 I want everyone to take a moment to think about your favorite story. Feel free to share it with me using the chat if you are able. For me, my all-time favorite book series is The Hunger Games, and I will argue with anyone as to why I believe Suzanne Collins is the Shakespeare of our time. My undeniable love of stories truly began around the fourth or fifth grade. If you ask anyone that knew me during this time, they will likely tell you I always had a book in hand. I enjoyed the feeling of getting lost in a fictional story, imagining myself narrating or observing the events written on the page. More recently, I have begun to love history books, memoirs, autobiographies, and biographies. Although the experience of reading sci-fi and nonfiction are completely different, any literary scholar or fourth grader can likely tell you every good story is comprised of five parts. We have come to know this as the plot diagram. First you have the exposition or beginning, then some rising actions, then a climax, some falling actions, and the resolution or ending. The exposition, climax, and resolution work together to build suspense to create a unified storyline called the plot. In fiction books, the last page, it denotes the end of the story, and the storyline of the characters are over. But in nonfiction books, while the last page may denote the end of the book, the story actually continues. Every day we are each living a nonfiction story and continuing a story that predates us. We each make individual decisions that impact our lives and the lives of many others. At the same time, we are inheritors of a collection of stories from our families, our communities, our nation, and all of humankind. Some of these stories are initiated by us, whereas others are inflicted upon us. This is the paradox of life. Now I want to continue by sharing a few short stories. They are not my story per se, but they are stories of this country, where we've been, where we are, and most importantly, how I hope our story continues. First is the story of repression. In 1492, Columbus saw the ocean blue, marking the beginning of America's war against indigenous populations, American Indians, Alaska Natives, and Native Hawaiians. This was later coined the indigenous Holocaust. Researchers estimate that over 175 million deaths were caused by war, repression, and harsh conditions. Today, American Indians and Alaska Native persons died from alcohol-related causes 6.6 times more than the general U.S. population. Next, a story of exploitation. In 1619, the first documented, stolen, enslaved Africans arrived in Jamestown, Virginia. From the mid-1800s to the 1990s, cruel medical experiments on black bodies were widespread throughout America, including electric shocks, brain surgery, and amputations without anesthesia, unethical clinical trials, and the development of modern gynecological procedures. Harriet A. Washington provides additional context in her book, The Medical apartheid. Today, black women are 3.5 times more likely to die of pregnancy-related causes than white women. And black infant mortality is two times higher than that of white infants. Finally, a story of exclusion. In 1882, America passed the Chinese Exclusion Act, effective until 1964. And more recently, the Department of Homeland Security has been enforcing stricter border patrol laws, detaining over 500,000 people every year, the majority of whom are Haitian and Mexican immigrants. Today, Chinese, Mexican, and Haitian immigrants are excluded from health insurance at disproportionate rates. 25% of documented immigrants and 46% of undocumented immigrants are uninsured, compared to just 9% of uninsured American citizens. These three stories provide evidence that we can attribute many of the existing health disparities in our country to our stories of repression, exploitation, and exclusion. These events have exacerbated the effects that we are continuing to experience from our COVID-19 pandemic story. Today, indigenous, black, and Hispanic persons are about two times more likely to die from COVID-19 when compared to white persons. But where did this story begin? The US government has acknowledged 16 critical foundational plots that are the underpinning of our broader American story. We have come to know these as infrastructures. Infrastructures from hospitals to plants, dams, water facilities, transportation systems, the internet. Critical infrastructure supports every aspect of our daily lives. But there is one infrastructure that the US government has failed to acknowledge until more recently, racism. Racism was the beginning of our American story. Racism is an infrastructure that perpetuates inequities and disparities across all 16 of our existing critical infrastructures. And until we decide to end this story of racism, it will continue to be the primary foundational plot in all of our stories. So how can we end this plot of racism? First, we acknowledge it. And healthcare racism as an infrastructure does not only materialize itself as health disparities. It is also recognized in the underrepresentation of minority medical providers, the unconscious and conscious bias that leads to discriminatory care practices, and limited access to high quality healthcare in many urban and rural settings. At the 1966 Medical Committee for Human Rights meeting, Dr. King is quoted saying, of all the forms of inequality, injustice and health is the most shocking and most inhuman, because it often results in physical death. More than 50 years later, we are finally beginning to listen to the story King was trying to tell. Today across the country, many local, state and federal organizations and governmental agencies have declared racism a public health crisis. This is an attempt to advance racial equity injustice by acknowledging racism as an infrastructure. So we have all of this, but then what? We established a new plot. The beauty of our nonfiction life stories as one story ends, another is just beginning. Other than continuing to let racism as an infrastructure be inflicted upon us, we as a society have the collective power to initiate a different story if we choose. As we work to end this plot of racism, we can begin to outline a new plot for our American healthcare infrastructure. Health equity. Health equity is achieved when everyone, regardless of their race, sex and socioeconomic status can attain their full potential for health and well being, eliminating inequalities, resulting from differences in health and overall living conditions as defined by the World Health Organization. So we have this new plot of health equity. Now what? We create and outline. The ideal time and setting would be after a devastating climax that revealed the repulsive disparities exacerbated by racism. After this crisis, there would be a narrow window of opportunity to rebuild differently. And if you haven't guessed it, I believe COVID-19 is the climax of our current story. The main ideas and actions needed in this outline would be to first embed social determinants of health within our medical care infrastructure. Social determinants of health are the conditions where people are born, live, learn, play, worship, and other forces that affect a wide range of health outcomes. Next, we establish and commit to anti-racism policies to begin combating the negative effects and detriments that racism as an infrastructure has caused. And finally, to restore our broken American healthcare infrastructure, we shift to a national learning health system where we can systematically integrate internal data and external evidence to continually improve and strengthen equity by putting new knowledge into practice. The main characters in this story are at different levels, individual, community, and national. From different disciplines, the government, engineering, education, sociology, public health infrastructure science, implementation science, urban planning, public policy, technical trades, law, and you. So this is our story. Stories of where we've been, where we are, and most importantly, how I hope our story continues. On July 4, 1776, the Declaration of Independence initiated our American story. We hold these truths to be self-evident that all men are created equal, that they are endowed by their creator with certain unalienable rights. However, the undoubted reality of this country is that all characters are not treated as equal. The undoubted reality of our country is that we have not ended this plot of racism, and it continues to perpetuate in human disparities in many of our critical infrastructures, because racism is an infrastructure. But there is hope. Together, we can mobilize the elimination of racialized health disparities in an effort to ensure that alongside life, liberty, and the pursuit of happiness, health equity becomes an unalienable right for all. But we cannot rewrite the stories of yesterday. We can turn the page and create an outline for how the story can continue with health equity as an infrastructure, becoming the new plot in our subsequent stories. And if we are able to do that, that will become my favorite story. Thank you.