 All right. Good morning, everyone. This is a joint meeting of Senate Health and Welfare and House Health Care. I'm Senator Ginny Lyons, Chair of Senate Health Care, Health and Welfare, and Bill. Good morning, Bill Lippert, Representative Bill Lippert, Chair of the House Health Care Committee. This morning we're, this morning we're very pleased to have with us Susanna Davis and others who have completed work on our report, our diversity report in health care. So I don't want to spend a lot of time talking before we jump right into hearing from you, Susanna, and the other folks with you and ask you how will you, how will you go through the testimony? Are you going to share the testimony or do you want to go in order? Thank you. Good morning. I had hoped just to speak very, very briefly and then turn it over to Anlea and Mark to add in filling any gaps that I may have missed. So that sounds perfect. I just, just as an FYI for you folks, Senate Health and Welfare will need to leave at 10 o'clock and if the House Health Care has additional questions, they may be able to sort that out until about 10.15. We do have a joint meeting on the floor at 10.30. So just some timing issues and we'll try to keep it, keep you informed as we go along. Okay. So please introduce yourself for the record and we're very happy that you're here and look forward to the report. Thank you for the record Susanna Davis, Executive Director of Racial Equity for the State of Vermont. I have six slides for you, so I hope I can get through them quickly and I just want to confirm if I can share those or if I should ask the... Yes, you can. Okay. Well, there's can and can, right? We'll see if this works. All right, you should be able to see my screen. Yes. Great. Okay. So I'm going to ask if you're not speaking to maybe mute yourself. I think the committee room is coming through. Oh, okay. This is the logistics of hybrid. Okay, Susanna, sorry for the interruption, why don't you go ahead? All right. Thank you. So I can only see one of you, so please do feel free to stop me with any questions or if you need me to repeat something. So we are here today to discuss the Health Equity Advisory Commission and I might refer to that as the HEAC here to forth. The HEAC's report, it is the first report which was originally due to be filed on January 15th of this year. The committees were gracious enough to give the commission a bit of an extension and I'm going to discuss why that was requested and what it meant for us. So first I will begin by giving you a little bit of background about how this committee, this commission has been set up. So it is a whopping 29 members large and includes representatives from state agencies including the Department of Disability, Aging and Independent Living, DCS, that's Department of Children and Families, it includes representatives from Agency of Administration, of course, that's Racial Equity Office. It also includes community partners and not-for-profits and community organizations including the NAACP, the Racial Justice Alliance, Outright Vermont, the Commission on Native American Affairs plus representatives from each of the state-recognized Abenaki Bands. It's a very large group and we are extremely fortunate to have that breath of expertise in the room. So with a large scope and with a large group, one of the early decisions that we made was to break our work down into seven main components and to create subcommittees aligned with those components. You'll see those described on the screen. Our subcommittee structure allows us to be able to take smaller bites. This is a very large sector of work that we're looking at. There are people who spend entire careers working full-time and around the clock to be able to figure out and think through some of the things that we're asked to think through here. So you'll see that these committees range from access to care, to policy, training, external engagement, data, upstream factors, grants, etc. This covers a lot of the tangible duties that we as a commission are asked to perform such as the distribution of grant funding and also covers some of the more theoretical and policy related matters such as upstream factors and social determinants of health which are going to lead us to topics that may not sit directly with health or the healthcare delivery system but which certainly have impact on individual and public health. So the commission is at a point right now where we are still standing up these subgroups. But before we got started on the subgroups, we did have a number of discussions as a larger group where we figured out, hey, you know what, this is a really big scope and we want to make sure that we do this correctly. In the room you have people who are in high-ranking roles of government, people who are in supervisory or managerial positions, people who are advocates. Some of us are invited into many spaces and others of us struggle to bring our folding chair to the table so to speak. And so with that wide of an experience, we wanted to make sure that we did some level setting and tried to model process equity as much as we could. Now we're not there yet. It's certainly not perfect and we're still having ongoing discussions about how we can make our group and its experience more equitable. But some of the things that we have agreed on and landed on early includes things like accessibility policy for our meeting. It includes things like making sure that our documents are formatted in a way that is accessible for people who may be visually impaired. It means that we have a team of people who are dedicated to engagement and communication should we receive inquiries from members of the public, members of the press, members of government, etc. All of these things contribute to a broader goal of process equity. It's not just about making sure that we arrive at the correct conclusion, but about making sure that we didn't step on anyone while we got there. Now the way that you go about it is one thing, but what we have to work with and what we have to talk about is quite another. One of the earliest findings that we arrived at was about data. We hear the same story in every sector imaginable, especially when it comes to equity. We have some data. It's not great. We need more data. It has to be better. We've got to collect it better more consistently. We need the technology. All of these things are true in the health equity space as well. And in addition to those things, here are a few other challenges that have made our data situation a little bit more fraught. We know that historically, and this is centuries and centuries, medical research has tended to focus on people in dominant groups. A lot of what we know about health and medicine is because of work that has been done that centers able-bodied people, male identified people, and people of European descent. What that means is, and I'll give you one example, and I think this example might even be in the report, if you ask somebody, what is the sign of a heart attack in progress? They might tell you, oh, left arm situation and whatever else. As a matter of fact, that is a symptom, that is a sign that is common in men, but not in women having a heart attack. But many people don't know that. The fact is a lot of what we know or what we think we know about health and medicine centers people who have historically been in positions of power. Here's another example. Early on during COVID-19, we were looking for symptoms and telling people what was the short list of things to look out for. One of those things that we said to look out for was, if you see discoloration around the lips, maybe if your lips are looking blue. Well, if you're a dark-skinned person, your lips may not appear blue. And if the guidance that we're putting out tends to center people with light-colored skin, then well, we're effectively excluding other people from being able to timely detect things like COVID-19 symptoms. So we know that medical research has tended to focus on able-bodied, male-identified, and European-descended people. And we also know that a lot of the more painful medical research has been done on, well, everybody else. Think of the more harrowing experiments that have happened over the years. We always talk about Tuskegee, but there's so much more, unfortunately, that's been inflicted on our community. We know that, for example, J. Marion Sims, who's regarded as the so-called father of gynecology, did a lot of his work on black and brown women. And it was grossly painful, often without any sort of anesthesia. Of course, no crediting or further assistance to the families or to the patients. We know that the experience of people like Henrietta Lacks, which touches on issues not just of medical ethics, but also things like intellectual property and ethics in the way that we communicate about diseases. We know that in Vermont we have a deep and extremely disturbing history of eugenics. And what's important to note here is we often talk about eugenics in Vermont as being directed at Indigenous people. And that is very much true, but it also had an incredibly deep impact on the community of people living with disabilities, who are also a major target. As a result, when we talk about things like trust, and I'll come back to trust in a moment, when we talk about things like trust, people living with disabilities, people who are Indigenous, and really the rest of us, all have the memory that is longer than our lifetime, right? The intergenerational trauma that these things have brought. I'll continue. We know that in the United States, women have been sterilized in carceral facilities as conditions of release. As recently as two years ago or last year at the southern border, involuntary hysterectomy of migrant people. We know that on Puerto Rico we were also, well, the United States was also sterilizing a lot of women. So when we think about the need for collecting data, so much of data requires the participation of individuals in the public. Collecting data about me requires some level of my participation, although the way the police state of the United States is shaping up, soon you won't even need me to participate. You'll have everything you need. Regardless, where we are right now, you've got to have some level of participation from the individual, him, her, or themselves. However, because of the history of medical research and experimentation, those of us who come from historically marginalized populations tend not to have that trust in government or in public health. Now, we also know in terms of data needs and availability that the technology we use to collect, aggregate, and report those data also makes it difficult to do certain things like add categories. For example, we know that for a long time the state has been having conversations about adding a third gender category for things like unemployment or driver license or birth certificate. And sometimes it's a matter of policy, whether people are willing to do it, but sometimes it's a matter of technology. The system will not let us put another letter that's not S or M. And it's a bizarre and strange thing that we're still having to overcome those hurdles, but that is some of the challenge. We also know that antiquated technology makes it harder for us to share across agencies. And that also leads us to another related issue, which is personally identifying information and small sample size. That creates challenges with statistical weighting, which in the long run also helps hinders our ability to understand the full picture of what's happening. So that's a little bit on data. What you're looking at now is a screen that is extremely overwhelming. And that is a little bit on purpose. When we were as a commission working through some of the issues that we wanted to discuss in our first report, and really trying to understand the full scope and breadth of this work, it became extremely clear that it was a lot. It was a whole lot. And again, going back to the point that we wanted to do this right meant that we were very intentional about wanting to take our time. Now, of course, we respect the legislature and specifically that these committees have carefully and meticulously put together timelines that could assist them in policy making and budgeting. And we certainly don't want to step on that. But more importantly, we also don't want to step on the decades of advocacy work and policy work that has been done on these issues for years. And so what you are looking at now is the product of some of those brainstorming and issue mapping conversations, where we said, okay, what are some of the things that we want to be able to uplift in this work and in the next few phases of our work. And so that includes things like addressing the issues of trust and intergenerational trauma. It includes things like compensating people for their labor when we bring them in to tell us about their experiences or to help us think through good policy, acknowledging history and incorporating traditional healing, process equity, accessibility, staffing and timelines and training, because we know as a commission we can come up with great ideas for policy. But are they going to be supported with the appropriate resources and given the time they need? We know that stakeholders in this work are going to include leaders and experts in transportation and housing and education, right, the upstream and social determinants. We felt strongly that we did not want to pit any groups of focus against one another, whether it was a community of people living with disabilities, the LGBTQIA plus population, people of color. We felt that, yes, we are all historically marginalized groups and have had varying degrees of problems with public health and with government. However, we felt strongly that it was a yes and and wanted to make sure that we were moving everybody forward together. We talked about whether data includes self-identified information or perceived information, for example, if I go to a doctor's appointment and they code me as an African-American person, they would have coded me incorrectly. Are our data accurate based on how people self-identify and how are we accounting for the increased number of mixed race people whose identities may not be as easy to spot from the outside? We talked about access to care, particularly for people who may use medical assistive devices. Are there Hoyer lists in dentist offices, et cetera? We talked about access for the trans and gender non-conforming population and how people's personal views and social views impact whether or not they are provided appropriate care. We talked about language barriers, age discrimination for youth and for older adults. We talked about some of the ways in which the work is siloed, for example, schools. And schools, really, that's multifaceted. One is the way that we teach health education in schools. And the other fork in that bifurcation is the way that we provide health in schools. For example, we have members of the commission who work as school health personnel and they have shared that they are largely restricted just to acute care in schools. There is not really a mechanism for a more holistic and a more long-term solution for health in schools. Siloes also exist with insurers, regulators, and providers, particularly when you consider the stratified federal and state issues around health. Of course, the carceral system is another area in which the work is very siloed. And I have to add that in the United States, because of course the United States, the name of the game here is math incarceration, what we have now is not only a bursting prison population, but also an aging one. And so around the country now, we are having to retrofit carceral facilities to accommodate the older population of people who are incarcerated. And as we think about things like changing legalities and, you know, I'm thinking about like the cannabis market and how many people have aged in place in jails around the country for something that now suddenly we're turning around and saying, oops, should have never been illegal. Let's figure out a way that we can help people make money from it. Well, let's also consider the health impact of those who had been harmed and incarcerated for it. And at the way bottom right there, you'll see a tiny one that says so many committees. And that's a big one because while it's really great that we as a state put attention on a lot of issues, it's also important that we make sure that the work is as streamlined as possible. Can we accomplish in one group what we set up three groups to do? Are those three groups talking to each other? Is it an appropriate use of resourcing? And are we really getting a broad set of perspective from all of them? So these are just some of the many issues that we were able to identify. I'm going to pull one quote from the report that I thought really highlighted this issue of pacing and timing, which says, because of the breadth and depth of these topics, the commission has chosen to perform its work at a pace that allows for thorough research and meaningful community input. I stress that this was very important to the group even with 29 of us who represent the Black and Latino and Asian and Indigenous and LGBTQIA plus population and people living with disabilities and people experiencing socioeconomic disparity and people who may be limited English proficient, even with all of us together as 29 people, we still do not represent the entirety of the statewide constituency who we need to be thinking about. And so we're committed to doing this right and that means both internal and outward facing protocols. So that's pretty much where we are. And I will just add that the, of course, here are links to the report. We will add that there is a plain language summary and also an audio reading of plain language summary. Again, these are some of the measures that we wanted to take to make sure that the report and our work were as accessible as possible. So just to look a little bit ahead on the horizon, some of the work that we intend to do going forward is going to be hearing more from providers. And everyone has a different idea of what the word provider means. I suppose as I use it here, we're thinking of, yes, major hospital networks and policy people in healthcare delivery, but absolutely from people who are doing the work. We want to hear more from nurses. We want to hear more from EMTs. We want to hear more from crisis prevention workers and crisis intervention workers, I should say, and everybody in between. We also want to look more closely at what data are available, what data are missing, and how we can bridge that gap and what's it going to take funding lines to be able to bridge that gap. It's also important that we understand the demographic landscape of the state. Now that we have 2020 census figures, we can sort of keep looking ahead at who is going to be more reflective of the statewide population and being able to prepare for that. Another big thing here is being trauma responsive. For example, it's great that we're looking to have more people coming in under the refugee program. That is something that I am particularly excited about, but it's no use bringing people here who are already coming from a background of trauma if we're not going to protect them and care for them while they're here. Looking at it from a multidisciplinary perspective, to make sure that we're including not just health-related people, but everyone who is playing a role here. I'll pause it there. I'm grateful for your time. Of course, I'm available for any questions you may have, but I also want to leave enough space for Mark and Andrea. Thank you. Thank you. That was very helpful. I think it resonates with many of us, the breadth and the depth of the issues that you are approaching are significant. I'll just ask one question and then I think we probably should just keep going and listening. But as you're looking for data and information, it seems that if you're using the typical research bases that we currently have, there may or may not be supporting information for the work that you're doing. Just as an observation, what research databases have you utilized as you've gone through the reporting work? Thank you for your comment, actually, because it does speak to another issue that I know we had this conversation a couple of weeks ago. Mark was present for that where he astutely pointed out that a lot of the data we have exist, were collected within a system that in itself is systemically biased and systemically racist. Being able not just to trust the numbers, but being able to trust the ways in which we collected it and the ways in which we're storing and grouping it is important, too. And so we're all swimming in that same water. But to answer your question specifically, some of the databases that we use include the national data, of course we're pulling from federal work, and I'm showing here how much of a data nerd I am not because there are some people on the commission are much better positioned to be able to explain that more clearly. But I will say that we have definitely a few people on the commission who are experts, researchers, who probably would be better at answering that question than I am. I will say, though, that we do have access to some of the more, to some of the databases where access is limited because we have state people who have access to certain, whatever it is, government data or healthcare system data. And that has been helpful, but we also don't want to rely on things that the public doesn't have access to either. So we're trying to, I think, use a good mix of qualitative data, quantitative data, and data that may not be publicly accessible right now, but that we can help make publicly accessible within, of course, applicable regulations. Okay, thank you. I might link up with you again going forward, and we can maybe talk about this a little bit within our committee with you. We're bumping up on crossover, so it may not be right away, but I think it's something that is important. So thank you. So I'll let you go ahead. You have the floor, Susanna. All right. So I see Andalea have come off mute. I'm going to take that as readiness. Yes, please. Thank you. Kwaikwae, Hiromak, Uli Giscat, Uli Papkeni. So that is Hello Friends and Good Morning. I am a native of Bermondur. I represent the Kawasaki Band. Thank you, Susanna, for saying that correctly. And all of this as a fellow commission member, I represent Kawasaki, and I also try to keep the lens that it's all Bermondur's, all Indigenous folks living in Vermont from that perspective. And we, as Susanna did talk about the trust, we are in the middle of Black slash African American History Month, and the theme this year is Black health and wellness. And so as we are also looking, as I'm looking at that in this lens for my testimony to you today, is we are looking, as Susanna said, hearing from providers. Can we think about outside of the box for between not just Western medicine and other ways of knowing? And so we, and looking at that data, how are we going to get that data? How are we going to have that trust? Because I, what I'm hearing from Kawasaki and other Indigenous folks, other Abenaki in Vermont, and as Susanna pointed out, I present to my healthcare provider as white-seeming. And when, even though I've put on the paperwork, I'm Abenaki. And that is, and then depending on who I have for a provider, I just recently had an interaction that I left feeling that they thought I was quote unquote crazy. And so I, these are the things that as I'm sitting on the commission that for my hat that I'm also thinking of for the community to make sure that we are being inclusive and representative of everyone in the state for birth doulas, midwives, and not just within a medical facility like the hospital offering midwives because it's still in a facility that looks like a medical model. I had my children at home with a team of midwives, women of color. And so I think about those things. So as we're, as we are talking about this health equity access, and I also within my work, because I do work in case management at the hospital for folks who are on and under insured for monitors. And I hear so many of these stories. So I'll leave it there. I don't want to belabor everybody. And hello, Jenny. Hello, Andrea. It's good to hear your voice, even though I can't see you. Yes, my camera seems to be broken. I'm working on that. Okay. Yes. But Andrea, thank you for your work on this. And I know that you have a long history of working on this. And we're very appreciative of your helping the state resolve some of these issues. Thank you. Thank you. Susanna, then as Mark Hughes next on the list, does anyone, I guess a quick question then for Andrea. You know, I know that there are folks, for example, who work in the medical community with indigenous folks. And in fact, my husband worked with some of the indigenous people in Alaska for a few years. And so I'm just, there must be some data out there that helps with the medical treatment for individuals from various tribal backgrounds or ethnic backgrounds that you've identified in the process. There are. And there are a lot of that data, like you said, is indigenous, not indigenous necessarily to Vermont to Avanaki. And so, and Dr. Avila has provided data for various reports, not necessarily for our commission, but I'm aware of the data that she has available. And so I believe that some of that has been being used and is being used as far as the medical setting goes. Also working for the hospital in that I see this is something that they are working on for DEI, Diversity, Equity, and Inclusion, for whether it's onboarding the medical students, the residents, whether it will be ongoing training for cultural competency, cultural humility, that type of thing for providers, managers, they, it's, you know, so as I come from that in that lens here in this world, and again with the commission work, and my being an Avanaki Vermonter and representing Kalil Suk, I trying to balance that to make sure. And then the question that I've had is, is the state expecting our commission to be the final content experts on these topics when as a commission we are saying, well, let's slow down, let's make sure we have these necessary voices at the table like Susanna said, the folding chair. And not necessarily, I, even though I represent Kalil Suk, I do want to make sure that we have the necessary voices that we're hearing them, and we're hearing their concerns, their ideas, and not just moving forward with the sort of that patriarchal model still of being the experts, and we know best for everybody else. Does that answer your question? Yeah, no, this is very helpful, and I greatly appreciate it because it helps to explain how the commission is working and the steps that you're taking to be, to clarify. It is very helpful. In some ways it sounds very much like the scientific process, but in other ways it allows for some social and cultural interaction. This is really very helpful to all of us. Thank you. You're very welcome. And I feel like we can't leave out the social and cultural aspects of health because, as Susanna mentioned with the report, there is the historical trauma and so on and so forth. And folks are bringing that to the table as well, not only the individual members of the commission, the folks that we are thinking about for how this will impact the health and equity for the state and how it is implemented in policy and legislation and everything. Well, we actually look forward to receiving recommendations from you folks. And so for some of us there's a little bit of disappointment that we don't have those in our hands, but this really helps us to understand the thoroughness with which you all are working and greatly appreciate it. Thank you. And I do have another meeting that I have to jump to. Do you think I'll still be needed or will it be okay for me to jump off? I think that's up to Susanna. I think that this is helpful to have heard your comments. Thank you, Andlea. I think if there's any other follow-up, I'm happy to connect with you offline, but thank you for being here. Thank you. Adios. Adios. Mark, I see you off mute. Good morning. I'm Reverend Mark Hughes. I am the executive director of the Vermont Racial Justice Alliance and Justice for All. I am also the principal of the Racial Equity Association and LLC and head of a community center here known as the Richard Kemp Center, which is a cultural empowerment center here in Burlington. Mark, Mark, can I ask for you to perhaps speak a little closer to your mic? While I do that, how about if I go towards my system preferences and look for volume, because every now and then it sneaks away from me. Okay. Yeah, that would be great. It was in the room as well. Thank you. See if I can work on that. Boy, this is exciting. Okay, so here we go. Here we go. That's much better, isn't it? Oh, absolutely. Thank you. So again, and for the record again, I'm Reverend Mark Hughes. I'm the executive director of the Vermont Racial Justice Alliance, also Justice for All in an LLC called the Racial Equity Association. The Richard Kemp Center, which is here in Burlington, and also minister at the New Alpha Missionary Baptist Church here, the only church in Vermont that worships in the African American tradition. So thank you for having me, and it's been a pleasure serving with the commission. It's interesting being a commissioner, being like a Nama commissioner again. I was a commissioner with the police here, and in Burlington now I'm a commissioner again. I just thought about that this morning. So it's really good to see many of your faces, which I recognize, and I'm normally welcome by your hallways in the state house. Just wanted to just give a shout out to Madam Chair and Mr. Chair over in the house as well, and thank you all for the work that y'all did on what was H 210. Our H 210 was enacted as Act 33, and we were happy to be able to bring this work forward, this racial equity work forward. Obviously we've segmented it in a way where we've envisioned it as work that was related to racial equity, but we put it forward in a way in acknowledging equity across all spectrum. Obviously we do the working racial equity. This is a part of a much larger strategy, and so what I'd like to do is just for a couple of minutes explain to you part of that and talk a little bit more also about where we are in this process with the HAC more importantly. What I will say is, it was our strategy to continue the work of community engagement and support. There's a lot of activities that we have which include the work of the the Kemp Center, and the reason why I'm framing this this way is because there is a lot to do to address equity, not just policy, not just commissions. There's a lot of stuff that's happening as you would know outside of those commission meetings across our communities and across various organizations across the state. So a lot of work which includes the work that we're rolling out in the Richard Kemp Center, the outreach and education component of the work that we're doing, which augments your R113, which was your racism health emergency, public health emergency. The part of that is that a seminar we have called Turning the Curve, various other outreach and education initiatives abolish slavery. There's one on reparations in Vermont, the definition of systemic racism and the economics of systemic racism. All of these are ongoing. There is obviously a component that has to do with platforms and initiatives which leads to our acknowledge change and transform platform here at the state legislature as well as our moral budget. And what we initiated last year was in addition to putting forward PR2, which you just passed over the last couple of weeks with the constitutional amendment. It also involved obviously the, as I said, R113, which was I think PRH6 last year, the racism public health emergency, as well as H210, which what we're here to talk about right now, NH406, which is an economic and cultural empowerment piece that's now over in, I believe it's in, no, not finance, but... Ways and needs. Somewhere in the house. We'll come back to that. Commerce, commerce. Thank you, Reptino. So the thing is, is that we've just got a lot of things going on that's directed currently with the geopolitical and economic implications of systemic racism. We believe that that's, it's driving all things right now. And obviously, we appreciate the consideration that you've given to this. And it is an integral component of the conversation that we're having within the committee. So I'll pause there for a minute. That was just the framing of how we got here and all the other stuff that we're doing as the Alliance. I want to talk a little bit more about the HGAC, but I just want to pause and just see if there's any questions that the committee has of me, or if there's anything not that I just covered, but also in your limited time that you have left, which is maybe about, we're going to call it 10 or 12 minutes, in your limited time that you have left, is there anything that you'd like to hear from me in what it is that I'm going to be presenting here? Because I can just go straight, cut straight to the chase if there's something, Madam Chair, that you'd like to hear. I'd like to hear your presentation first, and then there may be a question or two, but go right ahead. Thank you. Fantastic. So one of the things that I wanted to come and talk about is just to kind of echo what Tutana said. And first, I want to give a shout out to my colleagues, Andrea, Tutana, all of the stuff that we're doing together is pretty exciting. It's a huge challenge. It's a heavy lift. It's a lot of fun, and it doesn't go without complications. So one of the challenges that we're having right now within the committee is just coming to terms with the fact that in addition to all of the other demographics, we also have a demographic called government and non-government. And what that means is that there is a significant portion of folks within the committee that are government employees, which means they have access to the infrastructure, like SharePoint, various other technology assets. They are collaborative by nature. They're at work all at a time. They're always logging in. They're always communicative with one another. And this is most of them, it's not their first rodeo. And many of them, they're senior in the executive administration, which means that a lot, sometimes if we're not careful, this thing takes unto itself a life of its own. And what it does is it kind of negates the whole equity adventure that we're trying to build within this process. So we've identified that as an issue. And it's unfortunate, but in my opinion, it was post-report that we've actually had the conversation on it. Personally, I'm appreciative of the fact that we were able to get you a report. But you know me, I'm fairly candid. I don't think that the report really holds a lot of weight in my world, because what we were doing this is we were meeting a deadline. I think the vast majority of the report, personally, it does contain a lot of findings, or I should say it came from a conversation that we had prior to such time as we were able to really dig in. What we were doing was we just wanted to figure out what were the issues. So you'll see this thing called issues. And even with that, I don't know that they're comprehensive, and I don't know that we've really had a chance to dig into those, and they take up the vast majority of the report. And even looking through it now, me as being a member, and I'm pretty involved, there are things that I really didn't have a chance to even squeeze in there. So there's some challenges, because it's a really fast moving train, and it's really difficult and complicated for some folks who are community members to keep up with this process. Some of us are just trying to figure out how to log in to SharePoint from time to time. But we're figuring it out, I guess, is the good news. We are figuring it out. We've had the conversation. We'll continue to have the conversation. I think the biggest highlight or the biggest takeaway from the report is the word preliminary. It is preliminary. We have provided a report, I think, and from my personal perspective, again, I think it's largely perfunctory. I'm not trying to discredit the work of my commission, because I respect all of my colleagues, but I'm here to tell you from the perspective in which I've been operating in this process, I also sit on the policy committee. I sit on the data committee, and I also sit on the training committee, subcommittees of this group. I'm an integral component of what's going on here. This is very, very important to me. It's very important to the Alliance. It's unfortunate that we didn't get across the finish line, the HAC that we wanted, that we envisioned, but we're doing the best we can with what we were given, and process is really, really important here. I would also say that there are things that, from your perspective, the way I see this process is that with all due respect, I think there are some things that our policy makers and our executive branch and many others already know we must do. Already know we must do, and what I would encourage you and just really implore you is please don't wait for us. Please don't wait for us to come back. Please don't sit back and wait, and I know you're very busy. I know you've got a thousand things going on, different directions. You're sitting on multiple committees in a whole nine yards, plus you have a life, but please don't wait for us to come back with certain recommendations. For example, we know that there is a huge need for a data infrastructure as we sit on an unprecedented budget surplus as a state. We know that. We understand that this data infrastructure, it must accommodate these, you know, tracking these disparities across various systems, and I think it's the heart and soul of everything that we're doing, not just from the racial equity perspective, but from an equity perspective across the board. So please don't wait for that. Please make the necessary, the requisite investments in that immediately. Let's get the folks, just get a bunch of smart folks in a room and not let them out until they come out with a plan on how we move that forward. The other thing, it pertains to upstream. That's something that we refer to as upstream. One of the things that we believe in, you know, I want to just give a shout out to Andrea for acknowledging black history is what we believe at the racial justice alliance, as it pertains to black history, well, as it pertains to wellness, we have a wellness working group of which Repchina is a part of, and there are many others who are across the community who are part of this wellness working group. It was through this wellness working group that H210 was born. It was through this wellness working group that a lot of activities have been happening. And we've discovered that we can't just talk about health because we got this thing called upstream. And here's what we said. And if you don't mind me quoting this, it says, our wellness is at the epicenter of all we do and experience. We must consider every action taken to dismantle systemic racism as an act of enhancing our wellness. We will disrupt status quo systems and develop long range strategies for black led alternative approaches to create healthy outcomes. We will fight for wellness as if our life depends upon it because they do. So I just wanted to share that with you because that is the perspective that we have. There is a lot of work that's happening in housing, in education, in employment, workforce development, economic development, transportation, and also the criminal justice system across all of these. And we know that we need to be working simultaneously. And this goes back to, please do the work now and don't wait for us. It goes back to the fact that we already know that policy and training and ongoing education, we already know that data and the infrastructure required to support it are very important across every single one of those aforementioned areas. So as you go back to your committees and you focus your time and attention on what it is that's important, understand that it too, they too, also come back to our wellness. And finally, I just want to go back to this conversation on funding. This bill as Chair Lippert knows and those in the House know well, the fourth or fifth thing that happened in its preparation for crossover is that it was stripped of funding, those stripped of money. That doesn't mean if we see today that there is funding required in the initiatives that we are undertaking, that this joint committee shouldn't consider moving the necessary funding into place so we can do the work more effectively. Since we are in an unprecedented budget surplus and this work is about wellness, not just for racial equity, but for all equity across the entire state, and it too is unprecedented. So I thank you for your time. Thank you for the opportunity to come before you. It's really good to see some of you and I'll take your questions now if you have any, Madam Chair. Thank you, Reverend Hughes. That was very inspiring to say the least and we appreciate the time and energy that you and Andrea and Susanna have given to the Commission. I do have a couple of questions and I'll start with a budget at the end. So did the Commission have a budget request, a line item request, that perhaps went through the administration into the big bill, into the larger budget? Or do you have such a line item request that we could look at? I don't want to assume anything on answering that question. I'm going to defer to our fearless leader, Susanna Gaines, on that one. Okay. And I'll come back and ask another question, probably for both of you. Madam Chair, can you repeat it one more time so that I can answer you concisely? Sure. The comment was that the Commission really doesn't have the funding it needs and my question is did the Governor put in his budget any funding request for the Commission that based on your request and whether or not that happened, do you have a budget that we could look at a line item budget for the Commission? As a point of clarification before she answers that, just so I can be clear on the record. Sure. What I was actually stating was in the event that the Commission does require funding, we definitely need to know that that's available and I think that we need to be preemptive in that respect, particularly since we know that money is available now and work usually doesn't happen free. So I was just making some assumptions. I don't want that question to go to Susanna with that pretense that somehow or another there's something that we need that we have that we spoke about. Thank you. So okay, but I guess the question is will there be a request? Do you have a request? So the to my knowledge there is no item in the Governor's recommended budget for the Commission. The Commission has the $180,000 allocation that this committee put forth last year to support the hiring of a contractor to assist in the work around standing up in office of the recommendations around standing up in office of health equity. It is also from that pool that the Commission members per diem are being pulled. So that is an additional draw on that line item as well. What it does not account for also is any other kind of compensation that we may want to provide for people who are not Commission members who are performing labor joining us or doing any other kind of policy insights for us or with us. I can't necessarily foresee any space or equipment needs but again because we do want to be inclusive and provide physical accommodation that is something to consider as we eventually go back to in person meetings. Those are some of the things that I can think about but again I think that the Commission, I agree with Mark that this first report is not necessarily the substantive depth we wanted to get into because we chose to be very intentional in not wanting to rush something but still wanting to honor the deadlines which we were given but I will say that the budget conversations we do intend to have more deeply and more fully and come to you with well laid out recommendations on that when we have been able to give it the the time and the attention they deserve. Thank you and this actually links with a comment I made earlier about data analysis collection and analysis and maybe hopefully during one of our committee meetings after crossover we can get back and and look at this a little bit together. I won't ask my next question. My other question and something you can probably think about is how do you balance all the issues and needs that you have in your Commission and then there are bills as you said Reverend Hughes there are bills that are in in the legislature now or will be put in and we don't want to be business as usual and go catch as catch can but on the other hand the Commission may wish to support some of these bills so it would be helpful to know going forward which legislation would be important to the Commission as a whole so just those two things to think about representative Chena and then Senator Hardy. Thank you. I want to start by saying that I'm actually not disappointed with the presentation today because when we created this Commission we the intent was for this Commission to have greater autonomy than past groups and we acknowledged how you know how if we're going to change structural oppression we need to empower people to do things differently so for you to come to us and and be and give honest feedback that your assessment is that the amount of work is so monumental that it's going to take more time and the way you've sorted it to me will all make sense and I appreciate it and you know I think we can be patient and give the group time and space and resources to do that work. I might have missed something earlier because I came late because I'm not feeling good today and so I don't know if I missed an update on the Office of Health Equity I think I heard Susanna Davis say that someone was contracted to look at moving forward with the plan to open it up but if it was said already and you tell me that I'll go back and watch the tape but if it hasn't been settled already could you maybe take a minute to just explain kind of what we're looking at with that RFP and like you know what the plan is I have one other question too I'll ask and then I'll let Susanna and Mark kind of decide how to answer the second one is that considering that we're in the process right now fine tuning the budget the budget for 23 I am curious if either of you have any initial recommendations about areas where money should be spent right now and I don't know if this is out of bounds but like the health care committee has been looking at our recommendations I would at least as an individual I would be interested in having you or a subgroup of the commission look at what we're thinking and give us some quick feedback I don't know if there's a formal way to do that and have the committee you know have people come in and testify but I think there's little ways we can engage with the commission even before you're totally up and running and one might be to see if there's a way you could look at what we're doing and just give us some feedback before we you know finish our budget recommendations for example so I guess that question is sort of any ideas where money should be spent right now and what I did hear from Mark is talking about the social determinants of health but I'm just curious if there's any more detail so I know that was a lot but I think the two main questions are where are we at with the office of health equity and are there opportunities for you to shape our decisions as we make the budget by giving feedback and recommendations so let me just comment thank you for your questions it's 10 o'clock we're going to go a couple minutes over and then Senator Hardy will have a question and after that we're going to end I think as you're answering the question please answer whether or not you are working with the house human services committee because they are also looking at social determinants just the thought there but senator not not yet senator uh go ahead susanna thank you so the first question about where we are with the office of health equity the appropriated funds to hire the contractor have not been used yet we I chose not to do that um because it while we were still setting up the commission it basically just would have been me making that decision by myself and I didn't feel comfortable making that decision on behalf of a 29 member group that had barely been impaneled yet so I did not do that um because I again cost us equity so the answer is we are not anywhere with that um I think that it has taken this commission longer than expected to find itself and get its sea legs and I also simultaneously believe that we are exactly where we need to be so um so that's that's what we are we also do have to the second point about budget we have a subcommittee on grants and funding that has a number of people in state government and outside of state government who are familiar with our peace contracting processes and the landscape of what exists for example one of the members on that subcommittee is somebody who works at the health department who is in charge of managing at least one possibly more federal grant programs and CDC funded grants as well so we do have a good picture of the landscape of what opportunities there are in the health funding landscape and also what to look for in this kind of an RFP so we're looking for that group probably to lead on that and to your point representative Tina about whether there's an opportunity to jointly look at some of the recommendations from these committees I think that would be entirely appropriate and appreciated by the commission and I'm sure that we can figure out a formal or an informal way to to funnel that information back and forth I also want to apologize very deeply to this group um they are calling for me in senate natural and um I I need to step out so I apologize for that well we're very supportive of the work that's going on in senate natural so good luck thank you for being here and uh for bringing us the information we really do appreciate it very much thank you and I do see that Senator Hardy does have a question I apologize for not being able to stay and hear it but of course I'm available if you wanted to follow up by email after if I'm happy to speak more Senator Hardy go ahead and ask your question and then uh we can decide how to proceed go ahead director Davis needs to go that that's fine I will ask my question but I can follow up with you um also um so go ahead if you need to I I don't want to hold you up um but thank you for your work also um yeah so just thank you to director Davis and Reverend Hughes and others who've worked on this I think that we all knew when we were setting up this commission and doing the bill last year that it was a huge lift and a lot of work to do in a really fast time um but I mostly what I want to just say because I heard um Mark say something that I think is contradictory to what I've heard in the past from Mark so I I just want to just sort of lay out this confusion I have and I think it's worth a longer conversation so I don't want to have that necessarily now but um you said please I wrote it down please do the work now and don't wait for us and um that is credibly contradictory to what I've heard from you in the past and I understand what you mean but I also think we need to be really careful um you know the whole uh uh not about us without us um I'm really just conscious that we don't do anything that uh gets in the way of the work and as representative China knows very well he and I worked very closely at the end of last session to try to get all the language just right and the dates just right and to make sure there was a timeline in there that spoke to the urgency of this work so while I'm completely understanding and appreciative of the fact that it's super complicated and you need a lot more time to really work through it with such a big group and and such a huge topic I just want to make sure that we are uh our urgency and your urgency and our need for time and your need for time doesn't get confused and that we are making sure that we're all working with best intentions and and so I just wanted to that for me was kind of an elephant in the room and I just want to say it out loud and know that this means we have to have a lot more conversations senator senator let me let me just say that that is exactly what I meant by business as usual where the legislature takes off and it's catch is catch can rather than being built into a broader context and so it's great question go ahead Reverend Hughes yeah just a brief response to that because I appreciate you sticking around for a couple more minutes is is that you know actually there there is no contradiction um because there's there's always been work that the legislature could move ahead on that they've been reluctant to and I think if there's any if there's ever really been much contradiction from our perspective is that there's a sense of urgency with uh folks who own political and economic power in in times when they feel it's important but when folks who are in marginalized communities believe that there should be a sense of urgency then that's when folks with political and economic power usually have a tendency to put the brakes on and I think contextually that comment that was made just for clarity it had to do with those things that we know that we know that we must do for in the example the specific example that I use was this data infrastructure for example so the question that we might ask ourselves just to completely round this conversation out is is why is it that in uh 2021 why is that the first time that we've ever decided that there was even a need for health equity why did we wait until 2021 to even make that decision first of all and then here's the second question why was it such an emergency that we have that report within two months after that or whatever that time frame was and I think what that does is it really clearly points out the contrast in who's set the priorities and when um I think you know just to conclude on that and conclude with with you today unless there's any other questions is is that there are many things that are happening like for example h273 was on the wall last year and we're finally making some progress on it but why is it that it take is taking us so long to move that and why is it that we're still trying to you know play hot potato with h406 which is the economic development policy regarding you know economic equity for for black and brown and other folk so there are a number of you know again contextually the whole upstream in all of the activities that are happening in some of these communities upon which you serve which is why I believed it was proper for me to state that just so we can get beyond a health um conversation because wellness as as you know it spreads broadly is is that there are things on the wall or things that have been in deliberation that have come forward from us and other organizations that you are currently deliberating that there doesn't seem to be a sense of urgency on um and I would like to see you know I you know my hope is is that as we do our work as a as a um hgac as a health equity advisory commission those things that we've already established to you as priorities are those things that you already know to be priorities I would just think that you know we I would hope that you would continue to move forward on so as much as I appreciate uh senator hardy the clarification that you saw and I hopefully provide it I think that you know I think we we want to just be careful of a slippery slope of making assumptions that black and brown folks don't want you to do anything until we tell you to do uh what we'd like you to do is we'd like you to do what you know what you must thank you and with that we need to ask our visitors uh to leave this room the senate health and well welfare committee will stay here for a brief time and thank you so much uh marcus uh and please give our best again to susanna and andrea this has been a very informative session and uh very helpful thank you for having me madam chair and also I thank you the committee the joint the full joint committee and please feel free to follow back up with the other members directly if if necessary as well as myself thank you okay thank you all right so we end the joint committee meeting