outcomes. It's enforced legally by legalized dehumanization by legalized inequality by legalized unprotection of the law, unequal protection of the law, excuse me. At the bottom of the pyramid when you go up higher you see that health outcomes are disparate why because the social determinants of health are organized by these structurally racist environments. Right, so housing, education, food access, access to clean air, clean water, recreational spaces, these are organized in the second tier, the social determinants of health are organized to produce health outcomes that reflect structural racism. Remember the system that organizes and distributes resources. This is diagram in the second tier. And at the top. The place where I argue we waste too much time. At the top are the interpersonal attitudes of racial prejudice and bigotry. Now when I say we waste too much time don't get me wrong. These are things that are horrible, and they need to be corrected, but the danger. The real reason that there is structural inequality in health, the real threat is structural racism. I'll prove that with one example, the city of Charlottesville, I'll dive deeply by starting back where I began structural racism again remember is legal in human legal dehumanization legalized inequality and unequal protection of the law so I'm going to start with a law. This is 1912 segregation or ordinance from the city of Charlottesville. This provision actually has nine different sections nine paragraphs I've reproduced here. Two of them in 1912, the city council in Charlottesville past this ordinance to say that it shall be unlawful for any white person to move or thereby occupy a house next to a black person. A black person in this parlance right. It then section two said it'd be unlawful for a colored person to do the same can't occupy the same building I remember I said there were nine provisions. They went to a great length to make sure that we could not lease occupy spend the night in a hotel. The ordinances followed after that they proliferated to make sure that the races were segregated after this ordinance. Now when I give this speech in a longer format, I tell you about the fact that before this ordinance blacks and whites, during the period of reconstruction did not live a segregated life, according to oral histories in Charlottesville, but I would digress. Let me make the point that this segregation ordinance was very efficient. In allocating resources I've said in a structural racist way allocating resources that produce poor health, historically and contemporarily as well. So if you've ever heard of the series of maps called the sandborn maps I'm going to show you a series of three sandborn maps of Charlottesville, Virginia. There are maps prepared by a fire casualty company. There are sandborn maps from the 1920s 30s 40s and 50s for many localities and my slides are advancing when I don't want them to I want to stay on figure one at for many localities, and they tell a story. They tell a story because the fire casualty company made the maps in order to look at what the materials were that were used to build various edifices. They made the maps to tell them where they would find water. Right. And so these maps tell a story about dehumanization about the impact of that 1912 segregation ordinance. So here we have the map in 1907 in order to orient you to the Charlottesville maps that you will see in succession. I have identified Union station on this map. Now remember, this is immediately before the segregation audience, and you'll have to take it on faith that you will have proof positive that at that time, blacks and whites lived were pretty much scattered by income, rather than by race in Charlottesville. So if you see where Union station is a couple of things to be aware of one. Union station, there are two railways. These are the two railroads of CNO and the Norfolk Southern that came through Charlottesville, and they literally bifurcate the city of Charlottesville into four quadrants. These four quadrants are going to become very important after the segregation ordinance. Okay, so you'll know where Union station is, you know that it is divided. This is Charlottesville into quadrants. Last thing to remember from these, this first map, the colors, the colors matter. Pink is a industrial building, yellow is a home that is wood frame, right, and I'll tell you more about the lines later. Let's fast forward to two maps that are blown up sections of Charlottesville by 1920. By 1920, the segregation ordinance had done its deed. By 1920, on the left, you see the part of Charlottesville that is called Star Hill. It is predominantly excuse me, on the left, my left, you see the part of Charlottesville that is called Willan Mills. It is predominantly white. And on the right, you see the predominantly black neighborhood of Star Hill. So the difference is the density of houses. By 1920, blacks were occupying Star Hill in houses that were closely located to one another, and whites of the same or lesser income working class whites were occupying a more bucolic part of Charlottesville with the Rai-Vanna river running through it, with open space running through it, with a park running through it, and this was not provided to those in the black neighborhood of Star Hill. But the most important thing, and I'm going to rush because I think I'm more interested in conversation by the time I get through these maps, then I'm showing you the same phenomenon in the South Bronx. I'll let you know that those maps are in my deck too, but we'll speed through them. But let's just note one other very important feature, and that is the feature of water. Water is required in order for people to be human, to live, to drink. Now, if you had a close-up of this map, which you would see on the left in Woollen Mills, and again, this is a working class neighborhood. Woollen Mills is called Woollen Mills because the mill that made Confederate uniforms is located there and continued to employ people through the Great Depression. You will see that the water means that the fire casualty company needed in order to know whether they could put out fires, whether there was risk of fire in the residential neighborhood, in the white neighborhood, those lines curse in and out of the residential houses that are marked and separated in this bucolic section of Charlottesville called Woollen Mills. They're not just water around the pink industrial buildings as they are. By comparison, in the map on the right, Starr Hill, you see water go up to the edges on the top where the pink industrial buildings are, but no indoor plumbing, no water, no electricity, no paved streets. By 1920, segregation had done its deed and it had done it in a way that would have lasting health impacts. Why do we know that? Again, last map, this 1920 map, again, I'm showing you that the past is not the past. On the left, the Charlottesville map shows you where Union Station is so that you can see the area in that little pie chart, or I guess it looks more like a Pac-Man. That's Starr Hill. On the right, you see Starr Hill today in 2018. It is still segregated by race. If you were to look at education levels, they are lower here. Crime levels are higher here. Health outcomes are poorer here in this exact same geographical location. I'm going to keep going. I think that you don't need to know much more about Charlottesville. These are the nurses that would have delivered me. If I were born in Charlottesville, I show them just to make sure that the past is not that long ago. I'm not that old, right? They would have delivered me in Charlottesville and on the right, the hospital ward that I would have been born in. This is the University of Virginia Hospital Ward for Black patients at the time called Negro patients. It was located in the basement under the pipes and next to what the veterinary ward of the hospital. This is dehumanization. This is structural racism, right? I deserve to be born in the basement next to where the horses and the pigs and the dogs are cared for. This is what I mean by dehumanization being structural. What does it produce? It produces a black-white infant mortality gap from 1930 to 2018. That is no smaller today than it was when it was first recorded. Now, what has changed is the absolute rate of infant mortality, but the gap between black infant mortality and white infant mortality has not changed. We still see a gap in median household income in Charlottesville. We still see a gap in educational attainment in Charlottesville. We still see a gap in life expectancy. Not only for infants, the other one was all-cause mortality, excuse me, but for adults as well. Why? Because place matters. Because place matters and law operates to institutionalize the health resources that must be allocated in order to live well. I'll end with this story. This flight 1549 that went down on the Hudson River one cold freezing January morning when it was taking off from the airport. I don't remember whether it was LaGuardia or Kennedy. I think it was LaGuardia. I went to North Carolina and you know the story because there was a movie made about it. Sully, famously 155 souls on board, they were all saved and in this picture they are all on the exterior of the pain. What I want you to see is that they are grouped into two very separate groups. Clustered on the wing of the plane are the majority of those people they were writing coach. On the very front of the plane on both sides there are people who are in rafts. They have life jackets. They have little canteen kits. They have flares. They won't have to eat each other because they have some food that they can, they can last a long time in that cold Hudson River. Their life chances are better because of the place they sat in on the plane. This is what I mean by place matters. I could show you maps of my hometown. The South Bronx and the structural racism that produces the asthma alley that we live in in the South Bronx still today. The truck routes, the Superfund sites. I could show you that structural racism has harmed Black, Brown, especially Indigenous people with respect to death and hospitalization. You know the data. You know the statistics. I could show you that these data harm not only Black and Brown people, but we ignored the COVID-19, the COVID-19 pandemic and the dangers that it presented to our peril in the beginning because they were concentrated in other people's neighborhoods. But look where it is today. The past is not the past. It is not dead. And Requiem for a None Faulkner said this. And that is the theme I want to leave with you. The past is not the past. It is not even dead. It is not even the past. It is what we was reckoned with today. If we are ever, ever to reach health equity, we must eliminate structural racism. Thank you. My, my, my, what a powerful, powerful presentation full of thoughts, questions, challenges. I don't know where to begin. But let us start by our co-moderators, our student colleagues, to kind of feel the question and answers and let me start with Lizzie. What question do you have for the dean? Thank you so much, Dean Matthews. That was such an amazing talk and I've learned so much. I didn't know much about Charlottesville, but my dad is actually from the South Bronx and has asthma and so does my brother. But I guess I just wanted to talk, if you felt comfortable talking a little bit more about this idea that place matters and that as we know this results in these health inequities across racial lines, ethnic lines. But where do we even go from here? Yes, we know that we have to reckon with the past and, and you know, deal with all of their retributive justice, but like what actually would be the next step and like what should we be doing to make that happen? I know that's a lot. No, no, no, it's excellent question and, and, and Izzy, I'm so glad you're going to law school because I'm going to start with the law, right? I think structural racism is, is a legally enabled phenomena that must be dismantled by law, right? I started with the 13th amendment because we embedded structural racism in our Constitution. I started with the 1912 ordinance because we created. Desmond makes the point that residential segregation had to be invented, right? And the mechanism by which it was invented is law. That's the mechanism by which we must dismantle it. Now, what do we do? What do we do? One of the things I do, I like to do is go to audiences of non-lawyers, right? Go to audiences of people who work in health care. Go to audiences of school psychologists and I say, you know, the civil rights movement, the marches that were required, the people who are protesting for Black lives to matter in the streets today, they need your help. If we silo ourselves so that all we do is our bench science or our architectural work. We don't realize that the societal harm presented by structural racism harms everyone. I sped through those slides about the COVID-19 pandemic. So I'll end here. One of the ways that we all must work is we must work for civil rights laws that will desegregate, that will stop gentrification, that will allow us to find affordable homes and unsegregate our schools, right? We have to unsegregate our schools from an economic and from a racial standpoint. Now, we could have a long conversation about whether that means racially. I have a lot to say about what it means to unsegregate our schools. And I don't use unsegregate the same as I would desegregate, but let me say these are the social determinants of health that right now are organized in a discriminatory fashion, right? Why? Because we are not enforcing the Fair Housing Act. Because the Title VI law that should prevent pollution from being disproportionately burdened on Black and Brown communities is not being enforced, because the Supreme Court, as we know it today, has neutralized the Voting Rights Act. Because affirmative action is under threat. Because killing of Black and Brown bodies is done with impunity. Because the law is not enforced in an equal manner. Because the promise that was contained in our organizing documents that said, we hold these truths to be self-evident, that all men are created equal, has never ever been done under our law, right? And the Equal Protection Amendment. That's why I say structural racism is a function of that. So I think we all have to be about getting our laws to line up with our aspirations and enforcing the laws that prohibit discrimination in housing, in education, in the environment, in every place that people live, eat, and worship, and play. When they are able to do so equally and have equal access to resources, they will be healthy. Thank you, Mr. Cotton. One question from you, and then between the two of you, you will begin to feel the question from the chat box. Dr. Matthew, just to reiterate with Izzy again, yes, thank you for all your time and information that you shared with us this afternoon. It's been very helpful and beneficial. But my question for you would be, what was the trigger moment for a trigger event that made you realize this long history of racial disparity in America? Was there a single case or study or anything that really prompted your interest for you to be an advocate for it like you are today? What a great question. Yes and no. The real truth is that my passionate interest in advocacy against structural racism has evolved over time and has become deeper, hotter, I think, over time. I've become more certain about the theories that I advance and the interventions that I propose over time. That's a function of growing as an academic, getting good education, being able to have conversations with people like you, hearing your questions and bouncing off ideas. But there was a moment. There was a moment when I feel I realized that if I wanted the society around me to be different, it was incumbent upon me to do something, whatever something I could do. And I don't know if everybody has this experience. I'm old enough that I should not remember it, but I remember the first time someone used the N word against me. I remember. I remember I could not have been in double digits in terms of age. I remember the location if I went to 90th Street and 1st Avenue near the East River today, I could find that location because I was in a playground on a monkey bar and somebody came over to me. I was playing with some other children and somebody came over to me and told the children around me that they weren't to play with me because I wasn't in. And the children obeyed and left. I will be honest with you. I don't remember being hurt or insulted. I remember being appalled. Are they crazy? What are they talking about? I just remember thinking, what world are they living in? But that's at the stage for me to say, this world is a skew. There's something wrong here. And my personality from that moment began to evolve and amass some tools and more tools and more tools and more tools. And I hope tomorrow I'll have another tool that I didn't have today. So the answer is yes, there was a moment. I always remember that moment, but I got more and more, I guess, equipment and passion about it as each day passed. Okay, great. Thank you so much. For the next question, we have someone asking how did the ordinance become politically popular enough to be passed, even though the two communities were living harmoniously, or harmoniously loosely, I guess. Yeah, that is a really, really good question. This is the piece that I really have to rely upon dehumanization to explain because you ask yourself, my God, what is the story that we must tell ourselves in order to justify this social reordering. It wasn't unique to Charlottesville. At the turn of the century, it became very popular, the Ku Klux Klan arose historically, it became very popular for thought leaders to begin to think about the lost cause in the south, right. The Civil War was lost, but it should not have been, it was called the War of Northern Aggression. And you can see newspaper clippings, articles, you can see so many original sources of these thought leaders capturing the hearts and minds of people in order to explain in terms that can only be described as dehumanizing, that they would convince their neighbors. And let me say, in much the same way that the people who stormed the capital were convinced of untruths about the election, are convinced about, I mean, people walked in wearing shirts that said six million is not enough. How do you do that? You must buy the dehumanizing story. That's why the thought leadership. That's why the psychology of how we think of other people is so powerful. I maintain that the way that ordinance became effective was that people who were white supremacists won the hearts and minds of common, ordinary people who stayed silent, who thought it was not that big a deal. Who thought that the fringe could never capture the hearts and minds of mainstream as a society. And when I teach my students, I teach them, because again I'm in Washington DC, how fragile democracy is, how fragile equality is, if we don't ardently and vigilantly protected each and every day ourselves. Thank you so much for that amazing response. And the next question we have from the attendees comes from Mr. Jay Wilberforce. Question is, wasn't there a tendency of African American families to settle near our stations due to Pullman Porter work opportunities in rail, when other jobs are segregated slash block? Certainly that's part of the story. So one of the things that's important about this question or is to point out that structural racism as I showed in the diagram creates a seamless web of inequality in opportunity, right? So why should I, because of the color of my skin have access to one job and not another job, right? Will and Mills, which I showed you was all white and the salaries were not only better than Pullman Porter's, but in the 1920s the white workers in Will and Mills went on strike. That never happened in the Black neighborhoods, right? So this is an example of how segregation begets limited opportunity by education, begets limited opportunity by employment, begets a decision, right? A quote unquote choice, but the choice is structured by your employment, by your race, by your income, by your education, by your housing, right? That's what we mean by structural racism, right? Yeah, that was the choice. But all other choices were structured to be available or unavailable by race. So the next question is from Katrina Rhodes and she says, thanks for a great presentation. In a society constructed to disadvantage some and advantage others, how do you get those advantages to buy into the concept that more equitable distribution of resources benefits all? Yeah, that's a hard one. There's a debate among race scholars. There are two theories I'll tell you, two ways that you could do it. You could do it with Derek Bell's concept of interest convergence, right? And that's a little bit of what I was doing with the COVID maps. I was saying, look, you know, racism kills you just like it kills me. And there's data. There's plenty of data that shows that we have nice data that shows us that more explicitly racist counties in the United States experience higher all cause mortality for blacks and whites, higher infant mortality for blacks and whites, higher myocardial infarction for blacks and whites, right? So our interests converge. You guys want to live a little longer. We want to live a little longer. We better all get on this together. Look at the decline in life expectancy in the United States, right? One year for whites, two years for blacks, life expectancy does not decline in a year. So the COVID pandemic that we ignored while it was concentrated in urban black and brown neighborhoods and rural brown neighborhoods has killed us all, right? So that's an interest convergence idea. Another idea is that we're just in a moment right now. We're in a moment. The pandemic has paused us. We've had killing after killing on the national stage, Floyd, George Floyd, Breonna Taylor, I'm at Arbery. Even Amy Cooper, we've had this national pause to look at what racism does to us as a society, right? And we might as an ethical matter have a reckoning, a racial, a moment of racial reckoning. I don't know which is true. I only know these are my moments. And so I'm going to try and use them to convince some. Thank you to continue what you were talking about with George Floyd and Breonna Taylor. We have a question from Sheika Khalivor. She asked, how do you see the events of 2020, like those that you named before George Floyd, Breonna Taylor, et cetera, affect your professional work as a lawyer? Are you optimistic about the future or do you encounter barriers currently? Oh, yes, to all of that, right? So yes, I encounter barriers. Yes, I'm optimistic about the future. I'm optimistic about the future in large part, because I'm getting to talk to people who are getting ready to go to law school who are fourth generation students at Morehouse going to excuse me, at Tuskegee, getting ready to go to medical school. I'm optimistic because at the moment that we are in, there is more understanding of and more data of the detriment that structural racism does to our society than there ever has been before. I'm talking to audiences of students that are more articulate than I ever was before. I am optimistic because the student that I speak to today has no hesitation to say, on the one hand, I'm a law student. On the other hand, I'm going to march at the Capitol. I'm going to collaborate with communities. I'm not going to bifurcate by social status. They're going to do a better job yet. I am a lawyer and I watch the rule of law be broken every day. And that I have to reckon with. I have to reckon with the fact that when access to justice is denied along racial lines, there are days I have to get up and say, why am I doing this? I answer by saying that the American experiment is just that. It is an experiment. President Obama told us we are forming a more perfect union, right? The union is far from perfect. And it's my duty for the time that I have to try and perfect it further. So that kind of dovetails nicely into the next question, which is from AJ. And AJ asks about how, well, first AJ says, thank you, thank you, thank you. I appreciate your words and energy. In just medicine, you discussed the obfuscation of implicit bias and litigating inequities. I was so inspired, I created a measure of institutional racism and healthcare to support accountability. But as you spoke to today, laws were created to infuse discrimination into institutional behavior. At what point are we hoping the master's tools will dismantle the master's home? Oh, my goodness. So much in this, first of all, kudos to you for creating a metric of institutional racism. I want to see and read your work. That's one of the reasons I want to be clear. That's one of the reasons I'm so optimistic. I would love to read your work. Please send it to me. Yeah, Audrey Lord. So, in very real ways, if all we do is rely upon a white supremacist infused institutional racism environment, a set of laws. If we only rely upon the largesse, if you will, of someone who says, okay, I'll take the IIT, I'm biased. I'll do some bias training. If that's all we do, then we really are not going to make the kind of progress that I think this moment warrants. If on the other hand, we, and I want to be careful here, I'm using the word radical, advisedly, we radically enforce and insist that the doctrine, the principles, the ideals upon which this nation was built are actualized. If we radically demand that the notion that all humans are equal be absolutely and unequivocally manifested in our laws and institutions, then it is not the master with a small M that we are looking to use to dismantle racism. It is the master with a big M. And I would argue that I and that master are a majority. So our next question is from Mr Bob Chura. He asked, if I recall your book correctly, you believe the law should focus on the actual outcomes of the systems and not the intention of those who work in those systems. If this is correct, could you expand a bit on this idea. So I, I want to repeat it. My book, just medicine. The questioner says believes that the law should work on the outcomes and not the intense. Yes. Okay. I believe that structural racism is as my diagram suggested a institutional problem that does not require me to win the hearts and minds of every white supremacist. Right. I think that is a really tedious exercise. Trying to get people to like me and love me is not the objection objective excuse me. And so in just medicine, the call the person who's written this question is exactly right. I don't want to stop at the top start at the top of the pyramid looking to change individual prejudice. Right. That's not the enterprise that I think will really change the structures that have produced population level disparities. I think a public health approach to the problem of structural racism and suggest that it is population level patterns that I want to arrange differently. It is prevention of structures and institutions of discrimination, rather than worrying, at least in my work, worrying about whether I get you or the next person to act less. Like a bigot. Right. To like me more to want to sit next to me more to want to be my friend more the playground. Right. The kids that didn't want to play with me I thought I thought very little about trying to go after them and convince them that they were wrong as individuals. And that's, I think, the best example of how I can say, I'm concerned with the structures in the outcomes. Right. I definitely need you to like all the black children that you are disparately sending to to juvenile detention, as opposed to treatment as you are doing I just need you to change that structure. I want you to treat my children who are in need of mental health treatment. The same way you're treating your children. I don't care if you like us or not. The outcome is what I need to change. Hey, what a powerful way to end an exciting conversation. I'm in public health so when you end on public health you got my, my vote. Wonderful wonderful thing to say that let me thank you for spending this time with us and our two co moderators. You can see we've got a wonderful future ahead of us. And if you're a friend of black Lynn you were a friend of mine automatic. Indeed, indeed. Yeah, and this this is a powerful way to end this series you've had a wonderful celebration of more minority health month. Black History Month, all that males into being the same. So let me again thank you and we are going to do something with what we've heard, and we'll be back in touch. Thank you kindly. We promise you this has been wonderful. Thank you. I've enjoyed immensely. Thank you so much for having me. Thank you so much for being here.