 So, let me say, welcome everyone to COVID state of play, which is an irregular series, at least for the duration of the pandemic, hosted by myself and my wonderful colleague, Margaret Bordeaux, about what's going on with COVID and what we should be doing about it, what bigger lessons we can learn from it, and indeed what might be in front of our noses, but maybe not so often noticed. And for today's session, we're going to talk about environmental and racial justice issues. Two wonderful guests for that purpose. And I'll turn it over to Margaret for those introductions, just a warning that is suited for our times this is being recorded at least by us and probably by others. And we'll be made an historical artifact immediately after the event is over. If you have questions you want to ask, there's a Q&A tool at the bottom of the screen, and you can punch those in and might find them addressed during the session or after and those two can be made a record of what goes on. So Margaret, over to you to make introductions and to start us off with figuring out the state of play since we last gathered. I'm so glad to be here. I'm also hoping my dog doesn't burst in from behind the screen here I have behind me so apologize if I get interrupted by a canine force of nature. I am so so thrilled to have our session today with two just amazing thinkers about COVID and about the larger issues involved in what we're seeing and what we're experiencing in this epidemic. The first is Dr. Michelle Morris, who is an internal medicine and public health doctor at Brigham and Women's Hospital, where I said as well and an assistant professor at Harvard Medical School. She co-founded Equal Health, an organization that builds critical consciousness and collective action towards globally towards achieving health equity. And in September of last year she began her Robert Wood Johnson's Health Policy Fellowship and is placed on the Ways and Means Committee majority staff working with the committee staff on health equity priorities. So she has gotten a sort of incredible set of perspectives during this most unusual year, both as a practitioner, a provider, a policy thinker and now working on the Hill. And also we have Ms. Jackie Patterson. Jacqueline Patterson is the senior director of the NAACP Environmental and Climate Justice Program. She has worked as a researcher and advocate and activist and on a wide range of issues including racial justice, economic justice and environmental and climate justice. So a robust look at justice and in all of the ways that it comes together as an issue. So you guys kind of with a question we often start with, which is what is the state of play with COVID? And sometimes Jonathan will ask if you can give us kind of one word or two words of how you think things are going with the COVID crisis. What comes to mind? And then we can kind of jump backwards into kind of what brought you to the game and also take a forward look. Who would you like to go first? Let's see. Jackie, can we start with you? Sure, thank you. Yes, so it's hard to be here with you and I appreciate this conversation looking forward to this discussion very much. You know, it's hard because you started off in such a light and positive way and when you said one word, my word was devastating. So I felt like, wow, what a downer. So that's just a caveat to lead in. The risk of it being more of a downer. Can I ask Jackie, is it, I bet it's been devastating for quite a while. What's the slope of the curve for you? Is it attenuating or is it getting worse? A little bit of both. I mean, I would say in some ways it's obviously getting worse just in terms of the sheer numbers. In some ways it's getting worse in terms of the cliff we're about to fall off of in terms of the moratoriums and so forth and the gap between what's, you know, between kind of the cessation of those much needed supports and the incoming administration that will conceivably turn things around and offer a better suite of supports. And there you mean economic supports in particular. Yeah, among others, yeah. Yeah, so that, so there's that and also support in terms of, in terms of actually some common sense ways of actually dealing with containing this, the situation so really shifting a narrative from wearing masks as a theft of liberty to wearing mask as an act of public health and collective care. So there's a whole, you know, so economics is just part of it, there's a whole shift in mentality and approach to actually addressing this worsening situation. So that part, but then on a positive side I would also say that there is a dawning recognition of the depth of the systemic, the systemic vulnerabilities and equities in a way that really there's I keep quoting here, Steve, Steve Benjamin from Columbia, South Carolina, with whom I was on a panel panel and he said that Kobe acted as an x-ray to expose the broken bones of America society. And so that that that in and of itself and another quote from an older quote from James Baldwin that nothing can be changed. Unless, let's see, until what is it nothing can be changed unless it's based, or not everything that's changed that space can be changed but nothing can be changed unless it's based. And so, so really the recognition that we have as a society of the really truly broken bones of our systems is gives us some hope of actually recognizing the level of systemic changes that's going to be necessary to provide security for everyone. Well, Jackie, you don't know this but but you have just just done exactly what I serve the function I usually serve on most meetings at the Berkman Klein Center where everyone kind of goes around and is talking about cool things that are, they're learning or whatever and then I'm like, oh, it's horrible. You know, this is, you know, I'm so angry and it's been you know months and months of me of me doing that and I almost hate to have them turn to me and ask. I wish I think so so your your your comment is your word is well taken and it stacks up well with with our with comments on our previous episodes and so you're definitely not not out of place and you're also playing a little bit of a validator to me so that's that's helpful. Michelle, did you. Yeah, I have to second what Jackie said so deeply I think I have also felt like some of this just in in this year some of the highest highs and some of the lowest lows in my, you know, 15 years of doing this kind of work around health equity and global health and, and I just, I think that that x ray analogy is I mean it gave me goosebumps that really it really says it all and, and, and for me similarly, you know Jackie and Margaret it's, if I had to think of one word it's because it's because it truly is. And the way that coven has played out in the United States is, you know, again, a centuries old pattern that we have been unable to and unwilling to interrupt and break from. And, and on the one the reason I say I've had my highest highs and my lowest lows in this year is because you know, number one, seeing how the management of this pandemic within the United States has been just so wrong at every step in so many ways at the at the national level at the federal level, and at the same time. I have had experiences of connectedness and solidarity that are deeper than anything I've ever experienced in my 15 years of doing this work and the example I'll just share is supporting the work of the movement for black lives during the the Juneteenth Juneteenth mobilizations that happened all around the country and even some places outside of the United States. And, and you know folks asking the question well how can we do this safely in the middle of a once in a century pandemic and can we. A group of health workers and organizers and healers that we brought together said, Well, you know, protesting saves lives. And so how can we do this in a way that is a harm reduction approach right where we we do things as safely as we can, but also support people who want to demonstrate and express their right to protest, because of how profoundly tragic and violent George Floyd's murder was, and, and that should not be curved. And what we found of course was you know we we made recommendations like you know where your mask of course and bring your hand sanitizer and space out as much as you can and you know instead of using those big bull horns where you're kind of spinning on everybody. You know, you know, bring your drums and your, and your, you know, musical instruments and find other ways to make noise that are just a touch safer in the middle of a pandemic like this. But also, I think what we felt in that moment was that we are going to get us out of this pandemic, and the solidarity and the relationships that were built out of that experience. The deepest and most profound conversations relationships and experiences I've ever had, and of course what was shown afterwards was that you know study a study of over 300 US cities right looking at whether or not those protests led to increase the transmission of COVID showed that it didn't in fact right and so it was just another example of of us taking care of us and of us keeping each other safe. And of us demonstrating our solidarity in a way that, you know, certainly influence the election results. So, so a lot of, like I said hi highs and low lows, for sure for me. Okay, so see you shaking your head at some of what she said I, I guess I'm curious to know, you know, it's been a devastating experience. I'm wondering, as this started as the epidemic started, did you see that you know you're so well versed in so many different angles and conversations around justice. Did you think it would play out in this way. And when I say this way, maybe we can also be a little bit more specific about the inequities and disparities that we have seen play out in in COVID. And I think it's a good attitude of those. And, you know, and be a little bit more specific about about what we're, what we're talking about in terms of how this has been, you know, played out with more much more burden on black and Hispanic communities in particular. Yeah, you surprised, I guess Jackie. Yeah, thank you. Well it's interesting because I was actually taking a very small four day vacation when things really started to kind of pick up in terms of people recognize you know when it was back when it was just the nursing home in Washington State and maybe it was just beginning to come out the, the hotspot in New Rochelle. And so I was. I, at that time it was, it was around March the ninth when I sat down and spent like a 19 hour period, just writing this document called the 10 equity implications of the COVID-19 pandemic in the United States. And it, and it all came to pass and more and it wasn't like an act of prophecy by any stretch. It was just a repeating of the same patterns that we've seen in other disasters and in microcosm, whether it's hurricane Katrina, or, you know, the ways that climate impacts are rolling out in general, it's very parallel and it's all based on this analysis around the broken, the broken bones of American society. So if you just know, and you know it's, if you just know those systemic factors, then you can all you can predict how they're going to play out in any given situation. And so, so yes, to some extent, it was clear and anybody who's working on the front lines of this work would also be able to, to draw the same conclusions in terms of how it's going to roll out. So, and at the same time, the thing that I didn't kind of realize is the extent of, well, certainly didn't anticipate the extent to which the mask liberty nexus would would really roll out in such a deep and unbelievable way, just in terms of, you know, whether it's the acts of violence around around mass conflicts around mask wearing, or whether it's a person to person or it's people showing up armed at the State House in Michigan, like that, that's something that I never, never could have even conceived of you know of course mask for even a conversation back then but, but those kind of things are, but but the one thing that we, we did know was what would result is just a civil unrest that would come from something that is that is intensified to such an extent, the way this has so how I'll leave it there to me, you know, and brevity but yeah. You know, extensively and written extensively about this sort of legacy, you know that this code the Kobe crisis is really just one more example of, you know, how historically marginalized communities or marginalized, currently marginalized communities suffer in response to some type of natural disaster or human made disaster. Can you talk just a little bit about the connections that we see with what's happening with covert how is it similar to hurricane Katrina and the BP oil spill sort of specifically. Sure. Yeah, so just very specifically is, is the is the pre existing, the pre existing vulnerabilities like systemic vulnerability so whether it is where people are living and we know that that has, you know, come about from everything you know, historic slavery to the ways that people weren't able to hand down property because of the lack of legal legal standing to do so to historic redlining to modern day redlining. And all of that resulting in people living in places that leave them more likely to be in harm's way and less likely to have protective infrastructure so whether it's people living in places where the levees aren't aren't reinforced or are not properly invested in, and therefore I've seen more impacts from Katrina, or it's people who are living in places where PM 2.5 the particulate matter load in the air is high and other foods are in the air are are extreme and therefore making our lungs more compromised. And therefore, when we have any type of shop to the system like a COVID-19, you know, certainly Dr. Morris can speak more to this than I can, but that we are more likely to suffer the extreme impacts there. So that those are just a couple of concrete examples then also we look at climate change as a whole and we see that shifts in agricultural yields is one of the impacts of climate change and we, we know that from those same historic factors that already African started already 26% of African Americans according to, to, to studies are our food insecure already. And so then when we have the situation of COVID-19, then, and we're also kind of compromised by the, we know that the work insecurity is also made our economic situation more vulnerable as well, then those things combine, you know, places of residence and more likely to live in places that don't have access to healthy nutritious, nutritious foods, not being able to not being able to continue to work in the same way we were able to work to buy food, and, and then now shifts in agricultural yields and climate change and all of this combining to exacerbate food insecurity in our communities. So, yet yet another example there's so many examples but those are just a couple of together in a sense yeah. Right, so, you know, I guess the dividing it up a little bit and like okay you have vulnerabilities. You also have increased exposure with folks being needing to let's say go to work and not being able to you know not having sick leave without having childcare not having the supports they have to, you know, have to have the paycheck and they have to go into the community where they would be, you know, more exposed. And then after exposure, you know, dealing with, okay. You know, getting less access to care, you know, kind of the whole continuum lined up and stacked up against. Well, against large swath of different communities that intersect with that profile in different ways. But, you know, certainly, I think your, your, your point of the x-ray is quite valid there's so many breaks in the bones that it's sort of, I guess, a little bit hard to, you know, it's a whole picture, and rather than, you know, a very pinpointed fracture. Michelle, I think one of the things that I have struggled with and sort of delving into this is there's always a lot of hearing all of the ways that people are vulnerable all the ways that they're differentially exposed all the, you know, lack of resources that they might have to be able to cope with a crisis like this. It sort of feels overwhelming, you know, it feels like there's no remedy because it's so expansive, it's so global. I don't know. Michelle, if you want to talk a little bit about, you know, you've taken some really interesting work on in terms of, you know, drilling down and trying to unpack and unwind some of the issues in medical care and racism and systemic racism and medical care here in Boston. And I don't know whether you can speak a little bit to that of like, okay, given all of these bad things, how can you actually dig in and try to move the needle on making it less so. Yeah, no, I'm happy to try. And again, just really, really appreciate the analysis that Jackie put forward. I couldn't agree more. Couldn't agree more. And it's, and it's, as you said, it's also interconnected. And I think, yeah, the layers are many to numerous to count as they say. And at the same time, I think so much of how, especially for for folks who are in in healthcare in the in the work of doing service delivery and taking care of patients. It can be hard to zoom out sometimes and recognize how all those different layers are actually determining and defining the very choices that you're making at the bedside or the prescription that you're writing or the discharge plan that you're developing or whatever it might be it can be really hard to see those connections, particularly in the urgency of what clinical care is every day on the normal let alone in the middle of a tragedy like the COVID pandemic. And so I think we have to use theory, we have to use, you know, and learn from from social science frameworks to really help us to expand our aperture, I guess, and really look beyond the biomedical model right which is so ingrained in the way that we're that we, you know, can't see the air that we're breathing right we don't even recognize that we're missing a whole series of layers of forces and influences, because we're really caught in that we're caught in the biomedical trap for for the majority of our day. And, and I'm not saying that that means that all health workers are missing the point that's definitely not what I'm saying. But I think it's, it's really important for us to, to step back and and to find ways to do that regularly, rather than as kind of the exception and so what has helped one of the many tools that has helped me to do that is is critical race theory and Dr. Chandra Ford's work applying critical race theory to public health through public health critical race praxis. It's, you know, I mean it's not every day that I can sit down and read theory but at the same time just a little dose of it really helps you to see, make the make the invisible visible I guess as they say. And I think for for what part of what's helpful for kind of uncovering the forces and inequities and bias and discrimination and structural racism at a hospital like Brigham and women's where we've been trying to do that. People have been trying to do that for a very long time, but, but most recently we've been trying to do that with our heart failure work. What helps is that critical race theory allows you to just start from the point of structural racism is here. It's within our walls. It's impacting how we take care of patients it's impacting the resources our patients have at their disposal. And so instead of trying to prove that it's here starting from it's here, and then trying to understand the mechanism, as as Dr. Kamara Jones says, how is it operating how is racism operating within our walls. And I think you know COVID is no different than heart failure in so many ways right I mean for COVID it was very obvious that black and brown people were the people who were the most impacted and more likely to be in the hospital and more likely to have complications and all of those things. What happens usually is that we blame patients for that and say oh well you should have taken your diabetes medications and you should have taken those high blood pressure pills and you should have lost some weight like we told you. And in reality the reason that there is an unfair distribution of chronic diseases like diabetes and high blood pressure is because there's an unfair exposure to risk for black and brown communities and that risk is described by by what Jackie just said right all of those different layers at the, at the level of material conditions and social conditions in which people are living right and, and who gets to live where and why and for what reason so. So I think that that the critical race theory is helpful in that way I also think that concrete examples, like for for what we found it at Brigham and women's and in heart failure which is the most common admission diagnosis in our hospital. And looking at the fact that black and brown patients end up on the general medicine service instead of the specialty cardiology service at significantly different rates is an example of institutional racism and and you know we use the definition of racism that Dr. Jones put forward which is, it's a system of structuring opportunity and assigning value based on how one looks which is what we call race that unfairly advantages some and disadvantages others and saps the strength of the whole entire society. So if you look at subspecialty care cardiology care as a resource, then black and Latinx patients being systematically excluded from access to that resource, when they have heart failure I mean it is there's no more clear definition. But because of white fragility and because we are at a predominantly white institution, and because it's an institution whose practices have not always been welcoming of black and brown communities. So we have a lot of people who fought that definition and fought that framing. And that's really unfortunate, because we're just, we're, we're being truth tellers and defensiveness and fragility shows up anytime you talk about structural forces historical disadvantage bias discrimination all of these things. And yet it's the most important conversation we can be having in the midst of a pandemic that as Jackie said has has unearthed and and shown and demonstrated and brought light to things that we've been trying to see as a society for way too long. So I think that those kinds of concrete examples in clinical care and in the clinical world just help health workers to have to face the truth. Often we consider it to be something bad happening out there. But we're, you know, we're, you know, we're health workers and our intentions are good and that's all that matters and that's just not the case. I think it's funny it's so reminiscent of some of the work in complex systems theory on the technological side of the ledger around, you know, looking at the Exxon Valdez accident, and the first instinct is to say oh it's human you know the captain been drinking what's it's a drunk captain personal responsibility, and then a totally different approach which says well let's look at the whole picture here and what were the conditions that the company set that might be driving the captain to drink, and what redundancies might have been there so that there'd be support and etc etc. And I heard that a little bit echoed in Margaret's question which was. Gosh, if we're not going to just be looking at the specific and say all right here's a problem get me a vaccine as quickly as possible and then the problem will go away it's somehow much more embedded and structural. Thanks to the question of alright where's the first step of a journey of 1000 miles to take or is that a loser I mean I know with climate change and global warming there's debate around whether people trying to take up individual habits to deal with the audio to put print is kind of missing the forest for the burning trees, given the institutional again ways in which the problem arises so I guess I wonder for both of you. You're thinking around for somebody wanting to pitch in here and generally what would a first step be whether it's just as an interested citizen is it kind of the equivalent of minimizing my carbon footprint I'll wear a mask I'll go down the public health checklist of what would you do as a citizen, or is it something broader, and on the other end of the spectrum. If there's a new administration that wants to say, push through a new bill of federal policy in the United States for relief. What would be one or more things you'd want to make sure we're in there to try as much as possible to mitigate this problem, and possibly do so, not by being coven specific that by being specific to the problems behind the problem. I don't know who wants to go first. Maybe Jackie. Yeah, so there's so much there. Thank you for that question. So one, I think in terms of the suite of policies that we need to be thinking about is that we really need to think. Not informationally like we can't continue to, to just kind of tweak a system that fundamentally exists to favor the 1% in some way and so, so whether we're talking about policies like campaign finance reform so that we actually don't have policies that are literally bought by the highest bidder and and and and in some cases policy makers whose favor and votes are bought by by moneyed interest and so for so definitely we have to restore a true democracy first and foremost. And, and, and in terms of also kind of the systemic things we need to think about how wealth works in this country and how wealth has how the how the the enclosure of wealth and what is what is taken to do that has has actively harmed everything from objectifying folks to the extent that African folks were brought over to this country in the the hulls of ships as cargo, and really this whole notion of black lives matter is a fairly low bar, you know, to just matter, you know, is, and it's really rooted in the fact that that the dehumanization of people, the the messages of that are still very much there and the image that is ingrained in so many of our minds as of George Floyd with the with the knee on his neck. And in a posture that is is far less than human and humane and so we have to think about the roots of what what makes that happen. And certainly the enslavement of African peoples started with the, the, the, the pursuit of wealth and power. And, and so for us to think to get anywhere we have to really again face that that reality, and our policies need to govern away from that reality when we look at the energy system to have a system that is governed by the where where the goal of the energy system is to make as much money as possible for the already wealthy few versus the goal of the energy system to provide energy to all that in and of itself is is obviously a big problem and people like the grandmother in New Jersey who had her electricity shut off for non payment in the dead of a heat wave. And her son paid off her bill but two days later, the system hadn't caught up to it, and they shut off her electricity anyway and she was dependent on a respirator in the dead of a heat wave and she died she died of poverty with her life while that company that flipped that switch is making hundreds of millions of dollars in pure profit that they're using to lobby against clean air to lobby against clean energy to lobby to pay into the American legislative exchange council that pushes pushes on prison privatization school privatization water privatization and pushes back on voter rights and advances voter suppression laws. I recognize the interconnection of all of these issues and how they, they all compile to a press BIPOC communities in particular black indigenous people of color communities and low income communities in general. And therefore, when we think about policymaking it has to be systemic and it has to be transformational, or we're going to continue to be in the state that we're in now so that's kind of the answer to your second question. In terms of the types of policies and we deal okay so everything from campaign finance reform to to ways that we restructure that our energy systems ways that we restructure our food systems we have a food system where we have companies that are so concentrating on again enclosure of wealth that they will create products that are against the very laws of nature like the Terminator seeds that are that are developed by Monsanto one of the big agricultural groups. A Terminator seed which only has one life cycle which again this world is was designed divinely in terms of regenerative processes and so forth and so the cycle of seeds is is a natural way of the world, but yet we have folks who are actually genetically modify the very laws of nature in some ways, developing these types of scenes. And again it's all about the enclosure of wealth and so we have people lining up and food lines when we can really be constantly regenerating our food systems there's there's no reason that anyone should be going without food people should not be starving based on what they have in their pocket in a land of plenty and our land is one of plenty. And so we can really take each and every one of our systems and think of them that way and think about how do we have systems that actually provide for the Commons for all, as opposed to again, being limited and wealth and so but back to your other question to about what anyone can do. Small steps that people can take I put together this document called 20 things we can do to advance a sustainable planet on Earth Day a couple of years ago and posted it because out of that recognition that not everybody's going to run for office not everyone's going to start a community micro grid all of those kind of things that we all need to get to where we're going to go but anyone can. Yeah, I was just on a panel yesterday with someone actually asked that very same question. And, and they had put online on social media question like, what is something what what can I do that will take the least amount of effort, which I thought that was an interesting question. And actually putting that question out there on social media isn't act like, because it starts people thinking and it and it socializes some some remedies that people are putting out there. So just asking a question just starting the conversation is is an important step in and of itself and one that anyone can do. But then I have started to grow for the first time in my life that traveled 99% of the time before this thing happened. I grew up with the first time I left on my balcony a whole garden so now I'm growing everything from lemons to to tomatoes to peppers to dill to cilantro and parsley. And that's something that I'm just doing on my tiny little condo balcony and and it's something that you know that now I made my bruschetta out of what I grew on my balcony, which I was super excited about. And so, and that's something that we can all do, thinking about, you know, taking that, taking that walk instead of driving like that's one thing that makes a difference because every, every, every time we have we run those combustion engines, it puts the pollution in the air that won't that that that impacts the way someone else breathes and their ability to breathe so I'll stop there with my longest answer yet. It's a neat way of saying that the incremental and the transformational don't have to be an opposition that, you know, a path to transformation can be at times incremental, especially if you're trying to meet people where they're at, when the person asks you well what's something I can do but I don't have a lot of time. You know, if you flood our healthcare providers every night at 8pm, you know, I hear you saying, you know, meet them there and then maybe at 9pm. Here's another suggestion if you happen to have time and go from there. I don't know, Michelle, your thoughts on the same thing. Yeah, I think. Really, really great questions and again loving what Jackie is saying and learning so much from how you're just weaving it all together that spectrum together I really appreciate that and I think that's exactly the right approach. I might go ahead and answer the policy question first and then get into the personal. But I think from from the policy side there's so much I think we're at a point where in my opinion at least even asking for Medicare for all is too small we need something we need an even bolder more visionary ask demand I should say that takes us even further than just health insurance and and I think that that's happening in lots of different sectors and and movement folks and organizers are really we're alive because of them right now and and we should all be so thankful for for the sacrifices that organizers are making but but again they're like medical communities behind the curve I mean what is our version of abolition. What does that look like I mean you know there's a lot of great ideas out there I think we need to be far bolder and far more visionary and I think we need to. For the for the health and well being aspects we need to connect much more deeply and closely to our colleagues and other disciplines and in other spaces because I think we're we're a little bit stuck. But at the same time I think that there are like very real very exciting policy proposals that are out there and. Certainly not speaking on behalf of the ways it means committee but but I you know I think the breathe act is very exciting. That's been put forward by movement for black lives and I think there's a lot of other legislation out there that's very visionary that is going to take us somewhere. At least in our dreams if not in the political reality of the current moment. I also say that I think you know again critical race theory has really helped me on the policy side me and some colleagues wrote a piece a few months ago and health affairs talking about how interest convergence which is one of the kind of sub sub theories or tenets of political race theory helps us to understand you know past changes and you know the the example of Brown versus the Board of Education in the Supreme Court, which many people I think looking back see as, you know, a white awakening or white consciousness, perhaps was a you know a sudden consciousness amongst white people but actually you know again an example of interests of civil rights leaders organizers and mobilizers aligning with the interests of whites for a very interesting set of reasons but if you if you agree with that analysis which I do. It makes you think okay so how does that inform our policymaking and advocacy work going forward, are we stuck waiting until interests align again with you know white elites who have always run this country or are we going to build an alternative and what we describe in our health affairs pieces that you know health workers in particular again need to join the coalitions that are existing. For social justice across the country and around the world and we need to lend our voices and our power to those demands and those movements in coalition and we need to build an alternative nexus of power. If we are going to avoid having to sit around and wait until interests converge again, and I think that it's, it's, it's hard to do that and yet it's, it's critical and that's how all social change, you know through social movements has happened in the past and I think that that's really instructive. And I think on the personal side like what is a what's a step that everyone can take towards, you know, uplifting what we're talking about in terms of racial justice and environmental justice. Oh, there's so many right there are thousands there are thousands of great steps in fact I like, I myself am always trying to find new steps that I can take. But I think, particularly because this is not you know this is what equal health is really committed to over the past several years I do think that the critical consciousness pieces the first most important step I think it can be really damaging. In fact, if you haven't done that work of raising, you know, your own consciousness and your critical lens and, and learning before entering into spaces with others who are already doing that work or are are you know have already been committed to that work I think it's so important to do your homework first, and what that homework looks like you know varies depending on who you are and where you sit and what your training is and what community you're from but, but I think that all of us have to start with that internal step of acknowledging and humbly recognizing what we don't know, and really being open minded and curious and and being willing to listen to truth tellers who are often unpopular and you know scrutinized and marginalized, fairly or unfairly but listening to those folks who, yeah, who may get labeled as being either too radical or too forward thinking or whatever it might be. There's there's truth in those in the words that they're speaking and, and so I think getting out of our kind of, you know, our typical knowledge silos is really really helpful as a first step. That's fantastic. I, I have to say, I, you know, after 2016. I, I got a Twitter account, and I have very mixed feelings about Twitter. I have very, very mixed feelings but one of the things that it has allowed me to do is to actually let you know to tune into conversations that I would not otherwise in tune and listen to other voices I wouldn't otherwise listen to that would take a lot of effort, you know to listen and I sort of can lurk and listen to these, you know, kind of subculture conversations that have at least a tiny bit of a feel for what folks that I would not necessarily interact with are sort of saying and most of the time it's a very frightening experience and not very positive, but it does have that function, which does lead me to sort of another sort of question and, you know, to circle back again a little bit. You know, for me, what has been so, so upsetting, I think, in terms of how how COVID has played out is the sort of the cruelty that and the embracing of cruelty as a political strategy. You know, I'm our national leadership and, you know, armed mask, mask, you know, protest over masks, you know, you definitely I guess it's my opinion but I think that if it had been anything, there would have been a protest and armed and, and it number one, and, you know, number two, the sort of loss of life in minority communities, sort of, you know, not being addressed and almost being encouraged, refusing to take any public health action and undermining every public health action that may have prevented some of that or blunted that or mitigated it I think is just, you know, just deeply, deeply upsetting. But, but I think the, the, the thing that that has made me kind of wonder about is, you know, is what things have really been any different under under a different administration, you know, given the fact that these structural factors were in place, and that this crisis hit and these, you know, structural disadvantages and draining of resources out of out of communities that made them particularly uniquely vulnerable. So that's a long standing thing. So maybe things would not have actually been different but maybe I just would have felt better about them because I wouldn't have sort of seen the cruelty and I, I wouldn't have experienced personally that that that that the crisis in the same way. So I guess that's my first my question to you guys is to ask if you think it would have been different. If you would have felt differently about it. And, you know, I just give a small example of what I mean by a structural long standing issue that I discovered so when I started working with the state of Massachusetts on the contact tracing program. I realized we were, I was working with partners in health, which is the nonprofit here that was contracted with the state to help build out the contact tracing program and of course a contact tracing program is when you identify people who have who are infected and find out the people they may have exposed to the disease and then reach out to them and, and help them quarantine. We had to keep them from passing on the infection to others. And what we found was, you know, as we were going about building the contact tracing program, we were going to need to work with 351 local boards of health that are public health system in the state of Massachusetts was set up so that municipalities and towns ran local boards of health that had contact tracing programs already in them that needed to be bolstered. And that's a little unusual usually done by county not by municipality or town but nevertheless, it was run by 351 local boards of health, and how did they get paid what was the revenue stream for those local boards of health. And I remember learning that in, in, in March and just feeling like the floor opening up from under me I just I can't even describe how upsetting that fact was because that meant of course, you know that that communities that were going to be relying on their local health, you know, the communities that couldn't pay property taxes, you know we're going to be starting from an even deeper hole than the rest of us and it's just a little vignette to say like, that was, that was the whole you know those were those that were going to be running for 2016. We still would have been dealing with that. But, so I just offered that as an example but I would, I guess I'd love to hear from you guys what, what, what things have been different, if the outcome of the 2016 election were different. I will ask Michelle to go first. I mean if you don't feel like answering that I could, I could modify. I appreciate the question and I think it's, it's an important one. And I think it's one, I just hope that we don't lose that perspective. I think the new administration starts I worry that, you know, just sometimes we can be so short sided that even remembering that something that recent can be overlooked and I would also say that, you know, ultimately, I think it would have been significantly for sure. I think the like the direct answer to the question is yes. And I think that, you know, the projections of course that looked at if we had, if we had, you know, enacted social distancing and stay at home orders a few weeks earlier, how many lives would have been saved and some of those things, some of those projections are again why why I, my word was tragedy. You know, there was so much that could have been done differently early on before that amplification effect happened let alone what's happening in these past couple of months this fall. So I think yes it would have been different, significantly different I also think that administration of the, I think, I think this would have been a challenge for any administration, no matter the party. And I think the approaches would have been drastically different but I think it would have been very very difficult for any administration to manage a crisis of this magnitude. I worry the most of course about the the the global effects and and not just vaccine nationalism but nationalism period, and how we work our way out of that. How we repair from that how we acknowledge that how we rebuild global relationships and how we, I hope practice global solidarity differently because I also don't want us to go back to, you know, very security only oriented approaches to global I think that it's really important that we recognize that global solidarity can be practiced in a lot of different ways and they don't have to it doesn't have to be imperial, and it doesn't have to be, you know, militarized. And I'm not sure that that's a dream that will ever be fulfilled but but I think I hope that that's part of also what happens as we think forward. And as, as well, I also hope that, you know that part of the recognition of how things might have been different is really what guides the forward thinking visionary next steps of the new administration and that it not just be kind of a, let's reverse everything that's happened for the past four years but can we really dream a new vision and do things differently rather than just fix, fix some of what's happened over the past four years I think. Certainly there's fixing that needs to be done but also there's there's clearly more creative liberatory dream work that needs to happen if we're going to ever have a chance of preventing this same pattern that we're seeing with COVID from playing out in the next pandemic and the next pandemic I'm sure Jackie is going to say is coming way sooner than we think so I hope that some of that will happen going forward. And before Jackie will get what might well be the last word given our timing. And your answer Michelle really nicely connect to one of our participants questions about that vision which may not just be about a hypothetical what if it had been a different administration, but looking to other jurisdictions, whether it's a particular American state or a different country elsewhere in the world that maybe offers some insight into how to do things better. And I'm curious if anything for either of you jumps to mind on the way the question put it was comparative cases both within and outside the US hospital systems making incremental progress. And how do governments making inroads for better quality of life for people of color, as a background to medical care, and I don't know if there's anything that stands out as an example to emulate. I'll just be really fast because I think you want to go to Jackie, the countries that I think we don't hear enough about or Cuba. Sure. And, and Vietnam, both I think are, you know, our places I would like to be hearing more about and I'll say that I haven't looked at the numbers in South Korea in a while and I recognize that there've been some more recent challenges but, but I think that there's there's something to be learned, for sure. And then the last the tiny last thing I want to say is just that there is also evidence that ending the racial wealth gap through reparations for formerly and for descendants of formerly and say people really would be a very effective way to change transmission of COVID in fact and projections that researchers and collaborators that I know have looked at suggest that actually COVID transmission in Louisiana which was the test case would have been 30 to 68% lower for the whole entire state if the racial wealth gap had been eliminated before the COVID-19 pandemic started so no country has really done that yet, but, but that would be almost as good as the floor that the FDA has set for vaccine efficacy so I think we need to be thinking about things like that. Thanks, Jackie. Yeah, thank you. Yeah, so definitely echoing what Michelle said absolutely the racial wealth gap is the root of so much that addressing the racial wealth gap is critical. I recently bought the book that I had read a little bit online, the geography of bliss, which I don't know folks have heard of that but, but it really looked at I mean people have heard of this notion of the happiness index and so forth. I really went around this person really went around the world really asking people what what's making them happy. What is giving them fulfillment and so forth and one thing that that geography of bliss reveal this places that have the lowest level of, of racial wealth disparity are the places that are enjoying bliss. Everyone's rich. It just means that there is equity across the board and some of the places that that even have the lowest in the way way of, you know, gross national project product or whatever are are are are places that are experiencing more in the way of fulfillment and happiness and I think there's a lot to be drawn from lessons from those countries in terms of how they structure and how do they, how do they govern in a way that makes sure that everyone has their basic needs met, which is really in the ways that it, that it value the values that are at the center of governance in those nations are something that we definitely need to, to look at. So, I'll just keep it simple geography of bliss I highly recommend. Thank you. That sounds like what we what we need to all just read right now given this given this very dark winter that we are about to live through. And I just want to wrap up by saying an enormous thank you to both of you for sharing what you've learned and you know what your perspective is at this at this really critical moment and I, you know I've I, I was watching the Shakespeare Henry the fifth where he says you know he's the end of the movie he says he's about to kiss his newly won French bride and she says no no no we cannot kiss because that would be bad manners and says oh, we are the makers of manners of course we can kiss and I often think about we are the makers of manners and so to whatever extent that this moment helps us think about what we'd like in the future to remind ourselves that we have some control and agency over that future and I'm so thrilled that you guys are part of that that future and that future creation with us. So, thank you so much. Indeed. Thanks very much. I'm sorry there's not an earn with stale coffee for us to gather round with everyone and the participants but we'll see you online and we will press forward and try to move beyond devastating.