 All right. Hello and welcome to noon conferences hosted by MRI online in response to the changes happening around the world in the shutting down of in person events. We've decided to provide free daily noon conferences to all radiologists worldwide. Today we're joined by Dr. Zavaro, Chandy and Bulligan. We will begin with a presentation from Dr. Abaro and following that presentation we will be following up with a panel discussion. Dr. Abaro is a GI radiologist in the UK and current radiology research fellow at St. Mark's Hospital and Academic Institute where she was undertaking collaborative PhD research and CT colonography performance with the University of College London. Amanda, we will also be using the Q&A feature to ask all of questions that we want the panel to discuss in that later section. So please use that feature and we will get to as many as we can before our time is up. That being said, thank you so much for joining us today. Dr. Abaro, I'm going to let you take it from here. Okay, perfect. Thank you so much for the introduction and for having me. Okay, I'm Anu and I'm hopefully going to share with you. The UK perspective on racism is impact on the NHS, which is our national health service, my experience, working as a black female doctor in the NHS and hopefully finish up with an encouragement from my colleagues and friends and all of you to be proactively anti-racist. At the end of this talk I'll share a link where you can hear a slightly different presentation, the kind of longer version of this, which will describe a bit more of my personal experience and how I came to be in this position of wanting to speak out about racism in this context. Okay, so let's start with the colour of power in the UK. This is a visual depiction of Britain's most powerful leaders and it was researched done by an independent consultancy called Greenleaf and Operation Black Vote, which is an organisation that promotes justice and racial equality in the UK. And they assess 39 categories across central government, local government, public bodies, private sector, education, and on screen you can see our political party leaders, some cabinet members and government ministers. They basically found that 95% of those roles are filled by white people and only 4.7% of the most powerful roles in the UK are filled by non-white people and that's compared to 13% of the population being composed of non-white ethnic groups. So what does this look like on a more personal level? I'm sitting here speaking to you and I recognise that in this position or in my position in life I am considered a privileged black person for sure. Despite where I am now and what I've been able to achieve, I've always been acutely aware of my skin colour. All the way from childhood, getting teased at school or bullied to being told throughout my educational journey that either I was too ambitious to want to study medicine or that I wasn't intelligent enough to study medicine into navigating an environment where I'm always fighting against labels. And I think a lot of the black experience is kind of associated with questioning whether or not something that's happened to you is as a result of the colour of your skin. As I've got an older, got married and had children, the impact of race has kind of infiltrated every area of my life and especially in the last few weeks or months since George Floyd's killing it's been a massive topic of conversation in our house. And one of the things that I think is really important to understand from a black person's perspective is that there's no getting away from conversations about race, whether or not you want to discuss them. So I have two sons, one is five and one is almost two, and just a couple of days ago my five year old asked me if black people are more important than white people. And it was a really difficult moment because he's obviously picked up on the energy or the psyche of the moment and in wanting him to feel valued and recognised and important as a young black boy, I think we've almost had a pendulum swing of him now thinking that maybe there's certain groups of people that are more important than others. And really the message isn't that black people are more important than white people, all the white people are more important than black people, but that people are equal. And so these are conversations that we are already having with him to kind of redress the balance of making him feel valued despite the perceptions that are put on him by society. So when we consider the NHS, so that is in the UK, the National Health Service and it's our tax funded healthcare and it's provided to everyone irrespective of their gender, their race, their age, and it's provided on the basis of need versus the ability to pay at the point of delivery. The NHS employs over 1.2 million staff and it is the biggest employer of black and ethnic minority staff in the country. Now NHS trusts are the organisations that manage hospitals and community services and they commission services for their patients. There's 223 NHS trusts in the country and they have budgets of millions of pounds and they employ thousands of staff and they deliver care to hundreds of thousands of individuals. So when we consider the top 50 NHS trusts in the country and this is again researched and by the colour of power organisation and they assess the top 50 NHS trusts according to their busyness if you like. So the top 50 trusts that had the most consultant episodes and when you look at that group of people out of the 50 only three of them are from an ethnic minority and when you consider all of the NHS trusts across the country, 94% of them have white people as their chairs. So only 6% of chairs in the NHS are ethnic minorities and that is versus a workforce of almost 20% ethnic minority in the UK. So there's a huge disparity there. Now if you consider not just the chairs so that would be like the most executive board but look at just the workforce. So this is data from the workforce race equality standard and these are figures from 2019 and this is basically data that is collected from hospitals about the experience of their staff and part of that is their pay banding and their ethnicity. And so you can see on the graph that we have represented bands one to nine band one being the lowest nine being the highest and VSM being very senior managers. In London, which is what this graph is showing specifically we have a much higher percentage of ethnic minority staff 45% compared to about 19% in the rest of the country. So 45% of the clinical staff working in London are from an ethnic minority and that's the green line on the graph. When you consider their pay banding and their ethnicity you can see that we are over represented in the lower bands and under represented in the higher bands and the Congress is what is true for our white colleagues so they are lesser in the lower bands and they're massively over represented in the higher positions. And so obviously this leads to an inherent pay gap because of the lack of ethnic minorities in those higher banded job posts and so this is for the clinical workforce which is like our nurses and our radiographers and when we consider our medical staff. So this is data from the NHS pay studies is 2018 data updated last year and this shows us that for the, when you consider the mean monthly basic pay of doctors for every £1 that a black female doctor is paid a white male doctor is paid £1.38. And amongst all the ethnic groups that are evaluated in this particular day to say that black women are paid the lowest. And when you consider black male doctors as a reference standard point for every £1 they're paid white consultants are paid £1.15 and again compared to black female doctors they're paid more. So this pattern of inequality is is replicated throughout the kind of medical career trajectory here. So from medical school into junior training into your more senior posts, there's differential attainment amongst ethnic minorities. We don't do as well as white doctors and academic tests. We don't we're not getting into the top jobs. We're much more likely to be referred to the general medical council which is our regulatory body. And if we are referred and more likely to have our cases investigated and we're likely to face harsher sanctions for seemingly similar infractions to our white counterparts. Still white applicants are 1.4 times more likely to be appointed to roles from short listing than candidates from an ethnic minority. And importantly 15% of black and minority ethnic staff report experiencing discrimination or bullying in the last one year compared to 6.6% of white staff. Those are kind of like the broad overarching problems and it's really easy when you're looking at figures and things like that to forget about the individuals that make up all of those experiences and make up all of those numbers. So for me, these are just a few of the things I've experienced during the course of my career and training working in different hospitals around the southeast of England. And on some occasions there's been open hostility from patients related to my race and to a lesser degree from my colleagues that has happened far more infrequently. But what is frequent and probably no less harmful is the more subtle discrimination being overlooked for career progression opportunities, having to tolerate negative racial humour, feeling socially excluded, not listened to. And I think everybody can agree that being a doctor is difficult. And as a black female doctor, some of those experiences are compounded. So whatever is your baseline insecurities, they're amplified now by being black and female in the medical workplace. So all of those things contribute to feeling undervalued, isolated, misunderstood, ignored. And if you are kind of bold enough to raise any issues or tackle some discrimination that you've experienced in the workplace, invariably you're met with downplaying of the racialised aspect of the incidents or an outright denial or a, well, he's normally a really nice person or he must have caught him on a bad day and really excusing the perpetrator rather than holding them accountable for whatever it is that had just said, what has just happened. It's also, I think, really important to recognise that the, what the barriers are. So the barriers for me, for example, are not that I'm black and that I'm female. And if you place the emphasis there, then actually it makes me, it makes the owners of responsibility for changing the system of mine. And actually that's not the barrier. The barrier is the white dominant social construct that we are existing within. And the barrier is not me being female, but the patriarchy and the kind of holding out of white male, white men as the kind of reference standard for normal for everything else. And really what I guess black people and ethnic minorities are really asking for is that our contributions to our profession should be recognised and that we are given access to real opportunities and access to senior roles. So that was looking at the workforce. So when we consider that we're here to serve our patients, we recognise now that inequality doesn't just affect our staff, it affects our patients, as it also does in the US. And something that I've heard several times is that if the NHS is so-called free, how can it be structurally racist? And I would say that there's inherent inequality in our society and the NHS is essentially the sum of its parts, it's the sum of people and attitudes in society. So the natural extrapolation of that is that the inequality that we see in everyday life is invariably going to be replicated in healthcare. So despite being free at the point of delivery, we know in recent data from earlier this year that black women have a five times higher risk of dying in pregnancy than white women in this country. And this is just one example of worse health outcomes in ethnic groups. And this is not because black women have five times higher rates of heart disease, which is associated with increased maternal death. So there are other factors at play that have to be considered. Okay, and when you combine racial inequality in the workforce and racial inequality in patient health outcomes in COVID, we see that the impact of coronavirus has been disproportionate amongst communities of colour. And in the UK, in the first couple of months of coronavirus, of this pandemic, 95% of the doctors that died were BMA or BAME. So here we say BAME, which stands for Black and Asian Minority Ethnic Groups. And so basically everyone that isn't white. And so we know amongst doctors, we make up 45%, ethnic doctors make up 45% of the workforce, but we represented 95% of deaths. And is that because we were disproportionately inpatient facing roles, probably, had poorer access to PPE, probably, felt less confident or were more reluctant to raise concerns about the roles that we were being deployed to, probably. And all of these things kind of created the perfect storm to amplify the inequality that already exists. And this is, as I understand, something that is also happening and has been happening in the States that these are issues that have been in existence for so long, and coronavirus has basically just amplified all of that. So some of the men here are former colleagues and may their souls rest in peace. So the term Black Lives Matter is not a threat to other races. It's a cry for help. It's a cry for people to recognize that racism gives society license to treat people differently, and it allows them to do that, even if they die as a result because their lives don't matter. And in the recent weeks and months, we've been confronted by the racism and the ugliness of the racism that affects every area of our lives. So if we want to just talk about racism in general, I think it's really interesting that most people, well, nobody really wants to admit to being racist very few people, but the impact of racism is everywhere, and nobody admits to marginalizing people, but there is evidence of whole co-cults of people being marginalized. And I think when you recognize that racism is a cultural disease, it doesn't care if you're a white person that likes black people, it's a system that we are born into and that we have to fight to get out of. So racism is about power and privilege. I think if you have, for example, insults that aren't backed up by power or privilege, and they're nothing more than just insults, and people can deal with them. But when you have racial insults that are backed by a power structure, suddenly they become weapons that can derail people's lives, they can become life altering. So I think we need to consider racism as a spectrum that involves people and organizations, and so we're going to need both people and organizations with structures to deal with the discrimination. Racism doesn't just persist because of a handful of white supremacists. Even if you consciously reject racism, your innate biases and behaviors can still contribute and sustain discrimination. So I'm going to talk through just a couple of definitions because I think the language of this moment is really helpful to educate ourselves on. So we're going to do just a quick little social experiment. There's 18 pictures on your screen, and if you had to pick a single picture to answer the following questions, who would you pick? You don't have to write it in the chat or anything, just think in your head. So for example, who would you cross the road to avoid? Who would you be relieved to see as your bank manager that you needed to approve alone? Who would you assume has three children? Who are you most likely to trust? Who do you think is a teacher? Okay, so let's do some more. Who would you assume is telling the truth? Who would you be most comfortable approaching for directions? Who do you think is a doctor? Who do you think is a cleaner? So these are a series of photographs by a photographer called Bayette Ross Smith, and he's actually the gentleman in the bottom row of your screens. And this is a photography exhibition called Our Kind of People, and he basically wanted to examine how clothing, skin tone and gender affect our ideas about identity and value and character. And without giving you any context to assess the personality of the individuals, you project your own cultural bias onto each image. So that brings us to consider implicit bias. So although consciously we may reject negative ideas associated with minority groups, and we might even belong to those minority groups ourselves, we've all been immersed in a culture where these groups are constantly depicted in stereotyped, prejudiced ways. So we have to consider that that influence from society and from culture can impact how we treat our patients and basically every patient characteristic could cause bias. So their race or ethnicity, immigration status, how health literate they are, mental illness, their weight, their socioeconomic status, all of these things could cause bias in our minds, which potentially could then affect how we treat them, what treatment options we offer them, how willing we are to believe that they're genuinely in pain versus drug seeking. And this leads on to another difficult question, which is, does the cognitive awareness of your bias actually reduce its manifestation? So is anti-biased training as part of your diversity policy enough? Or, as more and more data and research is showing that it's not just enough to have individual anti-biased policy, but you need to actually have specific anti-biased processes that allow you to have multiple checks and balances and multiple points of accountability, not just for the individuals, but also for the organisation and for the organisational processes. So let's go on to talk about microaggressions. Compared to history and certainly centuries or decades ago, over displays of racism are rarer. They still occur, obviously, but they're to a degree lesser than in times gone by. What we are seeing now is more and more recognition of microaggressions. And initially when I would talk about these or discuss these with people who aren't Black, it always feels like you're kind of playing the race card or making a big deal out of something small. And I think one of the things that's really important to consider when you're talking about microaggressions is the cumulative effect. So non-white people are invariably going to experience these regularly, sometimes multiple times a day. And so it's been likened to death by a thousand paper cuts. The psychological impact of all of these things happening in your workspace when you go to the supermarket, when you're just kind of trying to carry on your regular life, cannot be overestimated. And although not everybody agrees about the significance of microaggressions, there is quantitative evidence that ethnic minorities experience these at a disproportionate degree. And that this subtle prejudice does impact psychological well-being. And even if you control for difference in behavior and qualification, ethnic minorities are less likely to be offered jobs. We're more likely to be treated with suspicion in shopping areas. We're more likely to be interpreted as more threatening. You have a son who's five but is really tall for his age. You know, we have this thing of kind of over amplification of age being seen as more adult. Black women are more sexualized. All of these things contribute to the inequality that we experience. And lastly, I wanted to touch on white privilege. And this is the metaphor of the invisible knapsack, which was described by Peggy McIntosh, who's a white activist, elderly lady now in the U.S. And she has described this invisible bag of special provisions that white people have. And I know white privilege can be a contentious topic, but I would say that it is really difficult to realize how important race is to your self-definition when you never have to think about it. When you're treated as the default norm and everything around you reinforces your self-worth versus somebody who isn't white. And white privilege isn't about money and it's not about class. For me, it's really summed up in the absence of suspicion. And when I was putting together this slide, I was like, there's too many examples. I should take some off. But then so all of these I've experienced the opposite of. And so it is just testament to the fact that you can someone, the white person can recognize actually there's a privilege that comes of the color of my skin. There's an absence of having to worry about certain things. There's an absence of suspicion when I have an interaction with authority that a black person doesn't have. And furthermore, if you are not black, for example, you can decide to disengage from conversations about race. You can decide that, you know what, this isn't something that I want to engage with, and there would be no impact. Black people don't have the privilege of disengaging from this conversation because it's something that is embedded in our experience of life every day. Okay, so I wanted to end with kind of some suggestions on how we can become anti-racist so that it's not a completely depressing talk. On the assumption that everybody wants to recognize as racism in our society recognizes that it exists and wants to challenge that. We have this diagram, the green path is basically racism, structural racism in society. And so that's the green road. So the top guy, the top stick man is your active racist. He is actively perpetuating discrimination against other races, deliberate acts, insults, the hate crime are the white supremacist. So he's actively moving towards racism. So the second path is our non-racist. So this person passively rejects racism. So they don't, they consider racism as extreme over highly visible behaviors of a small minority of people. And but non-racism unintentionally allows permission for racist actions to continue occurring because they're not challenging them. They're not putting a stop and standing against them. So they're still moving along the green path, even though they're not actively walking. And so on the bottom we have the anti-racist. So this is the person who is actively turned around and they're walking in the opposite direction to the path. They're working against the institutional nature of racial inequality. They're challenging those systems and they're recognizing that they need to be proactive to see change happen. So what can you do as an individual if you recognize, okay, now I want to be anti-racist, what can I do? So these are the seven A's of allyship and this was, these are a concept by Yvonne Coghill, who is the current director of the workforce race equality standard. I mentioned some of the data from at the beginning of the talk. And she's basically compiled these seven A's which I present to you here. And I guess fundamentally what she's saying is that being an ally or recognizing that you want to be anti-racist is one a conscious decision and you need to decide that you have that appetite to get involved in this. So it's a lifelong commitment, a lifelong effort that it's going to affect all different areas of your life. You need to be curious about race, your own, as well as the experiences of other people that are not from the same race as you. You have to accept there's a problem. One of the responses that I've seen amongst many of our organizations is the need for more data. And to be honest, there's a lot of data already. This isn't the time necessarily for more data. We need to be accepting that there's a problem that we can do something about. We need to acknowledge externally that we recognize there's a problem and this is where we stand on it. We are not going to tolerate racial inequality. Don't make assumptions. Not every black person or Asian person has had the same experience. It's important to enter into dialogue and to ask people directly. And then you want to take demonstrable steps and you want to be accountable. You want to know that these steps that you're making are tangible changes that are going to get you towards the goal of being anti-racist and challenging the structures that you exist in. So I think that everybody is at the center of their own sphere of influence. And this is a diagram that I've adapted from an artist called Danielle Coat. And this is basically to encourage us that there are so many different aspects of our lives that we can affect to tackle racism. And it's not just about making life better for black or brown people, but actually what we're trying to do is improve society as a whole. We can't just go to work and sign off on a diversity policy, but then tolerate racism in other areas of your life. Because then all that means is that you're anti-racist or your diversity policy at work is going to be ineffective because you've not really made the change or accepted that this needs to be a change affecting multiple areas of your life. So we need to consider how can we promote diversity in our leadership in health care? How can we see the diversity in our junior trainees replicated in our leadership? How can we promote more research into underrepresented patient groups? How can we promote research by ethnic minority staff? How can we attract funding so that we can plug data gaps amongst ethnic minority populations? How can we improve health outcomes for our patients and promote access to health care for those marginalized groups? Okay, so lastly, I wanted to just leave you with some suggestions for health care organizations. So there's a gentleman called Roger Klein who is an absolute legend, look him up on Twitter. And he is an author and advocate and consultant on workforce culture. And he wrote a document in 2014 called the Snowy White Peaks of the NHS and basically highlighted the scale of discrimination within the NHS. And he was also one of the pioneers of the workforce race equality standard which I've mentioned before. So he has written several articles on making suggestions of what organizations can do and all of these pertain to radiology or can pertain to radiology. So equality diversity inclusion has to be part of core business, has to be part of our strategic planning and has to have allocated resource. Our leaders and our board members need to be able to explain why tackling discrimination by race is important for the NHS and our patient outcomes. And they need to be able to show what they're doing personally to address these. One thing that we don't have well replicated here that I think you do have more of in the US is diversity officers, dedicated diversity committees. So many of our organizations have these roles kind of added on to other corporate responsibilities, which just means that this issue gets less attention. So organization leaders need to understand the local challenges of their workforce and of their patients. There needs to be transparency of the equality data. A lot of the data is poorly captured. It's not transparent. It's impossible to find. Nobody wants to spotlight that they're not diverse and that they're not representing the population. So there needs to be a push to that is the data that would be worth collecting in detail. Boards need to be proactive and preventative. They have to use real research, the current data, the lived experience of their workforce to drive evidence based interventions. There needs to be accountability at multiple stages with time limited goals. And it needs to be no more homogenous decision making by all white boards or all male boards, for example. And one of the things that Roger Klein highlights, which I think is really important is de biasing the processes. So you're not just targeting bias in individuals, but you're actually being proactive about developing processes that have anti bias kind of built into them. So better transparency on how we appoint people, consequences for not meeting targets, incentives to meet diversity goals, etc. And then lastly, I think one of the really important things is prioritizing the psychological safety. We, many of us will know what it's like to be the only black person in a room or the only black person in a particular group and feeling like the token person, the token black voice. And then feeling like your voice isn't even heard and that it doesn't really matter that you're just there to kind of keep up appearances. And in that sort of environment is very difficult to speak up. And so really what you want is leadership that welcomes different perspectives that promotes inclusion and value and creates a safe workplace for their staff. And invariably, then we're going to be able to support one another better, listen to each other better. There'll be less errors, there'll be less bullying and less absenteeism and that behavior has to be modeled from the top down. So I'll just leave you with this quote. I think that doing nothing has never been okay and is even less okay in this moment and we have a responsibility to amplify voices to try and create opportunities and networks and to try and improve things. So that hopefully within our lifetime and the lifetimes of our children, we'll be able to say that definitive progress has been made. So lastly, there's, as I mentioned at the beginning, I gave a kind of bigger version of this talk and explain how I came to kind of wanting to share my story a bit. So if you're interested, you can find it at the time URL racism ground round or you can scan the QR code. And these are my references. Thank you very much. Perfect. Thank you so much for that presentation. Dr. Bar. I really appreciate that. Next, we will move into the panel discussion. So I will ask our other two panels to turn their video cameras on. And while they're doing that, I just want to introduce some Dr. Chandee is the son of an Ethiopian immigrant from a rural village and an Italian American mother who was the first woman at her in her chemistry PhD program. He was born and raised in Michigan and received a PhD in medical physics from Harvard and MIT and then went to Harvard Medical School. Dr. Bullion specializes in the treatment of breast and gynecology malignancies. She is a graduate of Harvard University and Yale University School of Medicine. She completed her residency at New York University and she studies local and global cancer disparities. I will let you guys take it from here. I do see some questions in the Q&A feature if you would like to discuss some of those. And other than that, I will leave this time up to you. All right. Thank you for having us MRI online. So let's start with some questions because there's some good ones here. The first question is, what do you think about white privilege? Would it be better to describe it as non white disadvantage or are they the same? So I think that's a good question and it's important to acknowledge both sides of the coin. So you can't just focus on the fact that there are disadvantages to persons of color. For instance, they talk often about how if you change someone's name, right? Whether it's an application for a home loan or if it's a student who's looking for mentors for research. The person of color, someone whose name doesn't sound traditionally American or European is going to have a harder time getting mentors and that can impact things down the line. So you have to acknowledge that there's a disadvantage to that. But also the flip side is that if you do fall into the categories where you're more mainstream, you sound traditionally American, you're going to have that privilege. And yes, we've caught on to this term of white privilege, but that's because the privilege creates an inherent disadvantage to others. So they're both important to acknowledge in my opinion, but one has caught on more than the other. I think I would agree. I think, well, white privilege for a start is a bit more catchy. We could have talked about branding or whatever, but I think also I think we have to be careful about where we're placing the focus of responsibility for the change, right? So if the responsibility to make changes on people of color, for example, then the terminology should reflect that. But we know that we have been as black people unsuccessful in reversing racism because we can't, we don't hold the power. So I think the term white privilege speaks to the people that are in a position of power. And I think it kind of shines a light on what I believe are some of their responsibilities to one, recognize just the kind of cultural currency that they have, right? And so the, and it doesn't, it might not be fair, but that is the reality. It's no less fair than what's happening to us, right? So I think, so the term I think forces that kind of reflection. And so, and unfortunately getting people to try and understand our experience hasn't worked to change our experience. So there has to be a different kind of tact if you like. I mean, white privilege as a term is not new, it's been described since the 80s, right? But it's just a recognition that there's a difference in the societal experience. And I think you have to put that into the context of the white power structure, if you like, which is why I think white privilege speaks to that specifically versus focusing on the disadvantage that it then creates. And so I have two things to say to this. And so we start off with just educating in general, there's this idea called white fragility. Yeah. And white fragility is the feeling of discomfort when a white person is confronted about their whiteness. And of course, you could also talk about any group being experiencing discomfort when they are kind of faced with this issue. You could say, you know, heteronormative fragility, or you could say all sorts of fragilities. But white fragility has kind of come up in this discussion of white privilege because to say that it is non-white disadvantage is itself saying white is normal. Yeah. Because when you say white privilege, you're saying, okay, well, I feel normal, but I am elevated to certain things, right? And we talk about like as radiologists, many of us, not me sadly yet, are wealthy, right? And when someone says, oh, will you make a lot of money or you have a lot of money? Your first thought is like, do I though? And so these are the kind of things we always want to normalize yourself. And when you have to face that you may have some advantages, it can be challenging. So that's a little teaching. And so then that was a good question. I'm going to pick out the hard ones first, but hopefully we hit all of them. I really like this one down here. To be truly anti-racist institution, is it necessary to have affirmative action, open parentheses, positive discrimination, close parentheses? Yeah, that's, yeah, that's a, I'm not sure that I have a great answer for that, but I will say that I highly doubt that we would have seen integration of schools or the rates of persons of color that we have in institutions of higher learning. If we had not enacted things like affirmative action. So I know it's a touchy subject that causes a lot of issues, but I think if the question is, you know, is affirmative action needed, I absolutely think it was, you know, needed. Maybe not all institutions at present have to have it, but I would say given the gestalt, the dynamic of what's happening right now, look at us, we're in 2020 and we're having an uprising about race. So we haven't, I would say we haven't yet come to the point where we can do away with things like affirmative action and making sure that our institutions reflect the diversity of the world that we live in. So I'll jump in really quick on this because it's very interesting. So affirmative action for the audience out there here in America, because I'm a global audience, we had this thing like 1970s we started affirmative action. Google, right. So affirmative action was started. And if you look who the largest beneficiaries of affirmative action are. You know, you know, you know the answer. I'm guessing it's not who we think it is. It is not who you think it is white women. Yeah, what affirmative action was when has always been about underrepresented groups which includes minorities and white women. Now you might wonder what about the disabled, or what about vets, they're covered under separate laws, especially for them. So this has always been about, you know, sex based discrimination and race based discrimination. Over time, what you've actually seen happen is, you know, white women make great strides. And then as we kind of politicized it, the white women who were kind of, you know, gaining all this momentum and once they had gotten there, then it starts to turn off then people's perceptions of like is affirmative action a good thing start to shoot in the other direction and like well maybe we don't because we picked ourselves up by our bootstraps. So everyone else should. And then as far as like is affirmative action like a thing that we should engage in MIT in the past had terrible representation of women. When women would come and visit MIT, they'd say I don't want to go to MIT because there's no other women there. So what MIT did was they added 200 points to every woman's SAT score. And they held it that way for I think like three years. What ended up happening was they oversubscribed women in their first few years, knowing that many would not come, but then some did come. And then at that point they were able to stop this affirmative action, because there was a, there was enough women there to continue this momentum so now when these women who were applying and they come and they see it they say oh there's already other women here I can see myself here. This has been the intention of affirmative action. You have this affirmative kind of push for some period of time. And once it's succeeded, you turn it off and stop it. The problem with affirmative action in America is we were never able to actually turn it on. And so it's always been this kind of thing from day one where they're trying to chop it back with ever out ever really establishing it. This is just like the American focus, but Anu, let's hear the. Yeah, I mean, I think I find this an interesting concept because I feel like if you don't people don't love targets, but they respond to them, right. You respond to having goals as an organization if there's a penalty. If you're having all white leadership for five years in a row, then you probably will stop doing that. Right. And so, is that positive discrimination. I feel like whatever you want to call it if it redresses the balance, then that is the goal, right. And I think that the word discrimination is like so. Well, it's a negative word, right. So it has connotations attached to it. But really, are you positively discriminating if you're equaling the pain field like is it you're not Disadvantaging the people that got all of the advantage before you're giving advantage to people that never had it. You know, I mean, and I think you're not speaking specifically, you know, for our profession, the I always say it's not like we are asking for more than we are capable of, or more than we are, we have earned. We just want the same opportunity, right. We want the same access to the leadership roles to be policymakers and policy changes. And, you know, we're not coming with mediocrity invariably, we're coming with excellence. And so it's like, are you positively discriminating because you give me a chance at interview. And I still may not get the job. Like, so I'm like, I don't know, I feel like you have to, I think we've got we're leaning towards now organizations recognizing that they have to have quotas, and they have to be shown to be doing more than just getting the one person on the board, which means they can now say there's diversity amongst this organization. Do you know what I mean so add on to that, you know, I love what you just said and, and a further issue is, is it's so embedded in our culture, or, or our society right now that recently there was a publication from a respected NYU professor, right, Lawrence Mead, I don't even want to give it air. But this is a man who has built this grand reputation. Also, I think a former dean of of University of Pennsylvania Medical School, they have been able to put out papers and commentaries. Basically, Mead said that minorities and persons of color shy away when they're given opportunities to pull themselves up by the bootstraps. They were allergic to hard work. So when you have people who sit at the highest echelons of these institutions, still in 2020, putting out these sorts of opinions freely and thinking it's okay. It's not yet time for us to shy away from these, you know, these metrics, these policies because we are not there yet. We're not there yet. And I think, sorry, just to add to that, and I think part of that for me is where we really have to draw a distinction between what is diversity and what is inclusion, right. So I've had so many conversations in the last few weeks where I've been very frank about, I wouldn't be interested in applying for a role in this organization or to be part of this group, because it's all white. I'm not interested in coming on because I know that I won't be included. I will be the first and the last, right. You want me because now it's, it looks good to add that diversity, but there's no inclusion. So when people say like, oh, black people shy away from opportunity, we won't necessarily want to willingly walk into a toxic environment. That's what that is, right. So actually, if like you're saying of the MIT example, if I go to a university or to somewhere that I know I'm qualified to get into, but there are no ethnic people, like that is the measure that I am using to know what my experience is going to be like a benchmark here. So I'm like, I don't want to go there. So maybe I'll go somewhere else that maybe academically or whatever isn't on the same scale. But I know I'm probably going to last there more than I would last in this other environment where there's no one like me where I can't see anyone above me to aspire to where I can't see anybody else that's made it. Like, okay, are we always going to be the people that are spearheading are we always going to be the ones that are the change make the one. And I think there's a question here about not seeing many black radiologists at radiology meetings. And yes, I agree. Because until I gave this talk, I didn't know all of these great global black radiology superstars. And it's like, so talking about racism has ironically connected me to mentors and change makers that I would have had no access to and was kind of traveling this journey alone with great supervisors. I work with great people, but I'm the only black one. So let's knock out these two questions real quick. There's one is more of a comment from 365 diversity LLC. They're an organization that work on dismantling racism. You can find them at 365 diversity calm so we can say that's done. Thank you for doing your work so much. And then here is a question, which is, you know, should we expand this conversation to include sexual orientation religion lbgtq. I say 100% I'm something called a intersectional diversity person. So I believe you can't talk about diversity along a single axis which would be race or sex you have to do multiple at once. That's how you diversify your groups. So you can look up intersectional diversity, Kimberly Crenshaw established, brought it up I think in 79 or 89 or something. And so then let's devote the last five minutes to talk about this group of questions here what can we do. Anu was saying, we don't see black people at meetings. What can societies do. How do we teach it to our residents how can you talk about racism without fear of retaliation to answer that question, you can't. Unfortunately, sometimes you're going to get kicked in the gut for doing the right thing. That's the black tax. Good trouble. You're supposed to get into right doing the right things sometimes I we had a. So what are the things that you can do. So we had a group of residents when all this came to a head in radiation oncology we had a group of residents that said, we need to do more, and they formed a new subcommittee the first in the, in a decade that's been organized called the equity and inclusion subcommittee. And they're going to do a, you know, first step is to assess the climate they're going to do a survey of what are the thoughts of program directors the people who are the gatekeepers right for our specialty. They're going to do a survey they're going to create safe spaces to discuss these issues, because apparently there are, you know, in the 20s, the number of black residents in radiation oncology is in the 20s and it's been declining. So, I never knew it was that stark the number of faculty I realized that my colleague and I who are the same institution he calculated that we represent 7.5% of the black radiation oncologist at one institution. So it's just really eye opening so one thing you can do is find out what's your organization doing does there need to be a new committee and not just to form a committee. But what are your targets right a new talked about targets you can't just say, we're forming this committee. Let's just form it. What are you going to look at are you going to look at what's the pipeline. It's not just a leaky pipeline people just don't just drop out. Who is encouraging the individuals to enter radiology or radiation oncology or not encouraging them, and then find out what are the issues that people other trainees are dealing with and how can you tackle them together. What I'll say is that it's really an international reckoning. I remember seeing the images from Belgium from, you know, Sweden of people toppling statues and I was so touched, but a new year lecture has shown me that we, we had to have an international reckoning that black maternal mortality rate is high, you know, an NHS it's high in the USA two to three times more likely to die five times in the UK. There's structural racism, you know, in there it's not just oh black women are more likely to die. There's structural racism at play and we had to have we have to have an international reckoning. So I'll say on the individual level you have to ask yourself, what am I doing right. We know that black women are less likely to get their mammogram results at normal mammogram results as quickly as white women. There was a paper from Columbia University that showed that you know the lag time from abnormal mammogram to actual, you know, conveying of those results could be almost double for women of color. So ask yourself look at your own institution in your own sphere of influence as you said and and find out are you on an individual level taking the steps are you treating your patients the same. Do you report the mammogram results to the patient who's educated from you know the Upper East side the more affluent part of New York as quickly as you do to the patient who you know just says okay whatever you say doctor and just assumes that everything is fine because you didn't contact them. So on an individual level and also on a processes level. Look at your department. What are their policies that are in place to prevent women from getting later, you know, results and others. And I'm sure there are other things that you can do as well but those are some of the practical things that I would recommend to tie this to the last question. I would recommend anyone out there if you're in an institution that doesn't have a diversity equity and inclusion committee to form one and make sure that it is intersectional in its membership. So that should include everyone you should have, you know, your doctors your nurses your technologists your staff your porters, you know, the desk workers, it should include men, women, non binary individuals white black brown Asian. And what you can do is when you build that coalition, then it is very hard for anything you say when you speak up to come back at you as a problem because you've built this shield of allies. And, you know, when as black people as we are so, so underrepresented in radiology. All you can ask for his allies right now. Yeah, absolutely. Yeah, I think we'll just wrap up. And that I think in the spirit of our dear colleague Geraldine McGinty, I think that for our radiology societies and organizations we have to put pressure on them to develop a strategy that incorporates diversity and inclusion with timeline checkpoints has to become part of core business, and it cannot be an afterthought, we have to maintain that pressure, whether it's through setting up a specific committee committee to leverage that pressure. Then kind of by any means necessary at this point, there needs to be greater accountability, and then these this is our moment to kind of embed this into the work in practice. And so yeah, good trouble. I have to be ready to get into it. Perfect. So I do know whether we're at the hour and I appreciate your time and being here so to make sure I give that time back to you and so to bring so close I really want to thank all three of you for your time today and sharing your knowledge and shedding light on such an important issue, as well as giving some suggestions on how we can continue to make change. And thanks all of you for participating in this new conference reminder that it will be made available on demand at online.com in case you would like to watch it or share it with anyone. And tomorrow will be joined by Dr. Ben White for a new conference on student loans on for the resident and educator. So thank you and have a wonderful day. Thank you everyone. Thank you.