 Good morning Biohacking Village. I am so excited to be here today. My name is Nia Johnson. I'm a PhD candidate in health policy at Harvard University. I am also a bioethicist and a lawyer, and I'm just so excited to be here today to talk to you all about reflections on healthcare equity and how we can ultimately not miss the point of 2020. You know, we're coming into the middle of 2021. I can't even believe it. And I think it's time that we actually look back over 2020 and see what we may have missed and also reflect on where we need to be going and not just reflecting for reflection sake. I would like to thank Nina Ali for inviting me to be here today. She was so gracious by reaching out to be on Twitter, and I'm so happy that she, she did. And I am just looking forward to getting started with you all, even though this is in a virtual format. And even though the Delta variant, you know, seems to be taking over all of our lives. I do hope that we are able to hopefully meet in person one day. I'm excited to hear from all of the other speakers. And I think it's going to be a great day, a great day of presentations, whether we are doing this virtually or otherwise. So let's just go ahead and, you know, get on the ride, strap in and talk about how to not miss the point 2020 reflections on healthcare equity. And so, I was thinking about what I wanted to talk about today and thinking about how I wanted to frame this conversation. And, you know, I thought about where I was at the start of the pandemic. And so I remember I was in school, I was in class at Harvard Kennedy School of Government, and I was walking through the halls and we've been hearing about, you know, this thing called COVID-19 I had a friend who had recently been abroad and came back and was explaining to me like, yeah, this virus is really taking over abroad. And, you know, it's starting to become serious. And I was saying, there is no way that this could ultimately change all of our lives. It doesn't really make any sense. And as the days went on it started to become more and more apparent that this was actually serious and that we would actually be ending school. And I was just baffled. I was like, there's no way that this could actually be the case. And my last COVID memory I think at the start of the pandemic in March 2020 was giving my sneaking a hug to my friend in the hallway because that's when we like started hearing that we weren't supposed to be like in close contact with other people. We were supposed to be remaining socially distant. And we were like, oh my goodness, I don't know what I'm going to see you again and we just kind of looked around and hugged really quickly. And then, you know, just stopped hugging and that was the last experience I had with a lot of my friends from school. And that's where the pandemic really just started kicking into high gear. And being the thing that's ultimately changed all of our lives. And so, you know, just to review a bit of the pandemic timeline, you know, early 2020, you know, starting in March. We're all learning, you know, what COVID was, I like to describe this time with everybody kind of becoming a mini public health expert in thinking about COVID-19 and thinking about, okay, how is the pandemic affecting us adversely? A number of other things. And then also ultimately just like adjusting to the fact that no, this is actually happening. Lockdowns are actually happening. I remember being in meetings and literally saying there is no way that they're going to close everything. And I'm speaking to a colleague from a different state where they had already started closing down on everything and she was like, no, no, no, I don't think you understand. We're really about to move into a lockdown mode. You know, really just a devastating time as we're all adjusting to understanding how serious this is. And then by, you know, kind of spring summer 2020, we start realizing that like, no, this lockdown is happening. And we are all trying to understand our new normal, right? Like what does it mean to work at home with family and children? And, you know, we started seeing unemployment start to skyrocket. Like everybody was just trying to like wrap their mind about this really wild time where we are all forced to be indoors. By the time you get to summer 2020, you know, we start seeing the surges, right? And new normal, what everybody is calling the new normal and outdoor gatherings, right? We're watching the cases skyrocket and we're watching misinformation become rampant. We are watching, you know, individuals, you know, refuse to wear their masks, you know, refuse to socially distance from others. We saw a lot of denial the COVID-19 pandemic. And, you know, realizing that maybe the wavelength in our country on what public health should be and what COVID-19 should be is very, very different from what any of us could have anticipated. But we also started to learn how do we adjust. So I know for myself, you know, I spent more time with my family. So I left school, decided to spend some time with my parents and not spend my time in a traveling sense because of course no one was traveling. But, you know, when the stay at home order started, I got in my car and my parents were like, we don't really know what any of this is. We please just drive home. Like just try to be with other people in the midst of stay at home orders. And it was almost like an interesting time of reflection because I had not spent that much time with my parents as an adult before, but it ultimately ended up being very enriching. And so you kind of have these dual stories, right? You have some stories of people who were like learning more about their children learning more about their parents learning more about their partners during the pandemic. But then you also have just the mass devastation of people dying at rates that were staggering and having to grieve without being able to properly bury your friends and relatives without having the funerals that you may have wanted to have. And, you know, kind of finding the highs and lows of the pandemic and figuring out where, you know, we belong and I think in addition to that, you know, we've started developing an affinity for outdoor dining I will say I was not an outdoor dining person before the COVID-19 pandemic. And now apparently every time I go out to eat I want to be outdoors. I'm going to get to the fall of 20. Oh, and I'm sorry, once we get to the summer of 2020. We also see one of the largest uprisings and movements for racial equality that our country has seen in a very long time and I will circle back to that in greater detail. But I would be remiss to talk about a code, a COVID-19 timeline and not actually elaborate on what that meant for so many people in this country and why it's critical that we actually incorporate that into our reflections for COVID-19 for the COVID-19, I guess year 2020. And by the time we get to the fall. It's the holidays right and we're facing the bitter reality that we will have to pick between our family traditions and our help. We have many individuals who are starting to feel more isolated and feeling like you know, they don't really have anybody to connect to, and also some people who are just making the choice to say you know I need to be among family. And we start seeing you know, more people using COVID-19 tests to travel, learning about the importance of self-quarantining as well, to make sure that you're not getting your friends and family members sick, understanding you know the role that COVID-19 plays in cold and flu season, and also the importance of masks wearing for cold and flu season as well as COVID-19. By the time we get to winter 2020, we are moving towards actually having a vaccine, which you know feels amazing and you know of course there were the uprisings in 2021 with the storming of the capital, an election of a new president and many other events. But for the sake of this conversation, I want to focus specifically on 2020 and kind of isolate that year because you know we are still in 2021. I'm sure there will be a lot to reflect on you know if we look at both years in tandem, but I want to make sure that we concentrate this discussion to 2020 to kind of put in perspective where we started to see this massive paradigm shift. And so circling back to summer of 2020, you know, I did not expect to see in the middle of a COVID-19 pandemic in the middle of a global public health crisis to see a racial reckoning. You know, I am from the Washington DC area. You know, I have families I graduated from historically black colleges and universities I myself am a graduate of historically black college and university. And I've always been very familiar and like well first as a scholar of race and well familiar as a child but then well first as a scholar of race bioethics and the law and health policy in the history of black American people and movements and how a lot of the rights that have been achieved in this country have been done through really the battering of black and brown bodies, agitating for their rights, protesting for their rights and asking for full practical citizenship as members of this country. And so that's always been a part of the dialogue always been a part of black American culture. And yet, I don't know how in the middle of a pandemic I never thought that I would see this manifested self in the way that it did. And you know and I should clarify that when we see public health crises in the US, I generally expect disparities. Why do I expect disparities. Well, I mean first of all, our system to the United States have been built with both passive and active and private and public methods to just to encourage health disparities amongst racially marginalized individuals right. And so some of that isn't even necessarily intentional. When we think about it in the current context, but historically it was right because when you take health care from individuals and you allow for them to kind of live in a fluctuating state of not fluctuating, live in a constant state of poor you actually are really keeping them subjugated if for no other reason but for the fact that their bodies are not in tip top shape to push back against systems that oppress them and hurt them, even though in many cases. Black Americans have agitated regardless of the health care that's been taken away from them in regard regardless of the tip top health that most people would need to be able to move forward and press forward emotionally and physically through instances of domestic terrorism and violence against their communities. You know they still have pressed forward, but by keeping health from individuals you remind them on a regular basis that you are not equal with the rest of us and that is something that has happened in the United States for a long time, intentionally and unintentionally. And so historically, we understand a little bit about that right like we understand that there was segregation, but we don't talk about segregation deeply. We think about our health care history and we think about the history of innovation of health care in the United States so whether we are thinking about, you know, black women who were experimented upon to really found the field of gynecology and slave experimentation in general right this the idea that you could let because you owned you know individual because chattel slavery was present in the United States, you were able to. You know, sell or lend a slave to a provider to a physician at the time, and have them experimented on for the sake of scientific progress right so we don't talk about that in the everyday rhetoric. We don't talk about how hospitals were segregated and that didn't just mean that you know, black patients and white patients couldn't be treated in the same space. It also meant that if you are black person pursuing care that you could be turned away because of the color of your skin. And this is not just you know, for like little ailments right we're not talking about when you go to the emergency room, and you may have broken your finger and you want to be able to get a splinted sprain to ankle right we're talking about people who are dying from diseases dying from bullet wounds we're talking about women who are in labor, people who have real emergency situations who are being put you know being denied entry to hospitals. Because of the color of their skin, we are talking about black and brown Americans being treated in boiler rooms of hospitals, because they cannot be on wards with white Americans we are talking about black women giving birth and tuberculosis wards. These are all things that come together when we talk about the active impact of segregation in black American for black Americans and hospitals. Right, we are also talking about for nutrition and the impact of redlining and making sure that there are only certain grocery stores that come into black communities and certain grocery stores and grocery quality that does not come into black communities, ultimately perpetuating bad health and poor outcomes and black communities right. And that's kind of very surface level historical analysis of where our country has moved with healthcare, really culminating with the passage of the Medicare and Medicaid. Legislation that was tied to the Social Security Act that ultimately desegregated hospitals because Medicare Medicaid funding was tied to federal funding through the Civil Rights Act of 1964. And so that's when we start seeing the opening up of the healthcare system, but they're also with the disparities persist, even when we're not necessarily talking about, you know, actively keeping black Americans from being treated in the same hospital as you, or, you know, or providers, you know thing like will we only treat one type of patient we don't treat another type of patient. These aren't and we're not also talking about the explicit racial animosity that we even see today sometimes right we're not talking about burning crosses, we're not talking about you know, using racial slurs to patients or, you know, writing swastikas on dorm rooms like you know these very poignant indicators of racial animosity. Right, some of these disparities are perpetuated in very subtle ways such as you know a nurse saying that a black patient is difficult because they ask a lot of questions. And so, as a result, they start visiting the patient less and visiting the patient family less, allowing for the patient to not be monitored as closely as they should be. You know, if you can see it in other settings like in school settings it could be like a parent of your child's classmate saying that social welfare programs are for people who don't work as hard and want to game the system. You know, meanwhile you're working in multiple job multiple jobs to stay a quote, and are using health entitlement programs just to make ends meet not because you're not working hard, but because sometimes you were down on your luck or system has been built in a way that keeps you from having all of the opportunities that you would like, you know it could even be seen in the graduate school setting right it could be a classmate in your medical school, or your nursing school saying to you that you are probably just a quota or diversity candidate. Even when their test scores are lower than yours but they're relying on stereotypes about who you are. And the thing is that you know these are not instances that you know we're just pulling out of hats here right. Like these are instances that have been backed by scientific research, and I've been this accounts of marginalized people. We know that black Americans receive worth care across 40% of quality measures. We know that there have been multiple studies that have said. Excuse me, we know that there have been multiple studies that have said that you know black Americans and brown Americans have received as being more belligerent patients and that does lead to providers visiting them less interacting with their families less and if you're not monitoring your patients. They are ultimately getting less care. Right, and these events inadvertently for many create disparities and treatment. They also create stress on the body, and also create a certain amount of environmental weathering on the body, ultimately putting people in a worse position to fight off global events like a pandemic. And so when I saw that black American for dying from COVID-19 average equal to their share of the population in all states regardless of income. I was not surprised, you know, I'm sure that there were many people who thought that COVID, you know, was just going to be a disease that, you know, poor black Americans experience or could be attributed to economic status. But we know that a lot of these disparities really, you know, overshadow or not overshadow but interact with patients regardless of their income because health is something that's solely determined by income right health is also determined by environmental factors health is also determined by you know your patient history. And so the disparities that affected your forefathers can then affect you. So none of these things were surprising to me, though unfortunate right when we knew that black Americans and brown Americans made up most of the central workers workforce, you know, also was not surprised right, these are jobs that tend to be a little bit more transient. So ultimately, we're the most front facing towards the pandemic. When I read that you know black Americans knew double the amount of people who caught or died from COVID-19 compared to white Americans, I also was not surprised due to that proximity to the disease in general, due to the fact that many black and brown Americans tend to live in larger communities of people where they're interacting with each other more often. And these were all things that came together that I can't, you know, confidently say, surprise me or caught me off guard, especially as somebody who thinks about these topics regularly. But what I did not expect was to see the racial reckoning of summer 2020 combined with the astonishment for many white Americans that things were still this unjust, and you know in case anybody forgot, you know, close to death of George Floyd, and Breonna Taylor, and a moderate being killed really by a civilian, you know, many black Americans rally together and galvanize and, you know, march and moved for change, and called out with all of the strength in the streets for something to be different, right. And there are many different ways that people have chosen to remember this moment. Some people have remembered as riots, right, some people have, you know, remembered as a movement. And, you know, at this point I don't really know if it matters what we physically define it as right like if we're drawing lines between, you know, from the burning of the first building to the last march as to put together what this event actually was. I think what is important is to understand the heart and spirit of this event because you're seeing a combination of injustice and frustration and pain and anguish of a community that is grieving, double the rate of the majority population in this country. You know, a group of people who have experienced unemployment at unprecedented rates, not only during the COVID-19, during the COVID-19 pandemic that is still ongoing, but also in other events, other historical events like the Great Depression being adversely affected and disproportionately affected by these events, and by a community that's been historically disrespected and exploited by the health care system at a time where they need to interact with the health care system most because of the prevalence of this disease. And so many people just decided that enough was enough and we finally had a captive audience and you know it's insane to me because when you think of when the Black Lives Matter movement started in 2013 with the death of Trayvon Martin to now, we would think that the death of a child would be enough, you know, multiple children along the way would be enough. We're coming up, you know, almost in 10 years since the Black Lives Matter movement. And yet there was something about the summer of 2020 that made everybody kind of stop and listen and start combining the dots. And it was happening in a very public way, in a way that forced everybody to listen and everybody to tune in and to have something to say about what was happening. And so as somebody who works in the health equity space, and in the health policy space, we also started to see a lot more conversations about, well, how can we create more equitable environments, right, like seeing a lot more emails of, you know, from schools saying like, well, we've, we've thought about this and we realized that this is a problem or we've engaged in this and realized that, you know, the inequities are a problem and that the uprising they're not okay, and that we need to do something. And it almost made me wonder if a bit of this was actually becoming performative, because this was something that was not only happening in the public sphere, but it was also happening in the height of cancel culture right. And so for those of us that may not know what cancel culture is. It is when an individual is socially punished by having a stance that many people believe is, you know, not moral or not optimal for society. And so generally this occurs online and it involves a fair amount of online harassment. You know, you kind of have now we're kind of looking at a society that's afraid of being canceled right, you know, like you don't want your business to be canceled because you could lose income which is, you know, a valid point and something to be concerned about we were growing up in an era of seeing an era of a lot of online apologies of people, you know, being afraid of being canceled and being afraid of, you know, losing out on opportunities or losing out on collaborations and other things and ultimately being ostracized by their peers. So there are some that argue that canceling doesn't really exist right like one cannot truly be canceled. It is for a season, you know, as some people say that ultimately individuals may come back and, you know, be able to interact in the populace the way they did before. I do think it's something to really think about when we think about how not only do you remember 2020 and think about health equity, but also in how we think about what people did to step forward and say they did something about this right so if you're afraid of being canceled, were you talking about racial equity because you did not want to be canceled, or because you were generally genuinely engaged in this process, or was it a little bit of both. And so, you know, in the, and it's ironic because this was also happening in the, you know, for many individuals who had just not thought about racial equity being something that was on the radar in their everyday headspace. Right. And so, even though it's wonderful that we have people who are pledging to do better in healthcare institution pledging to do better in the government. In all of these different spaces and it seemed like for once get with the captive audience to think about all of the ways that racial inequities effect our day to day lives. I almost wonder if many of these actions have missed the point, you know, and it's all said and done. They missed why this was happening and why it matters. And so, you know, one could ask, well, why do you think that they have missed the point. And I would argue that first of all, you know, because if you're pursuing equity just to not be canceled will be harassed by the public online. It also encourages us to do the bare minimum and fixing our systems right. And this is the core when you know the argument when people talk about performative activism right where you are just engaging in something so that way everybody can see that you did something equitable you're posting the black square on your grand page or you're posting a statement on your YouTube page or, you know, like in the influence of world you're promoting black businesses once but then you're never doing it again you're following black influencers, but you're, you know, unfollowing them as soon as a movement is over, right, you're literally doing the bare minimum, you're not actually thinking deeply about okay, what is it about our system that may have encouraged this type of behavior, and how can we actually fundamentally make it different. You know, and I think the second way that they may invest the point is that it's actually not that genuine. You know when you hear about you know black Americans who work in the tech space, or in the influencer space during the social media space losing engagement, you know, two months after the summer of 2020 uprising, you know, it shows that they weren't actually interested in your content, right, like they were just interested in saying here are black people that I follow. Let me take some of the guilt off of my shoulder so that way I feel like I've done better. When we see this in healthcare institutions right it's about having all of these meetings about diversity and inclusion, but then like forcing black and brown providers to be the faces of them and to have to relive trauma on a day to day basis to fix these problems, or asking them to come and do what's really considered a level of consulting and not paying them equitably requiring them to do free labor for our health systems and other systems and companies to fix the racial inequities that are there when really, you know, you've had the black and brown providers have been speaking up from the beginning saying like these are things that need to be different. And yet nobody was actually listening to them or engaging with them then and then coming around on the back and asking them to get engaged in free labor. That's not necessarily what we want to build right we want something that's sustainable and part of sustainability means actually being genuine and actually being invested in the process of equity. And then lastly how like what happens when they missed a point or how many have missed a point that they rushed through it right it takes no time at all to put a racial equities statement on your website. It takes no time at all to post a black square on your Instagram page saying, you know we stand in solidarity with these groups, and it's actually become like a signaling technique online right just to say, hey, you know we care about the issues or we're aware of the issues, but you're rushing through it and you're not necessarily learning right or you may be learning a little bit by reading articles here and there but you're not really engaging with the. You're engaging with the body of work but you're not engaging with the day to day activities and learning how do you not only be better but how do you look at the systems that are happening around us and build something that actually includes everybody. And so, with all of these things happening around us, even though we can look like we're all doing the right thing or some people are doing the right thing or corporation suddenly care or healthcare institution suddenly care. I think they're missing the point because they're just trying to cover themselves versus actually creating an environment where we're moving towards equitable equitable systems every single day for the long haul. Right, not just for the diversity and inclusion inclusion statement, not just to say we brought somebody on board who specializes in these issues, not just something to think about once a year or once a month or, you know with the occasional community day, you know, bringing, you know blood pressure trucks out to certain communities and what have you. We need to actually get to a point of genuine reflection, and ways that don't just keep us comfortable and keep our revenue high, but in ways that actually may involve making some mistakes. And so, as I think about you know what we should have learned in 2020, you know how to not miss the point like what we really should be absorbing. This is just my take right like in my humble opinion. This is what I believe that we should be thinking about as we move deeper into 2021. Hopefully someday past this pandemic, as we engage with what we should have been gathering this entire time. And so first of all, you know, I think one thing that we need to reflect on is that it's possible to be the most technologically advanced place, and the least equipped to engage with a pandemic. You know, so we know that the United States is one of the most technologically advanced nations in the world, one of the wealthiest nations in the world as well. You know, if we were kind of the country that theoretically you know whether that was just through a certain level of messaging that we told ourselves, or messaging that we promoted to the world like this should have been the nation that was well equipped to deal with the pandemic. And yet we look at the death toll from the pandemic and we looked at how hard it was to get our nation on one accord about how to handle this, in addition to the violence and the stressors and the, the uprisings regarding mass mandates that we actually maybe it's safe to say did not handle the pandemic particularly well, and I'm sure that there are many people who would say that that just had to do with leadership at the time. You know, maybe we didn't have the right people in charge and I think that's a very valid and truthful argument, and many different ways not to, you know, it's found upon political affiliation. I also think there's something to be said about the American approach to health care, not necessarily being the most appropriate approach for a pandemic. You know the United States is one of is the country that spends the most money on health care. It takes up a large amount of our GDP, and that just takes a large amount of our GDP when we think about social welfare, right because there are other nations that spend quite a bit on social welfare as well. We have a lot of that revenue through taxes and through other avenues, but the United States also spends a lot on treatment, you know, our pharmaceutical. The price of our pharmaceuticals is very, very high, and we have a lot of Americans have struggled to pay off their health care bills to even begin with. And so these are things that our country has struggled with well before the pandemic. It's a country that likes to throw money at our problems to some extent right. So we want the most technologically advanced treatment at all times, we want to, you know, be able to have like these elaborate engagement with health care at all times as well. We are focused more on you know medication on the back end versus prevention at the front end right. And so those things though helpful during non emergency situations. So it's time for us to think about how you can have all of these benefits and accoutrements, but you don't actually have the tools needed to survive emergency situations and to survive a pandemic. And so I would like to turn an eye towards the African continent and the countries, you know, on the continent that have performed very, very well. You know, especially in Sub-Saharan Africa, you know, different countries like Rwanda, Nigeria, that have really performed well during the pandemic. And what's very interesting about the way that many of the countries on the African continent have handled the pandemic that they were projected to do poorly, right, you know, many people looked at statistics from the Ebola crisis, and then looked at, you know, just like the amount of money that the country had to themselves amongst other infrastructural issues, and projected that there's no way that they can perform well during the pandemic. And yet they outperform most of the Western world when it came to keeping down cases and, you know, engaging in preventative measures and also keeping people on the same page. And so why did this happen? Well, a lot of this came through collaboration, you know, many of the countries were willing to collaborate with each other. Local governments within countries were willing to collaborate with each other to make sure that there was information being passed along about COVID-19 that they were all on the same page about how they were going to handle COVID-19. They also have built systems due to previous pandemics that relied on prevention in advance and sharing of information and making sure that there was good public health messaging from the beginning. Right. And these are all things that came together and made it very, you know, what could we say seamless in a pandemic, but it's created a seamless transition into protecting many African, many African individuals who live on this continent from COVID-19 while you have many people in North America, South America, in Asia, in Europe dying at insane rates, right? And so we can't, you know, as we look at our country, we can't just rely on the muscle that wealth and technological systems give us. We have to be willing to learn from other people, right, and maybe reexamine some of our principles as Americans and say, you know, individualism maybe has carried us this far. So given a time of crisis, what should we be taking on from other nations? Is it time to put aside some of that individualism and rely on unity and rely on collaboration and rely on, you know, maybe a little bit of federalism, having a piece of system across the United States versus it being every state for themselves, you know, like there are other nations that have done this well. And we also need to be willing to give them their credit. And yes, we know that, you know, living in a post-colonial society, it's really easy for individuals to act like Black and brown countries don't actually create great systems and don't have great ways of handling public health or other infrastructural issues. And, you know, we've had, you know, presidents that have spoken disparagingly about those nations. But it's important to give those nations their time in the sun and their due because there are many, we can learn from all other nations. And there are countries that have done a phenomenal job, especially on the African continent, managing and managing through, you know, the earliest stages of the pandemic. And we need to learn from them, be willing to acknowledge that we do not have all of the answers and tip off our hat and actually build more sustainable systems. And so we need to think about, well, what does prevention look like post-pandemic? How can we build innovative technological systems that bring about, you know, pandemic preparedness? What does collaboration look like post-pandemic, right? You know, we think about, you know, how every state kind of had their own set of laws during the pandemic. You know, is there a way we can use technology to come to some sort of consensus about what is happening between states? How do we share information between states in a way that's equitable and doesn't rely on hiding data or not emitting to data because we're ashamed of our outcomes? You know, how do we use like message system to make sure that we are informing individuals of health risk? How do we use technology to encourage prevention, right? Like not just through, you know, Apple Watches or other things that are very high tech, you know, through, you know, systems that are relatively expensive, but maybe in a more low tech way that allows for everybody to be engaged with building the healthiest person that they can be to prepare for a pandemic. I think that's one thing that we should have learned that it is possible to be the most technologically advanced and still perform poorly during a pandemic. Second of all, one thing that I think we should absolutely think about during the pandemic from a reflection point is that equity is critical and it's not just to keep you or your corporation from being canceled, right? Equity does so much for our society. It's not just about, like we said, like avoiding cancellation or making a statement to the public. Equity creates a healthier society. Equity creates an more accessible society and we're talking a lot of the accessible society and equity fosters unity and cooperation. So when we think about, you know, why we need to be moving for equity in our day to day lives, we need to think about the death toll that took place during the pandemic and the disproportionate rates that the death tolls, the disproportionate rates that the death toll took on black and brown communities. And it's very interesting when we think about the United States history with subjugation of black Americans and reliance on anti-blackness and the law and policy to make sure that they were not able to achieve the health care that they deserve were exploited by the health care system and a number of other things. You know, at the time, and even today, those were seen as ways to remind black Americans that you are not fully practical citizens of this country. The Constitution may say that you are a citizen, but in day to day life, you need to understand that you are subjugated. But what has happened at multiple points of history is that when you use a lack of equity to make a statement towards marginalized people, you actually ended up, you end up shooting yourself in the foot. That's like a perfect example. You know, when we saw like the earliest smallpox outbreaks in the United States, there were many slaveholders that said, you know, we don't need to vaccinate slaves like they're just slaves, you know, they don't need to have vaccination they don't need to have access to the smallpox vaccine. And what ultimately happened is that the entire community started to die and get sick of white Americans. And what we found out is that, well, fun fact black Americans are people to they can also transmit the disease and if they are dying from smallpox I mean that you will be dying for smallpox. And then you started to see legislation and mandates that were pushing for black and brown enslaved, I'm sorry black enslaved individuals to be vaccinated for smallpox. And what we're seeing is something very analogous today and it may not just be about, you know, slavery right like we moved away from channel slavery this couldn't possibly be the same thing. What is analogous to what we're seeing, where you know it's okay to speak down to a black patient and if they don't come back it doesn't really matter. You know like we're interested in keeping a certain type of clientele at our healthcare institution and that's something that we would never really say, but that's the vibe that we feel right you know we want, like if the community that lived here before we built our hospitals in their spaces doesn't want to interact with our healthcare institutions. We're overly concerned about it, it couldn't possibly be the end of the world. And so what happens is that when you don't have the community engaging with the healthcare institutions that are there, when black patients feel like they are disrespected and aren't listened to by their providers. When they feel like they can't trust their providers, what ultimately happens is that they don't go to these spaces, and you see a deterioration of health in the community because they're not getting preventative care. They're not engaging with providers, they don't have a consistent provider, and it feels good, right, or rather it may not feel good, but it may feel like it doesn't really matter it's not the thing you should be thinking about every single day, when everything's fine right you're just going through your day to day basic health, you know work, but when there's a pandemic right where you need people to be healthy, when you have to start talking about co morbidity when you're talking about heart disease and hypertension and diabetes, all of which are diseases that disproportionately affect black and brown communities, especially the black community, not because you know black people are just being irresponsible but because black people have historically not had access to healthy food and healthy communities, then, and also to providers and preventative care and a number of other things. Now we start realizing the impact of a lack of equity in our society. And it's time that we remember and keep that in the forefront of our brains, every single day we rebuild our systems to be better and to bring our country back better than before. When everybody is not well, eventually it will show itself and we have to do what we need to do to make sure that we are remedying those disparities on a day to day basis. Yes, a lack of equity has been used to enforce white supremacy, it's been used as a subjugation tool, but it does shoot you in the foot and it does shoot our country in the foot. And so if we really want to be prepared for the next pandemic, if we want to be prepared for another emergency situation, we have to build equity, equity is critical and it's important. And then thirdly, the last thing I think we should absolutely learn from the pandemic is that your true values will show themselves at the most inopportune moments, right? You know, in other words, you know, you may be caught on Zoom with your pants off at the most inopportune moments, as I'm sure many of us have seen during the pandemic. And so I would like to call to a book written by Tali Mendelberg. So in 2001, political scientist Tali Mendelberg wrote a book called The Race Card campaign strategy implicit messages and the norm of equality. And what Tali Mendelberg looks for in this book or rather builds as her thesis is how do racialized messages affect campaigns and she calls to the Willie Horton ads of the George Bush presidential election. She calls to other instances like the welfare queen, utilized by the Reagan administration and the Reagan campaign to promote, you know, stereotypical, inappropriate, inaccurate portrayal of black and brown American to kind of ask the real questions about how do we utilize racialized messaging in campaigns and how do we use that to galvanize people. And what she found is that, you know, racialized messaging in the United States does work and it's a very effective way to galvanize voters, especially when you want to capitalize on white resentment. And so she also finds that explicit racial messaging doesn't really work in this country. And trust me, I'm going somewhere with this. But at the time when she did her experiments you think you know it really is about implicit racialized messaging that you know because and she found that the reason why implicit racial messaging holds tighter than explicit racial messaging is because there is a norm and a value in the states of racial equality that most people adhere to, even if they can't execute it properly. And so when you give people information in a political setting that contradicts what they believe about themselves in their country, they simply will not respond to it. If you frame it with implicitness, then they will respond to it because they still recognize those feelings in themselves. And so why did this matter well according to Mandelberg this matter because it helps us understand how politicians can claim to say that they did not use racialized messaging, even when they read the benefits of it. And that's also really important. But for the purposes of this talk, it's important because it helps us see how our country can hide its true tendencies and feelings very quickly and efficiently, but then still have that end up killing feel in the future. And so just because a value is implicit does not mean that it is not there. You know we're starting to see a lot of conversation around implicit bias not just in, you know, healthcare institutions but also in artificial intelligence, and somehow because these systems that we have are built by flawed individuals, we're seeing flaws in these systems that have manifested themselves in ways that have contributed to racial inequity. And so I think it's time that as we look over 2020 and think about what we should gather from it, we need to be in tune with our true values, not just the values that we want to have but the true values that we act on on a day to day basis. To understand those values, we need to start shifting them and making a fundamental change away from the values of old to the values of new, and start really, you know, doing a bit of surgery on ourselves and digging out, you know, the deep seated racial resentment in inequality, our, our, our willingness to consistently lean into inequality as a way of subjugating people who don't agree with us and just having an honest conversation with ourselves about who we are elevating during the pandemic and who we aren't who are we learning from during the pandemic and who we are not because at the end of the day if we do not rebuild healthcare and technological systems that are sustainable and are accessible to everyone or as many people as possible. We will fail again. You know, as I come to the close of my presentation. This will not be our last pandemic we've had many scientists. And you know and healthcare provider project that one not our, not only are we not fully out of the COVID-19 pandemic, but that there will be other pandemics that come in the future, and due to climate change and a number of other things. This will also certainly not be the last time that our systems are tested. But the real question is, you know, what will our systems show about us next time. What should we hope to see from our systems in the future. And I think to start, I would hope that our systems would show that we learned from 2020. Right. The idea that we have lost so many people during the pandemic, and to come through another pandemic, or another time when our systems are tested, and not even be able to say that we can't overcome it. It would be a disgrace to everybody who sacrificed their lives needlessly. You know needlessly during the pandemic that we need to actually come to the next opportunity of testing was learned skills from 2020. And I hope that they were so that we thought deeply about what happened this year, and thought deeper about equity and why it matters right why it matters to all of our patients. Why does it matter that everybody has access to the Internet. Why does it matter that people feel welcome in our system feel welcome in our space so that we're not just asking black Americans and brown Americans to do free labor over and over and over again, that doesn't even necessarily take hold because it's not a priority anymore. Every day equity needs to be a priority because every day that we invest in equity, we invest in building system that can last the test of time, and also allows for society to stand up against things that require health right that require, you know, not just an internal strength but also a fortification of the body to be able to survive some of these situations. And I ultimately hope that our systems move towards a consistent state of equity, and not just one that we use to signal to other people that we are doing the right thing, we need to actually do the right thing. And it makes, you know, we may make mistakes along the way we may bumble along sometimes it may not be the easiest thing to remedy, but we need to do more than the bare minimum we need to do more than what it just takes to show to the people around us that we understand COVID or we did the right thing or we care about, you know, our employees that are marginalized like we actually need to take a deep look at our systems be willing to be uncomfortable be willing to make mistakes and actually move in a different direction. When one of us does well, we all do well, and we have to be willing to pursue that every single day in all of our environments and systems. So again, thank you so much biohacking village for having me. This has been a phenomenal experience and I hope that what I presented today ultimately helps you have a wonderful day.