 Hello everyone, I'm James Milan and this is our series Justice in the Balance. Today we are welcoming someone who we've spoken to before, Susan Surred is a Suffolk University professor and a medical sociologist and welcome Susan. Thank you so much. Again, really appreciate it. What we are here to talk about today is a variation. In our last conversation we were talking about the plight of women who are incarcerated and then coming back out into society, et cetera. Today we are going to be focusing mostly outside of the walls of prison but nonetheless on inequity as it plays out in an emphasized way in the pandemic. So I'd like to start just by asking, hey, how are you doing? We always want to know these days how things are going with the folks we're talking to. Thank you for asking and for me and I think for many of my neighbors and friends and members of my community, this pandemic has really dramatized for us what it means to have privilege. I can just go for a walk outside in my lovely neighborhood. It's not crowded, there's not a lot of traffic, it's a lovely spring day. I can work from home and I'm still getting paid to do my job. I'm not afraid that I'm going to be evicted from my house. When the fears started, I was able to stock up my pantry. I didn't hoard, I'm happy to say, but I have a fully stocked freezer and so I don't have to worry in a way that most people would have to and I'm aware of that every hour of every day. Well, I join you in that. Everything you said, I think I could say for myself as well and it's interesting because of course the very nature of this particular situation is that we are kind of atomized now, all of us, you know, living just within the confines of our own home or in our neighborhood for the vast majority of our waking hours and I think that therefore that does mean that many of us are just unaware, wholly unaware of what this experience is like for others and can only do so by imagining. You of course do so by profession, by professional focus as well. So please open the door for us a little bit on what life is like for some of the populations, unlike ourselves, who really don't have all of the privileges and luxuries you were describing. So thank you and I think as a really brief segue from our previous conversation about the experiences of women who are criminalized, you know, it seems to me that the women who end up in prison overwhelmingly are women who began with a long list of misfortunes and subordinate statuses and tragedies and miseries and poor access to anything good in life way before they were arrested and ended up in prison and prison and having a prison record exacerbates all of the problems they had before, but overwhelmingly the women who are incarcerated have histories of having been victims of sexual abuse, of domestic violence. Many of them were in the juvenile system because things were just so horrible in their families when they were growing up. Many of them have had series of relationships with abusive partners, they've lost custody of their children, they have chronic health problems, not just mental health problems, but also physical health problems. And once they're incarcerated, well, first of all, health deteriorates in prison and we're hearing a lot about that right now, how the prisons are just pressure cookers for the spread of disease. But once women are released from prison, it's not that their problems have gone away. If anything, they're more vulnerable, they're less likely to have secure housing, they're more likely to be dependent upon financial support from men who may be abusive or exploitive. They tend not to get custody of their children back, which has a detrimental effect on their mental health, which then has a detrimental effect on substance misuse and then can lead to another arrest and incarceration. So in some ways, I think we're seeing similar cycles right now where certainly the data that we're seeing about who is most affected by the pandemic in the United States in terms of serious illness and death rate, overwhelmingly people of color and people of low incomes. So that was their situation before the pandemic. There was racism. We have horrible economic disparities in our country. Most Americans are living paycheck to paycheck or maybe it's better to say scraping by paycheck to paycheck. They are disproportionately dying. And then once the pandemic is over or once individuals, if they survive, get out of the hospital, their situations are going to be worse than they were before. And while you were sick, you weren't earning money. If you're living paycheck to paycheck, that means you're not paying your rent. Where are you going to go? Where are you going to live when you get out of the hospital? You know, I'm hearing from people that I know who are in precarious situations. And I'm also hearing from positions that, you know, we hear this advice of well, if somebody has symptoms, they should self isolate and we see all these instructions about having a kit, you know, with enough water and your own private bathroom and your hand sanitizer so you can be in a room by yourself. What if you share a two bedroom apartment with eight people or 10 people? Or what if you had an apartment that you only shared with four people but you've lost it now because two people are sick and two people are out of work. So you moved in with another eight people. You can't quarantine. Yeah. I mean, there are so, there's so much to unpack and what you've already laid out for us. I guess I'd like to take the approach of looking at different broad areas in which the pandemic is playing out. So looking at health, then looking at economic welfare and the future thereafter, then also looking at those kind of that exacerbation, as you were mentioning, of relationship tensions or perhaps safety issues, etc. So let's start with health though. Obviously, we know what the right things to do are. We have been told over and over again. And for those of us again, your situation, my situation, those of so many that we know, we can do those things. Those things are in our control. But as you've already started to talk about, that's simply that all of that whole laundry list of things that you're supposed to do and the way that you're supposed to do them, very little of that applies, like you said, right, to people who are living in very common situations in this. And I think that's the important term, very common situations. You know, I think it's easy for me, for you, for maybe some of the watchers of this program to understand that people who are homeless or living on the streets don't have access to a place to wash their hands or to a place to be separate from people who are sick or to self isolate. But I think there's a larger group of the American population that is not dramatically vulnerable in that way. But in fact, they're living in crowded conditions, they're living in a space that maybe would be optimal for four people, but eight people are living there or two people and four people are living there. So just as a couple of examples of how this can play out and things that that I know about. So some of the women that I know who had been incarcerated and had been living very precariously post prison. So they've been kind of circulating from homeless shelters to battered women shelters to drug treatment programs. In many instances, their families have said, look, you can come home, come home to us now. It's not safe for you out there. So they've moved in with their families who don't have space for them. So they're sleeping on a couch in the living room. And very likely in some of these families, and I know this from women I've spoken to, there's also elderly grandparents who had been in some kind of a long term care facility. And the family said, look, we can't leave you there or the facility closed down. So the grandparents have moved back in. Maybe there are young adults in the family who had been kind of managing with a couple of roommates, a couple of different jobs. They've moved back in as well. So now you have eight, nine, 10 people in a one or two bedroom apartment with one bathroom. And yes, all of those people are happy that they have this, that they're not sleeping on the streets, that they're not in shelters. In a sense, it's funny because some parts of what you say or describe, I think people would understand, hey, that's luck. That's good. That's a good instinct or that's a good opportunity at least to be, you know, again, pulled within the embrace of your family. But it's a struggle and it's a struggle to follow the health rules. You know, I've heard a fair amount of ranting about parents who are not adequately supervising their children. You know, my kids are grown up now, but I have four kids. And looking back at what it was like to have four little kids at home, I think that my kids would be literally climbing the walls. They would be scratching each other's faces. They would be throwing things around. They wouldn't be sitting in front of the computer doing their homework that the teachers have so nicely assigned. And then I think of families that I know where the parents are really trying and maybe even one of the parents is home is not considered an essential worker, so is home and can supervise the kids. But there's one computer. And there's three kids. And there's a couple of adults. And there's lousy internet access. And there's kind of a lousy computer that keeps breaking. What are they supposed to do? So those kids are going to fall further behind in their schoolwork. Right. And I know that there's, there is a lot of data already out there over, you know, decades that show that a disruption to the school cycle like this is disproportionately emphasizes again the existing inequities that people are dealing with. Oh, absolutely. You know, so I talked to some of my friends who have grandchildren and they can't be with their grandchildren right now. And it's very difficult for them. But they spend hours every day face timing with their grandchildren, meeting them stories, helping them with homework. And I think that for many households, that's just not a possibility. Grandma doesn't have the technology. She doesn't have the know how she doesn't have the time. She's not healthy enough to do this. Yeah. And, you know, again, I'm thinking, as you, as you speak, I realize, what do I complain to my friends about? And you complain, you're, you know, being cooped up as we are talking to them on our devices as we are noting that, Oh my God, this pandemic is happening at least at a point in our technological evolution in this country, where we can connect with each other. And in fact, we have a better chance of getting our work done efficiently in some ways and of getting to our friends and loved ones because we know everybody's accessible in a way that they aren't usually. And I think that's true for a certain segment of the American population and actually a fairly small segment. So one of the pleas that I would make if they're educators watching, if they're media folks watching, if they're healthcare professionals watching, social workers watching, when, when you give all of your excellent advice about how to manage anxiety and how to manage hygiene and how to manage your kids education during this time, please try to hold an image of a family that has three kids, a couple of elderly, perhaps disabled grandparents, maybe a 50 year old uncle who just got out of prison, and they're all living in a small space. So, you know, can we think of helpful ways to engage with them to offer some kind of support to people who are not in privileged circumstances right now? Yeah, especially because you, you've just very aptly and kind of evocatively describe the conditions within an apartment. But then that apartment is also located in a high density area where you have all kinds of people walking back and forth and just touching the same doorknobs and the same banisters. And, you know, and that is life that that is, you know, again, we cannot close those folks in that situation. And we just I think it bears repeating that's common, you know, the privileges that I enjoy are not common in a lot of ways. And those folks don't have the opportunity or the option of cloistering themselves in the same way as those of us who do are doing and complaining about, of course. So, you know, we think of the challenges of people who live in crowded urban areas. And certainly the pandemic has, you know, hit hard first in urban areas. But it's certainly spreading throughout the country. And I think there's going to be a whole other range of challenges for people who live in Appalachia for people who live in rural areas, where they're not going to have the challenge of the dense populations, but they're going to have the challenge of the absence of hospitals and doctors. You know, our health care system is heavily privatized in this country. And many, many rural hospitals have shut down over the past couple of decades. So in a previous incarnation, I did research in South Texas, Idaho and Mississippi, with Americans who don't have health insurance, which was about a third of the people in those states. And for many of them, the closest health care provider was 50 or 100 miles away, with no public transportation to get there. And, you know, if your income is low, you probably don't have a reliable car. So I think that's another whole piece that's going to open up. There's one more thing I want to say about health care before we move on to the next topic. So it's very concerning, obviously, that people who have what we call preexisting conditions seem to become sicker from the virus. And that leads to all kinds of dilemmas about rationing of health care. Do we ration health care to people who are most likely to survive? Well, then that's not people with preexisting conditions. But we know that poor health is not spread evenly around the population. We know that low income Americans and Americans of color, indigenous Americans in particular, just have higher rates of chronic illness because of racism, because of, you know, lack of opportunity to good health care. So an additional concern that I have right now, and this is what I see from the women that I know, which is that because they've been told not to go to their doctor's offices during the pandemic, they're not managing their chronic health conditions properly. So they're not managing their diabetes or their COPD, or their arthritis. And at some point, that's going to erupt into kind of a second wave of an epidemic. And I don't know if we're prepared for that. Yeah, I mean, what you describe is an understanding of, you know, it's understandable that it is grim. What you're describing is a grim depiction indeed. And I hate to throw this back at you, somebody like me, somebody listening probably are like, you know, is there anything that that we can do about this that you would suggest recommend that that can be done? I think there are things that can be done. Look, individuals can't make systemic change. You know, for me personally, this systemic change that I want to see was the change talked about by Elizabeth Warren and Bernie Sanders. And I hope that their ideas will make it into the Democratic Party platform. But as individuals, things that we can do, I think that healthcare providers can proactively reach out to their patients, they can proactively call their patients and say, How are you doing? How can I help you? Do you have enough medication? Do you need me to phone in a renewal of any of your medication? Don't wait for your patients to call you. I called one of my doctors the other day and had to go through a menu of about 10 different numbers to press before I got to a receptionist, not even to the doctor. If I had kids screaming at me and pulling at my pants while I was doing this, I would have given up. So please healthcare providers. I mean, obviously not if you're working in the ICU. Yeah. But you know, primary care physicians, etc. folks who are not seeing their patients. Yeah. And you know, not just primary care physicians, I think dermatologists and gastroenterologists and all of those kinds of people can reach out. I think therapists can reach out. I think another group that can reach out is teachers. I think that for a lot of kids, there would be great benefit in a teacher speaking on the phone directly to the child as opposed to doing this over the computer with, you know, kind of a more formal way. I've been I've been speaking with my students one on one on the telephone. And I think it's really been helpful for everybody. It's just a other way to relate. I think that staff at places like boys and girls clubs that have closed down, you have lists, you have phone numbers, you can be reaching out to kids, community policing groups can be reaching out. The senior center in my town, I know is reaching out to everybody over the age of 80 or something like that. I hope that other towns were doing it as well. Yeah, also recently spoke to sorry, just a brief interruption, we recently spoke to the executive director of our own council on aging here in Arlington. And it's amazing how proactive they are being. In fact, not only with their own population, but in fact, Arlingtonians of all ages, they're providing kind of essential goods and services for helping to provide those. That's very encouraging. And then many towns are asking people to sign up to call elders or to call people who are housebound because of health issues. And I think those are the kinds of things that we can do. Now that's not going to solve the systemic problem. It's not going to solve centuries of racism. And it's not going to solve the reality that the majority of Americans do not have any savings and scrape by paycheck to paycheck. But I think that it, you know, I think that every drop counts. I don't think that's what I was hearing in saying that or thinking about I was thinking that's those are drops, but drops matter too. Right. And drops are something that we as individuals can contribute and and making those connections just just trying to pull, you know, people in just just addressing that the essential isolation that we in which we have placed ourselves understanding again that there are many, many folks out there who do not have their own home in which to do it and and a way to either connect to other people because they are by themselves or they're in a situation where there's too many people around and they can't get enough privacy. So just again reaching out into all those households. That makes that makes a lot of sense. And then I think on a sort of middle level, I would appeal to landlords. And you know, I think that there are many landlords who resent that their tenants are not paying them rent. You know, take a chill pill is what I would say. If you kick them out, you're unlikely to find other tenants right now. So you'll be getting nothing and no hope of getting anything. So I think that this is a good time to feel that you're very blessed that you own not only your own place to live but other places that people live in and just allow things to to calm down a little bit and don't turn people out onto the streets. If nothing else is going to hurt your own health, people turned out on the streets can't do proper social distancing and that's going to keep the virus spreading. I think I would similarly say to employers, you know, think about whether you can afford to keep paying partial salaries to people. You know, it's not the people that you're letting go or furloughing without pay or getting other jobs. Nothing. And you know, I know we don't like paying people for doing nothing. But sometimes that's better than if you've if there has ever been a situation in which that makes sense. And even the federal government has, you know, understood that on some level. Yeah. Then this is it. We let let's let's move on. Although I think, you know, obviously each one of these topics could could easily cover we could cover we can devote hours to them. But you've mentioned a number of things that obviously there's a lot of interconnection and so segueing from the public health or even private health situation, individual health situations into the economic situation is it is, you know, makes a lot of sense. So what I wanted to ask you about specifically is that you had mentioned the fact that there are a lot of folks out there, many, many women who and you had talked about essential work or vital work. And I know that there are real that there's a real conundrum for a lot of especially women who are working in what is called essential or vital work. Tell us a little bit about their situations. Yeah, so I think the easiest way to to get at that is, you know, we hear so much about the heroes who are working in the front lines of health care. And the face of that is usually doctors and registered nurses. But the majority of people working in hospitals are not doctors or registered nurses. They're actually cafeteria workers and cleaners and above all aids. And the workers who have the most prolonged up close personal intimate contact with patients are the aids. Those are the people who are washing patients, turning them over in bed, feeding them. So they're very highly exposed to the virus. So I think that's, you know, a broad issue that a lot of the what we would call the intimate labor that's done in this country is done by women for low pay and heavily women of color and also a fairly high percentage of undocumented women. And you mentioned intimate and we could also say invisible. Yeah. Right. Because again, the problem is as you just aptly noted, the majority of employees in any given hospital or care facility are going to be those who are providing the most kind of menial necessary, but unappreciated services. And they are virtually invisible to most of us. Yeah. So a lot of them have been laid off. Which means that they just don't have an income and a lot of women are the primary financial supports of their families. A lot are still going to work and they're balancing going to work with still running the household. We know that overwhelmingly although women have entered the labor force at numbers pretty much equal to men at this point, women are still doing the overwhelming majority of housework. You know, one of the things that we like to think about and I like to think about is whether a major crisis shakes things up enough that it can be an impetus for change. And you know, I'm hoping that maybe in the wake of this, we'll start to see more equal distributions of gender in housework. Because there are many households where the woman has a job that's considered essential and the man has been furloughed. Right. It'll be interesting. I hope you have. Yeah, looking for our silver linings, that could definitely be one of them. What I'm hearing informally is that that's not happening to a large degree and more than that what I'm hearing is there's been a serious uptick in domestic violence. Yeah, so yeah, we might as well actually fold that in now to the conversation. Yeah, obviously we all know no matter how fortunate we are, we all know that in sharing a space with the same person or people for a prolonged period of time, you know, it ain't easy for any of us, but significantly worse obviously in so many situations where right now, as you said, people can't even access therapy if they, you know, we're getting those kinds of services or they have no buddy to, you know, no recourse to go, you know, into the emergency room or something like that if something were to happen. Yeah, so one of my students works in one of the local police departments at the front desk and she said there's been an enormous increase in domestic violence complaints, but I had a conversation with my son who is a prosecutor in New York City and I asked him if they're seeing the same situation there and he said they just had an informal discussion about this the other day. They're not seeing an increase in domestic violence calls and they think the reason is that people don't even have a safe place to make the call from. So that's really a scary thing. Yeah, you know it's interesting also because I've been reading recently about how in New York City as well as other major metropolitan areas crime itself what they, you know, what the police would treat as crime as plummeted because of course people can't get out and about and in confrontations etc etc but that discounts what you're just talking about. So I think we have a very funny idea of crime in our country and I think you just sort of ask people what's crime they think about violent street crime committed by a stranger probably by a male person of color but not only have we seen an increase in intimate and domestic violence and crime there's probably although I don't see that it's been tracked carefully yet been an increase in white collar crime which is a big part of the landscape of criminal activity in our society but it's not the iconic you know masked criminal but um you know I know we're running out of time and I wanted to just segue a little bit if we're talking about gender issues right now. The elephant in the room of course is that men are becoming much sicker and dying at a significantly higher rate from coronavirus than women so I think it's not appropriate for us only to talk about how this pandemic discriminates against women to talk about why it is that men are dying more than women. Was that a direction that interests you? Oh absolutely please and then we'll just we'll we'll find out about that I'm going to ask you about resources and strategies around some of the things that we haven't meant you know that we've mentioned the problems but not what might be done about it and that and then we'll wrap up please by all means. So this is kind of a big mystery and it's possible that there is just simply a genetic component you know we all learned in high school biology that women have two X chromosomes and men have an X and a Y chromosome and a Y chromosome just doesn't have as much genetic material on it. We've known for quite a while that in once kind once the society reaches a certain level of being able to meet basic needs. Men die younger than women that's true almost everywhere in the world today. One of the things that we know is women are sicker but men die quicker. Women make more visits to the doctor. Women take more medicine than men but men die younger than women overall. So some of the thinking that I've been hearing and you know some of my own thoughts on this issue based on research that I've done is that a couple of things might be contributing to higher mortality rates among men. The first one is that more men than women smoke and we know that that damages lungs. Right well some of the first stuff that we heard coming out of China right first theories I should say. China was certainly the case that more men than women work in occupations like mining that damage the lungs but the truth is in the US women work in equal numbers in occupations that use chemicals and various kinds of cleaning chemicals. So it's I'm not sure that that is a real gender distinction here though it might be. Something else that we know is that you know because of how people are socialized into gender roles men are more reluctant than women to say when they're sick. Studies show that already in third grade girls are more likely to tell the teacher when they have a tummy ache. We're in kindergarten that's not the case. So in those couple of years this gender gap opens up. So it's likely that men were not getting adequate health care before coronavirus and we know that that's the case we know men make fewer preventative care visits to doctors. Women men read less about health. Men are less likely to take vitamins all that sort of thing. So they entered in poorer health. It could be that men are less willing to admit to really being sick and so they're taking longer to get appropriate care once they're sick. We just don't know but the final piece that I think is really important to think about is that more men than women live in situations of really extreme social isolation. A very interesting study was done during a major heat wave in Chicago a number of years ago. It was just an unbelievable heat wave. The city had never seen anything like it. There was a huge number of deaths but when the numbers were examined afterwards it turned out that the deaths were disproportionately of men who live alone. And it turned out that women who lived alone had social contacts who were calling up. Are you okay? Can I bring you some ice cubes? Do you want to come sit in front of my air conditioner? And more men were just dying of heat stroke in their own apartments. So I wonder if that's a piece of what's going on as well. This question is not specific to there is no gender distinction in this question but what you just brought up the fact that what was happening the fact that men live in greater social isolation in general or numbers much greater than women. I'm wondering whether you have heard formally or informally about any rise in suicides coming out of you know the current situation? I believe there has been. I haven't seen numbers recently but I I did glimpse a study. There has been a rise. You know it's it's so hard to assess deaths from suicide as opposed to deaths from other causes. You know there's a sense that coronavirus deaths are under reported because people who die at home. Right, right. Are not counting. You know in terms of the social isolation you know you wanted to get back to you know what are some things we can do what are some resources. When I go for a walk with one of my girlfriends which I do every single day I see dozens and dozens of pairs of women socially distanced very nicely six or eight feet walking together. I see almost no men doing that. So I guess I want to encourage men to think about how you can make your social connections stronger. I think that's good for you and I think it's good for the women in your lives. I think if you're if you have stronger social connections you're less likely to become really angry. You're less likely to drink too much and those are things that hurt families not just the individual. Yeah I mean just as an aside just over the weekend an opportunity arose because of all the things we've already been talking about for myself to to get together virtually through Zoom with a team in a sport that I played a team of guys that I haven't seen some of whom I haven't seen in 25 years and it was very clear as I was looking at the screen that these guys are all in different kinds of situations. Some of them had little kids or you know kids or grandkids or whatever kind of coming through the picture others were clearly by themselves but this was an opportunity for all of us to connect everybody clearly you know felt like it had been well worth it and we want to do it again etc. That's lovely. That's another of the kinds of things I think perhaps that you're advocating. So circling back to things that we were talking about earlier you know I particularly urge teachers to reach out to boys and to male students you know I'm a woman's health advocate so it you know it might sound funny for me to be advocating right now for boys and for men but you know we all live together and you know we all are our survivals are interdependent we know that girls do better in school than boys girls graduated a much higher rate girls have higher grades girls are much more likely to be compliant with homework that teachers assign that means boys are at risk right now we know that the school to prison pipeline which is kids getting in trouble in school and ending up in prison yes there are girls in the pipeline but there are many more boys so teachers please please reach out to the boys think really creatively about how to get them engaged in something that's socially productive that can help them feel good about themselves that can help them feel competent I would say the same thing to healthcare providers you know your women patients might be more persistent in trying to call you your male patients are more likely to not even remember what your name is or to certainly not work through that 10-stage phone menu I think the same thing would be true for leaders of churches and of synagogues the women probably are doing a better job right now of being socially engaged and of understanding what socially engaged physical distancing means I think that we need to do some really good proactive outreach to men I think when we think about domestic violence our tendency is to think about how to protect the woman we need to be putting some creative energy and resources into how to encourage more men to find ways other than violence to manage their frustrations their feelings their despair excellent excellent points and yeah the fact that your particular area of expertise as women's health doesn't make you any less of an authority in a lot of ways and certainly that sounds like excellent excellent advice I'm wondering do you have any resources that you would point people towards for dealing with all the different situations or any of the different situations that that have you know that we've described in our conversation today I mean I don't have any secret resource that I know about but every one of the towns and cities in Massachusetts has some kind of a centralized number to call to connect with food pantries to connect with healthcare with whatever so that's really what I would it's it's all being organized at the municipal level not at the federal level and you need to support our communities yes but anything else that that you would like to at least mention before we sign off the final thing I want to mention is you know I I encourage everyone myself you everyone I know everyone who might be listening to this or watching this to think about how we can use this horrific crisis as an opportunity to hit the reset button on a lot of the problems in our society can we rethink education can we rethink health care can we rethink political participation and let's use this crisis as an opportunity and not just as another nail in the coffin of democracy and I think that is a real option of what's going to happen and we need to fight against it yeah and as you said you know we can and should work to get those drips and drops that we can as individuals and as small communities etc systemic change is necessary is is out there you know we can stay hopeful and we need to stay alive yeah there's that all right well thank you very much for taking the time yet again a very substantive and and kind of thought-provoking conversation I also think you did open the door for a lot of folks who might be viewing to the situations of a lot of other people not similarly situated so wish that we could do more for those populations nonetheless recognizing what they're up against is in and of itself at least a move in the right direction hopefully recognizing that when we say those populations we're talking about the vast majority of americans again yes again to to to reiterate that it is you and me we are the ones who are you know in the kind of special situations in a lot of ways and we're talking about many many more americans than us and our friends who are dealing with this stuff so appreciate your sharing this with us and and let us stay hopeful um uh that that change can happen that things can get better and that we will not be next time we talk to you that it will be once again in the studio or side by side as we were last last time so uh thank you very much professor susan sarad appreciate it we'll talk to you again good luck with everything both within your family and in your work and the folks you deal with thanks for joining us thank you appreciate it and to you our audience thank you for joining us for this episode of justice in the balance i'm james melanne we'll see you later