A health equity podcast by students, faculty and staff of Public Health and Health Professions.
Season one took a deeper look at racism and health. Experts from Buffalo and around the U.S. talk about how racism negatively impacts health, groups working to address this problem, and how to make our classes and campus more inclusive for all students. Future episodes will focus on health equity issues.
Tobacco-related health disparities are a pressing issue in the area of tobacco prevention and cessation. Schuyler Lawson sits down with Dr. Monica Webb-Hooper of the NIMHD to discuss the implications of tobacco on communities of color, and why these disparities exist in the first place.
Hello and welcome to Buffalo HealthCast, a podcast by students, faculty, and staff of the University at Buffalo's School of Public Health and Health Professions. We are your cohosts, Tia Palermo, Jessica Kruger, and Schuyler Lawson, and in this podcast, we cover topics related to health equity here in Buffalo, around the US, and globally. In this first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US, as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health equity and inclusion.
Schuyler Lawson 0:47
Alright. Hello, everyone and welcome to another episode of Buffalo HealthCast, the University at Buffalo's premier public health podcast. I'm your host, Schuyler Lawson, a second year PhD student in the Department of Community Health and Health Behavior. With us today is Dr. Monica Webb-Hooper, the Deputy Director of the National Institute on Minority Health and Health Disparities. Thank you very much for your time to speak with us today.
Dr. Monica Webb-Hooper 1:08
Absolutely, happy to be here.
Schuyler Lawson 1:09
Alright, so I'll begin by having you tell us about yourself and a little about your own education background too.
Dr. Monica Webb-Hooper 1:16
Sure. Well, I am originally from South Florida, from Miami, Florida. And I attended undergrad at the University of Miami in Coral Gables, Florida. And then I earned a PhD in clinical health psychology from the University of South Florida in Tampa, in the Moffitt Cancer Center. And then I completed a clinical internship in medical psychology at the University of Florida. And after that, I had faculty positions. My first one was at Syracuse University. Then I returned home and I was at the University of Miami as a faculty member in the Department of Psychology. And before I joined NIH, I was at Case Western Reserve University, where I directed an Office of Cancer Disparities Research, in addition to being a professor.
Schuyler Lawson 2:07
Seems like you have quite the illustrious background, and that kind of segues into a question about NIH. As the Deputy Director of the National Institute on Minority Health and Health Disparities, what are your work duties?
Dr. Monica Webb-Hooper 2:22
It's an interesting question, what my work duties are, because every day looks a little bit different, which I think keeps it fun. But if I were to discuss it in broad categories, I would say that first, I am one of the senior leaders. I work closely with our director to sort of oversee all aspects of the Institute and everything that we do in terms of how we advance our mission, which is about reducing health disparities, improving minority health, and the promotion of health equity. So that's just really broad. I also work on developing scientific initiatives that fall within our scope, and NIMHD funds research focused on this topic, or these topics, and they're disease agnostic. So we also have partnerships, and we are mandated congressionally to work across all of the NIH institutes to coordinate activities around health disparities and minority health. And then, of course, across the Department of Health and Human Services more generally, I also supervise and oversee the directors of several of our offices, like our Office of Communication, our Policy and Evaluation Office. I also work on just general issues around the climate within our institutes. So I have a set of of areas and tasks that I focus on with what's happening in our institute. So that's separate from the science that we are promoting. And then I work on NIH-wide initiatives, NIH-wide efforts. So I serve as an ambassador, and leading several committees and task forces within NIH more broadly.
Schuyler Lawson 3:59
I have a follow up question to that. Since the 2020 social justice movements after the murder of George Floyd, has there been any kind of increased interest in health disparities or more funding for health disparities based research?
Dr. Monica Webb-Hooper 4:17
I'd say yes, I think that 2020 - I call it the collision of 2020, the collision of events that led to an increased emphasis on the reality around structural racism, discrimination, how it affects health, COVID-19, social justice issues, such as police brutality, and you know, we saw many organizations, including NIH, writing a letter or making a statement standing in solidarity, etc. And I think one of the questions that many of us who've been focused on this, not just in the past two years, but for many years, or live it every day, wondered was, how long is this going to remain a part of the conversation? Is this going to stay a significant issue, or is it going to fall apart? I think that what I've observed, and I'm interested in if you see this differently, is that the momentum around this topic and the focus on it has remained. And it's two plus years later in terms of into the pandemic, and we're still concerned about it. I do think that this Institute does receive elevated attention, because this is what we focus on. And so they turn to our institute to look at how do you advance science in this area? With the most recent president's budget, the budget for the country, NIMHD did receive its largest increase since its inception, or becoming an institute, which is with the passage of the Affordable Care Act. And so we did have an increase in our budget, which is pretty sizable, and just allows us to invest more resources into the best science that addresses the areas of greatest interest to us.
Schuyler Lawson 5:51
From my perspective, I noticed a similar trend, I would say yes. Recent conferences I attended at the Society for Research on Nicotine and Tobacco, there was a heightened focus on tobacco-related health disparities, more than what I was seeing in previous conferences. So I think that there's still the momentum there.
Dr. Monica Webb-Hooper 6:09
I think so.
Schuyler Lawson 6:10
So I do have another question for you. What are your specific research interests?
Dr. Monica Webb-Hooper 6:16
So I am interested broadly, in clinical health psychology, biobehavioral research, health behavior change, all the work I've done, has had the backdrop, for the majority of the work, I would say, the backdrop of Minority Health and Health Disparities within the areas that I'm interested in. I'm also interested in cancer prevention and control, a lot of focus on tobacco use, and smoking and smoking cessation, weight management, obesity reduction. So cancer risk behavior in general, but the types of behaviors that I'm interested in, health behaviors, have implications not only for cancer, but you know, heart disease, and stroke. And so it's really kind of transdiagnostic in a sense, of things that I'm interested in. And I think I've always been interested also, in broadly this category of, that you also hear a lot about now, which is social determinants of health, and how the social determinants of health impact our health in a number of ways.
Schuyler Lawson 7:18
So for our listeners, could you define what the social determinants of health are?
Dr. Monica Webb-Hooper 7:22
Sure. Social determinants of health is a term that you see if you look at the Healthy People 2010, 2020, now 2030 effort, and it's really about the conditions in which people live, where you're born, where you work, where you play, where you experience life, and how those conditions have a direct impact on health. So a few examples of those could be the neighborhood that you live in, the access to transportation, the access to healthy food, the access to not only health care, but high quality health care, access to not only education, but school systems with quality education - those are social determinants of health. And it is that these are different from health disparities. And sometimes I hear people kind of use these words almost interchangeably. Health disparities is about differences rooted in disadvantage. Social determinants, they're often discussed in a negative way. So likening them to, and they can be drivers of health disparities, but not necessarily, they also can be drivers of really good health, if you live in neighborhoods and communities where you have plenty of green space, and people are out jogging and walking their dog and with low crime, and everybody has nice cars and great school systems. So those are also social determinants of health, but they lead in a different direction.
Schuyler Lawson 8:42
Okay. Thank you for that definition. So, getting back to it, you mentioned your research interest in tobacco. So in your view, what drives tobacco-related health disparities experienced by African Americans, because from what I understand African Americans, they bear the disproportionate disease burden when it comes to tobacco-related illnesses.
Dr. Monica Webb-Hooper 9:04
That's true. And a large part of my work focused on tobacco related disparities, specifically among African American adults. And I think it remains a critical problem to address, I have to say, we need more scientists who are focused on this community because African American people certainly suffer the great undue burden of tobacco-related illnesses. And actually, when you look at it - if you just look at the prevalence of any tobacco use, the prevalence of smoking by race/ethnicity in the United States, you don't see that there is a disparity when you compare white and African American adults, and actually, there was a disparity there. And in the early 2000s, 2000-2001, we saw an elimination of that disparity. That doesn't, however, account for the greater prevalence of smoking menthol brands, among African American adults, which is, 80-90%. I mean, many times at least 90% of my participants were menthol brand - their preference was for menthol brands, compared to about 30% of white adults. But I think the most persistent disparity, if you compare African American males and females to their white male and female counterparts, it's the difference in cessation, that ability to quit successfully over the long term. And we see that in national epidemiologic surveys, we see it in clinical trials. And the difficulty quitting is partly what leads to health disparities. If you can't quit, then you have more years of exposure to smoking, even with a lower number of cigarettes smoked per day, you have the longer exposure because you haven't been able to quit. But I have to also just say that the difficulty quitting that many African American adults experience is not due to just our individual failures, why can't you just quit? It's much more complex than that. There are multiple levels of factors that contribute to why it is so hard for African American people to quit smoking. But certainly, this has to be a priority if we want to save lives and reduce disparities.
Schuyler Lawson 11:14
I love that you mentioned that it emphasizes not individual failing, and it's actually kind of ties in nicely to publication you had in 2019, when you examined the reasons for exclusion from smoking cessation trials. From my understanding those studies are ways that people can actually get access to free smoking cessation treatments like nicotine replacement therapy or prescription medications like Chantix or Wellbutrin. So could you summarize the findings of that study? And initially, do you think that the findings factor into tobacco-related health disparities in African Americans?
Dr. Monica Webb-Hooper 11:54
Sure, I think that study, the reason that we conducted that analysis is it was part of a randomized controlled trial, where we were wanting to kind of look at in the larger study, whether or not a cognitive behavioral therapy intervention could eliminate cessation disparities by race and ethnicity. And so we wanted to recruit an equal number, for the most part, of white adults, African American or Black adults, and Hispanic or Latino adults. And so it provided an opportunity to look at, well, we're recruiting these numbers, but are we excluding people based on race, ethnicity, and what would be the reasons for that? There is an act that was passed in 1993. It's called the NIH Revitalization Act. And in that act, it specified that grant proposals are required to include people who are identified or identify as racial ethnic minority persons as participants. And then you also have to describe your planned distribution of enrollment by race/ethnicity, at the end of your grant, you have to report how well you did. So in this study, we weren't able to recruit the numbers that we were looking for. But what we found, when we looked at our screening data, we found that about a third of the sample, a little bit more than a third of the sample, were deemed ineligible. And we had a long list of criteria. This was a group based face-to-face study. So this happened, the study actually ended just before the pandemic. So this was people coming in for face-to-face intervention. So we looked at all the reasons why people weren't eligible. The most frequent reason was serious mental illness. Second was alcohol dependence or drug use, and then barriers to attendance, like they couldn't come in person, would be an example. And what we found overall, was that the ineligibility or being excluded from the study was actually greatest among African American adults, and then second, about 42%. And then Hispanic individuals, 37%, white individuals were excluded at about 24%. So we were significantly more likely to exclude people who expressed interest in the study, but didn't meet the criteria that happened to be African American or Latino. And then we looked at the reasons why. And we found that the white individuals who expressed interest were more likely to be excluded for just one reason, like maybe they had an attendance barrier, or they had a medical condition that would preclude them from using nicotine replacement therapy. When you looked at African American adults, however, this group was more than twice as likely as our white individuals who expressed interest, to be excluded for three or more reasons. So people were being excluded for lots of reasons. And what it highlighted to me, among other things was that it's necessary for some trials to set exclusion criteria because of the study, you have to have inclusion/exclusion criteria, but I think the point is that those criteria may have unintended consequences where certain groups of interested potential participants are being excluded by design. And that might be one reason that this act, the NIH Revitalization Act, still, we have progress to be made in this space. So I think it potentially has implications for health disparities, because, as you mentioned, it's an opportunity for people to have access to state of the art, cutting edge medication, or treatment of whatever kind it is. I also think that when it comes to implementation, and we saw this with COVID in the vaccine trials, it's a bit different. But people are interested in knowing whether there were people like me in the study. And so it also, I think, has implications for implementation and uptake, if we can make that statement that the findings seem to generalize across populations. And I think that's important for reducing disparities and just assuring equity,
Schuyler Lawson 15:53
Thank you for your answer. So now we're gonna talk about another publication that you had in 2021. And this was a study that tested a Video Text tobacco cessation prevention intervention among economically disadvantaged African American adults. Could you summarize the findings of that and explain their public health applications?
Dr. Monica Webb-Hooper 16:16
Sure, this was a foray by our research group into mobile health interventions. And so we developed a video text tobacco cessation intervention. And so it was sending individuals, instead of just texts about quitting smoking, or education about why you should, or motivational messages, we actually had developed a video that's called Pathways to Freedom, Leading the Way to a Smoke Free Community. And we used that video, and we segmented it into smaller sections that would send out messages via the videos, parts of the video. So it was video text. And so we compared that in a pilot randomized trial. We call our intervention "Path to Quit", and we compared it to "Smoke Free Text", which is the standard text messaging program that NCI uses, and Path to Quit was based on Pathways to Freedom, so it's culturally specific to address the unique concerns of African American individuals such as the menthol smoking, the smoking of little cigars - things that you don't talk about, or you wouldn't receive in a text message from NCI's Smoke Free texts. And essentially, in this randomized trial, where people received one of these two interventions, plus nicotine replacement therapy, what we found was that at the end of the intervention - it was a first study, so it was a pilot - we looked at people right at the end of the intervention, which was six weeks later, and we found a pretty high proportion of the sample was biochemically confirmed as abstinence at the end of the intervention, which was 38%. And then we did find, and we didn't really expect to see this, that carbon monoxide confirmed abstinence was significantly greater for people who received the Path to Quit Video Text intervention, compared with NCI Smoke Free texts. As a matter of fact, the rate of quitting was 3.5 times greater in the Path to Quit condition compared with Smoke Free Text. And I think for me, when we talk about technology-based interventions, digital health, telemedicine, telehealth, it's really just imperative that all populations have access, can benefit equitably, know how to use the technology. Otherwise, you risk widening disparities, as technology-based interventions become the way of the future. So I think that some of the public health implications are that not only technology might be a way to disseminate interventions across the population, which is really important for increasing reach. But the culturally specific version was better in this case. And in addition to that, something we didn't really expect, but we found when we looked at our data, so in an ex post facto kind of way, that we did have some feasibility challenges. So again, I'm always interested in from an equity lens - who didn't have the opportunity to benefit from this intervention? That's what health equity is about, making sure everyone can benefit. So I'm interested in well, who didn't? And what we found was that, of the people who were ineligible, mostly they were ineligible because they did not have the phones that would be necessary to allow them to draw from the internet. 98% of the participants who were excluded, had Android phones and 80% had no contract Pay As You Go phones from the small carriers. Then of the ineligible respondents about 39% just didn't have the stable Internet access to get onto the internet, which you needed to be able to pull those videos. So I think this study, it shows that you can develop and disseminate a high - an acceptable, scalable tobacco cessation intervention that addresses key community concerns and needs, but you have to be careful about the ability for people to engage and not be left behind as you move toward technology.
Schuyler Lawson 20:03
I was going to ask about the digital divide, and whether or not there were any kind of differences in effectiveness as a function of age, for example.
Dr. Monica Webb-Hooper 20:10
So, we didn't analyze the differences stratified by age, but we did find just initially, that age was different when we randomize participants. So we sort of just controlled for age and age did not emerge in our regression analyses as a significant predictor of outcomes. But we didn't actually compare, in a stratified way, to look at whether age made a difference in this sample. But looking in the overall regression, it didn't emerge as an overall predictor of abstinence with either of these interventions. And both, of course, are technology based.
Schuyler Lawson 20:44
So this is very novel and promising really, because it's a nice improvement with what you described in the 2019 paper about African Americans being systematically screened out in some ways by the kind of existing status quo smoking cessation trial criteria. But what it seems like with studies like this that are more tailored, you can have sort of a broader reach and kind of be able to provide more help, in that kind of scalable and customizable way with technology. You just have to be careful not to exclude people, which is always going to be a challenge.
Dr. Monica Webb-Hooper 21:19
Schuyler Lawson 21:21
Okay. This one's pretty pressing, because it's recent news. So what are your thoughts about the Food and Drug Administration's recent rule proposals prohibiting menthol cigarettes and flavored cigars? And also, could you give context to our listeners about why menthol in cigarettes and flavors in cigars are significant tobacco control issues?
Dr. Monica Webb-Hooper 21:46
Sure. Based on my experience, conducting research and with treating individuals who prefer methylated tobacco products, this rule, if it becomes official, has the potential for strong, positive impact on reducing tobacco use among African American adolescents and adults. Among women and adolescents in general, menthol was the only flavor still allowed in tobacco products in the Family Smoking Prevention and Tobacco Control Act that was passed in June of 2009 by President Barack Obama. And what was troubling for many about that act, although it was a huge step forward in tobacco control, because it banned flavorings and allowed the FDA to regulate tobacco products for the first time ever, that menthol was still allowed. It was the only flavor that remained there, and that are still allowed in these products. There have been many - tobacco control leaders, advocates, scientists, and community organizations have really been pushing for this, for many years, for this ban. And I think there's empirical evidence that a significant number of people who smoke menthol brands would quit if menthol was not in the product, or at least that's what they report. And if that did happen, it would have a major effect on the health of individuals who smoke menthol tobacco products, it would prevent illness, and it would save lives. And isn't that what we all want?
Schuyler Lawson 23:18
And what about removing the flavors from from cigars?
Dr. Monica Webb-Hooper 23:23
I think, again, is that that is important because we know that especially among adolescents, many African American adolescents in particular, not smoking cigarettes, not even menthol cigarettes - they're smoking things like black and mild, little cigars, flavored cigars. And so this could be important for prevention among young people, if you don't have flavors that make it more attractive. I mean, I think it's the same reason why other flavors from other products were removed and why you can't buy candy cigarettes, like we used to puff on when when I was a kid, and you could have these little gum packages that looks exactly like cigarettes - the same reason and that's why it's important not to flavor cigars, and mostly our youth, African American youth, are those who smoke little cigars, and they're flavored, you know?
Schuyler Lawson 24:10
They're flavored. And from what I understand, they're relatively inexpensive, and they're taxed differently than cigarettes, right?
Dr. Monica Webb-Hooper 24:16
That's right, and you can buy them in smaller packages. They're definitely not the same as buying an $8 pack of cigarettes. So, I think the point of these kinds of policy changes are about how do we move public health forward? Some people have argued that this is punitive, because they're concerned about the criminalization potential for this, if in fact, it is difficult for people to quit smoking and they are concerned about some sort of menthol cigarette or flavored cigar black market comeabout, but I think most people are on board with this and want to see it become successful, which would be more likely a huge win for tobacco control and for addressing minority health.
Schuyler Lawson 25:05
Thanks for that background about public health significance of removing menthol from cigarettes and cigars. So I remember earlier in this interview, you mentioned that African Americans disproportionately use menthol cigarettes. Do you know why that is?
Dr. Monica Webb-Hooper 25:22
Well, I think the main reason is because of targeted tobacco product marketing. When you just - if you're observant at all, and you drive through a neighborhood that has predominantly black or African American residents, particularly a lower income neighborhood with predominantly black residents, and you drive past corner stores, gas stations, billboards, you still see advertisements for menthol cigarette brands. I mean, you see outside the corner stores, you see advertisement for three things: menthol cigarettes, alcohol, and the lottery. And so these kinds of targeted messages have been in the black community for decades, and if you look at the tobacco industry document, and one of my good colleagues, Dr. Valerie Yerger, has written a lot about this and really looked at those documents. And you see the way the tobacco industry referred to, spoke about, and thought of, in African American individuals. So this has been very intentional on their part. And part of the thing about menthol cigarettes, and this is what many of my participants and patients would say is that they taste much better, it's minty, it's smooth, that goes down more easily. So you create a product that allows people to become addicted much quicker, it only takes about three cigarettes to become addicted and you make it taste better and go down more smoothly, you can hook more people quickly. And that's been a major concern with how the targeted marketing has been so successful.
Schuyler Lawson 26:54
So given that menthol cigarettes and flavored cigars have been on the market for decades, what do you think inspired the Food and Drug Administration's proposal to prohibit them?
Dr. Monica Webb-Hooper 27:04
Well, I'm not an FDA employee, so I can only speculate like everyone else. I would like to think that this proposed rule finally occurred with the mounting evidence pointing in the same direction of menthol cigarettes being harder to quit. And as we talked about earlier, with this emphasis on equity that we've observed since 2020, maybe that had something to do with it. And I think, you know, assuring equity is about doing what is just and fair. And that's been the emphasis about equity since 2020, is correcting social injustices. And so it gives everyone that optimal opportunity to literally live their best lives. And I hope that that is partly what this, that people have advocated for a long time, seems to be possible.
Schuyler Lawson 27:09
I have another question. So if it were up to you, if it was within your power, what type of tobacco control measures would you implement to address these tobacco-related health disparities?
Dr. Monica Webb-Hooper 28:05
One of the most effective interventions or tobacco control measures that you can implement is around policy. Policy change has demonstrated positive effects on promoting smoking cessation, and encouraging people to smoke fewer cigarettes per day, things like increased taxes, making it more expensive to smoke. We also are seeing positive effects from tobacco 21 laws that are now passed in an increasing number of locations - cities, counties - and those prohibit people under 21 years of age to purchase tobacco products. And because of the policies, in terms of thinking about why and how they're effective, because of these kinds of policies, that's why we're not able to smoke in restaurants in most states, some states still don't have full Clean Indoor Air Acts. But we're not allowed to smoke on airplanes and in many public places, so that exposure gets reduced, especially exposure among young people who don't smoke and also children. So I think policies that have equity in the lens from the beginning would be important in any intervention that you're working on, including policy. Who's likely to be punished by this policy, who's likely to benefit? Is anyone likely to be left out? So I would want to look at policies, go back and look at current policies, and develop new policies that would only promote health and not leave someone behind. I think other important measures are in the space of prevention. How do we prevent people from starting to smoke in the first place? I mean, you know the saying, "an ounce of prevention is worth a pound of cure". It's a true statement. It's very true. So should we go back and rethink? Should smoking prevention be part of the curriculum and health courses as early as elementary school, middle school? Should hard hitting campaigns like the Truth Campaign that showed some success be brought back in full force? And then of course, where I've focused my efforts are really around comprehensive tobacco cessation programs that need to be widely available at no cost or low cost, and in communities with high need high smoking prevalence that also include medication, and that are culturally appropriate or culturally specific, because it's certainly one size does not fit all. And we need to think about all of these things given the strength of this addiction, which is really unlike any other addiction.
Schuyler Lawson 30:26
Very detailed answer. Is there anything else you'd like to share with listeners about your research or about tobacco-related health disparities?
Dr. Monica Webb-Hooper 30:40
I'd like to say one other thing, or a couple of things about this topic of disparities. It's that health disparities, by definition, are modifiable, and they don't have to exist. The reason that we study health disparities, and we need to continue to do that is because there have been so many significant scientific treatment advances, and they have just not benefited all populations. So it's beyond time that we really hit the gas and move into the third and fourth generation of health disparities science and research where we really are looking at interventions that have the potential or population level implementation uptake outcomes, applying that health equity lens from the start of the process. And tobacco related health disparities, like other disparities are not based on one's genetics, genomics, or biology. It's not about an inherent deficit. These disparities happen, not by accident, because when you look across populations that experience health disparities, they are disadvantaged, and that's the link between all of them, so it's rooted in disadvantage, versus being rooted in differences due to biological or genetic factors.
Schuyler Lawson 31:55
It is a very important distinction to make. Thank you for making that clarification. Again, thank you so much for taking the time to be interviewed for the podcast. We hope to have you on again to discuss future issues, and also future publications, I'm pretty sure that's gonna happen. And is there a way that listeners can learn more about your research?
Dr. Monica Webb-Hooper 32:17
Sure. So I certainly encourage everyone to follow NIMHD. We have a listserv that everyone can join by going to the NIH listserv website, and you can sign up and find out all the things that we're doing that have to do with health disparities in general, and also the things that we support that are in the Tobacco Control Space. My own research can, of course, just be tracked through, you know, PubMed and other things. If I publish a new article, sometimes we push it out through NIMHD, depending on what it is, and then I'm also on Twitter. Let's see if I remember my Twitter handle. It's @DrMWHooper. So certainly invite anyone to follow what I'm talking about there, which isn't a whole lot, but mostly the work that we're doing
Schuyler Lawson 33:06
Will do. I'm pretty sure quite a few of our listeners are on Twitter, so it'll be great. It's good to see scientists promoting their research and their focus on Twitter. That's a good dissemination tool, I think.
Dr. Monica Webb-Hooper 33:17
Yeah, I agree.
Schuyler Lawson 33:18
All right, so I'm Schuyler Lawson. Thank you for listening to another episode of Buffalo HealthCast. Take care and be well.
This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.
Recreational cannabis legalization in New York State comes with many questions. This conversation between our cohost Schuyler Lawson and renowned researcher Dr. R. Lorraine Collins answers all of them. Listen to learn more about the legalization process, regulatory issues, and social justice around cannabis legalization on this 4/20.
Hello and welcome to Buffalo HealthCast, a podcast by students, faculty and staff of the University at Buffalo's School of Public Health and Health Professions. We are your cohosts Tia Palermo, Jessica Kruger, and Schuyler Lawson, and in this podcast, we cover topics related to health equity here in Buffalo, around the US and globally. In this first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US, as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health equity and inclusion.
Schuyler Lawson 0:47
Hello everyone, and welcome to another episode of Buffalo HealthCast, the University at Buffalo's premier public health podcast. I'm your host, Schuyler Lawson, a second-year PhD student in the Department of Community Health and Health Behavior. With us today is Dr. R. Lorraine Collins, the Associate Dean for Research and tenured professor in the Department of Community Health and Health Behavior in the University at Buffalo's School of Public Health and Health Professions. Thank you very much for taking the time to speak with us today.
Dr. R. Lorraine Collins 1:12
Thank you for inviting me.
Schuyler Lawson 1:13
You're welcome. So first off, tell us a little about yourself.
Dr. R. Lorraine Collins 1:19
It's a complicated story. So, from birth to now, I was born in Jamaica, I emigrated to Canada when I was nine years old and grew up there and went to undergraduate university there. Graduated from McGill University with a Bachelor's in Psychology. I moved to the US in order to pursue behavioral training in psychology and went to Rutgers. After Rutgers, or at least as part of my PhD, I went to University of Washington in Seattle, where I did a one-year internship. And following that I wanted to stay in Seattle, and I landed a two-year postdoctoral training position in the Department of Psychology at U-Dub, as we call it. Subsequently, I came back east and started my academic career in the SUNY system at Stony Brook in their Department of Psychology. I am grateful for the fact that somebody from Buffalo at the Research Institute on Addictions, the new director, Howard Blane, called me literally out of the blue to ask if I might be interested in a full-time research position. And I'm like, full time research? I'm there! Anyway, I came, gave a talk, saw a little bit of the city. Wasn't sure, so I accepted the position. But then I maintained a one-year position continuing at Stony Brook because they didn't want me to go, especially because I landed my first grant, just there and decided after a year at RIA that I really liked Buffalo, so I've been in Buffalo ever since. That's a long story.
Schuyler Lawson 3:12
It is, but you summarized it pretty well, so I'm pretty sure there are more rich details there. But I think that's a pretty good summary of it.
Dr. R. Lorraine Collins 3:21
You can follow up on whatever you'd like.
Schuyler Lawson 3:23
So how long have you been in Buffalo?
Dr. R. Lorraine Collins 3:25
I came to Buffalo in the late 80s, and didn't think I would be in Buffalo for my entire career. But among other things, I met and married here, and have a daughter who was born in Buffalo. And that among other things, the satisfaction I had in my career while at Buffalo kept me here, and at this point, I'm just happy to continue living in Buffalo. It's a wonderful city and has a lot of amenities that I don't know that everyone appreciates. Great parks, good restaurant culture, proximity to the outdoors. There's just a lot going on in Buffalo.
Schuyler Lawson 4:13
As a transplant, I can also agree to that sentiment.
Dr. R. Lorraine Collins 4:17
Schuyler Lawson 4:17
So getting back to your trajectory that landed you here, tell us a bit about your research background.
Dr. R. Lorraine Collins 4:25
So at Rutgers, I actually did my dissertation, behavioral intervention related to obesity. But when I got to my postdoc, I switched from obesity to alcohol research. And part of this switch had to do with the fact that the overall issue in which I was interested was self-control. And the interesting thing about eating is you really have to exhibit some kind of self-control because you have to eat, some people, three meals a day. With alcohol, it was different because alcohol is not essential the way food is essential. But still, there were similar issues with regard to self-control. And so, making that transition actually went, I think, pretty smoothly. I mean, I ended up doing a lot of reading at the start of my postdoc, but I was able to catch up relatively quickly, because the underlying issues and many of the theories overlapped. And so it worked out well.
Schuyler Lawson 5:41
Okay, and I guess what led to the transition to cannabis?
Dr. R. Lorraine Collins 5:47
So that happened in a study that I ran in Buffalo. We had gotten a grant to look at malt liquor use. And the reason I was interested in it is because the stereotype of who uses malt liquor is that it's an African American male. And I'm not fond of stereotypes, and so I wanted to look into what's going on there. And there was a special RFA from the NIH, because they were also interested. What had happened is, each year the heads of Addictions Institute, well, all the institutes in NIH, go in front of Congress, and a congress person asked the then head of NIAAA, "You know, there's a lot of malt liquor in my community, what are you doing about that?" And he literally did not have an answer, and so they scrambled to provide an answer. So anyway, got this grant, applied, and went through all the peer review and what have you. And in it, we conducted a survey, in which we tried to recruit people who were regular malt liquor drinkers, and I give my staff an incredible amount of credit. I mean, they were at Thursday in the Square, they were all over Buffalo, recruiting folks who drank malt liquor. And we ended up with a sample of over 600 people, which was just, I think blew my mind and all of our minds. And the stereotype is not true. Among the folks who responded to our survey, were kind of the range of ethnicities, but definitely a sizable number of people who were from European backgrounds, as well as African, as well as you know, you name it. So given all of that, we were able to publish a couple of papers making that point. But one of the intriguing findings, unexpected for me, anyway, was that half of our sample also reported regular cannabis use. And we always ask about use of a wide range of substances, and usually, you have a sprinkling here and there, but for half of our 600 participants, who were predominantly male, to report regular cannabis use was very intriguing. And so, I said to my staff, we got to follow up on this, because this is new. I'm trying to think of when that work was published, it was probably early 90s. And so that's when we started to pursue cannabis research. And at that time, there was hardly any.
Schuyler Lawson 8:45
This is pre-medical cannabis?
Dr. R. Lorraine Collins 8:48
Oh yes, it was pre-medical cannabis. And there were kind of reports of cannabis use, kind of often linked to other illicit drugs, but an out and out study of just what's going on with cannabis was not that common.
Schuyler Lawson 9:11
Okay, and since conducting that study, was there any follow-up studies you did involving cannabis specifically?
Dr. R. Lorraine Collins 9:20
I've done some studies, again, funded by NIH. I did one where we looked at behavioral economic demand for cannabis, and that's kind of an experimental procedure where we vary the price of the product and ask people to respond to those differences in price by telling us how much they would purchase.
Schuyler Lawson 9:46
This is hypothetical?
Dr. R. Lorraine Collins 9:48
It is all hypothetical, done in a lab, and what we found is that cannabis is like every other product, which is as prices go up, purchases go down. We also found, and I don't have the numbers in my mind, but we also found that there was a price at which people would essentially lessen their purchases. Well, I won't say a number because I know I'll be wrong. But anyway, that, I'm proud to say, was the first experimental behavioral economics study of cannabis purchasing and demand curves and characteristics related to cannabis. Others have continued in that work. There had been work done on alcohol for a number of years. But we were the first with cannabis. I probably, most recently, I did a pilot study that we're hoping will turn into a bigger grant, but did a pilot study for cannabis users where we developed a smartphone app. So, folks came into Kimball, they met with a therapist for about an hour. There were four sessions where they learned all sorts of behavioral techniques. And then they interacted with the app, learning tips, kind of being able to reinforce what had happened in the session, and providing us with self-reports that are related to another innovation with which I've contributed, and that is ecological momentary assessment of substance use. So that research started with tobacco smoking. Saul Shiffman, at University of Pittsburgh, was the innovator. I saw Saul give a talk and I said to him, we have to apply that to alcohol. And so, after some efforts, we got funding to do that. Just so you know, the reviewers at NIH, were not convinced that people could self-report on their alcohol use if they had been drinking. So, we have to do studies to make that case. And what ecological momentary assessment involves is, we randomly prompt them, usually three to four times a day just to find out, hey, what's going on? How are you feeling? Who are you with? What are your plans? What activities? Where are you located - home, driving? And then what we do is, before they drink, and this is after some training, we ask them to report on what's going on - similar questions, but then we might also ask about, are they craving? Do they have specific amounts that they plan to consume during that party or that dinner? And then after the episode has ended, we asked them, how are they feeling? How intoxicated are they? What's their mood, plans to continue drinking, that sort of thing. So, we did that for a few years. And again, an innovation of mine was to move ecological momentary assessment to cell phones. Prior to that, we had used what are called personal digital assistants, and they were fraught with problems. People were carrying their phones and this other device, the data that they provided was loaded on the device, which sometimes would lead to glitches with data, storage, and so forth. So, we did, again, proud to say, the first cell phone study involving ecological momentary assessment for anything. That was published in 2003. So, you can tell we've come a long way when it comes to smartphones now. So anyway, we did a study where we had people coming in for sessions using our smartphone app during the rest of the week and providing us with ecological momentary assessment data. One of the groups, so we had two groups. One was what I just described, and the second group, just because of some other work I had done looking at physical activity and substance use, we included a physical activity component where we recommended three free fitness apps. We kind of used multiple apps and found three that we thought were reasonable. And long story short, at six months, although both groups had reduced their cannabis consumption, the group that included the physical activity had reduced it more so, significantly more so. Which kind of reinforced the idea that was in the literature that physical activity was actually a useful component in behavioral programs to lessen substance use. It's been done in smoking and alcohol, and again, we showed it in cannabis, and we were one of the first. Boy, talking about this, I'm like, Whoa! I have fun doing research. I have fun thinking about things and applying ideas from one area to another. So I suppose that's how it's come.
Schuyler Lawson 15:27
Another interesting part of your trajectory is that you actually had a stint in the public policy realm. In 2018, you were part of a working group created by then Governor Andrew Cuomo, that was tasked with drafting legislation on how to regulate cannabis in New York State. What did your work entail?
Dr. R. Lorraine Collins 15:45
So, it was about a six-month very intense experience, intense in the sense that we were trying to get a lot done in a relatively short time. It was a wide-ranging group of professionals. One of the people I was kind of surprised to see in the room, although now I understand why, was the Department of Agriculture. Like, oh, why would they be there, but guess what, you have to cultivate cannabis, so they were there. Obviously, physicians, public health, the Sheriff's office and State Police. So, kind of judicial folks, a couple of community-oriented prevention people, and then the New York State office that focuses on substance abuse treatment, OASAS, they had representation. And we met mostly in New York City. I can remember at least one meeting in Albany, and we would discuss all the issues that we thought were relevant to New York's moving to adult recreational cannabis access. And I say adult because the age of 21 was kind of our marker. One good thing for us is that other states had moved into recreational cannabis well ahead of us. I think another useful thing was that New York State had a medicinal cannabis program, and so we could learn from that, in terms of what parameters might be useful, who might be involved, that sort of thing. In the end, we made - Oh, I should mention, we also as a group, there were 17 community sessions where, not all of the group, but members of the group attended. We did not participate, but we attended and listened to testimonials and other statements from folks who are on both sides of the recreational cannabis issue, and I attended two held in this area and it was very interesting. A lot of the people who made statements were medicinal cannabis users. And they supported recreational cannabis in certain ways. But I think everyone expressed, well, no, I shouldn't say everyone, many expressed concerns about what recreational cannabis might mean. Would it mean lower prices for medicinal? They were all for that. Many parents and prevention types were concerned about kids getting access in upstate. There were folks who were farmers, or in areas where they thought they might want to grow cannabis. And so, folks in those rural areas, who often are concerned about jobs, and just being able to survive and make a living, they were keen, so it was quite a diverse group. Each session lasted a couple of hours. And in that time, I think each person had about two minutes. There were transcripts and so forth, but it really gave us a feel for how the residents and citizens of New York felt about this issue. And those community listening sessions were everywhere from New York City to obviously Western New York, all of Central New York and as far north as the Canadian border, so we covered a lot of territory.
Schuyler Lawson 19:47
A pretty broad range of New Yorkers.
Dr. R. Lorraine Collins 19:49
Schuyler Lawson 19:50
So in light of your contributions to the working group, what are your thoughts about how New York State rolled out its recreational cannabis? Like legalization?
Dr. R. Lorraine Collins 20:01
So what everyone has to understand is it's not rolled out yet, we're still in the implementation phase. The law was passed in March of 2021, actually just about a year ago, because it was March 31. It's a very complicated bill, and that's probably going to mean hiccups along the way. I think New York had the right idea in terms of having this working group listening to its citizens, and really trying to put a lot of limitations in place so that it wasn't just a wild and crazy rollout the way we've seen in other states, some other states. So, all of that is to the good. One of the things that I advocated for, and I was not alone in this, is that day the working group started to meet, given that we were looking at this issue, we should start public health education. We should have, just like we have with COVID, we should have public health ads that talk about 'New York is considering this, and here's what you need to know.' And we should be doing pretty wide-ranging assessments of current use patterns, especially in high-risk groups like young adults. To my knowledge, that has not happened. And we are in kind of this rush now to implement, and I still haven't seen a single public health message anywhere that talks about the fact that recreational cannabis is coming, what it might mean, how to approach it, what the products are, how it will help New Yorkers to know that they're using safe and well-regulated products, the goal of it. I mean, the goal is to kind of move people away from the illegal market to the legal market where there are, I think, a lot of safety procedures and licensing requirements in place. The illegal market is wild, and I don't think people understand that. I mean, you can cut cannabis with so many other scary drugs like fentanyl, and people don't know it, and they smoke it, and the next thing you know, we have an opiate overdose. So, I'm all for the regulation, which is why I participated in the New York working group. I personally would like to see federal regulation so that we don't have the patchwork that we currently have. And I also, as a researcher, would like to see the removal of constraints on access to cannabis. So, the big one, as everyone probably knows, is that the Drug Enforcement Agency, the DEA designated cannabis as schedule I, which means it's in the same class as heroin, it's designated as not having any medicinal properties, which we know is not true. I participated, the year before New York State, I participated in a national academies review of the health effects of cannabis. And although the evidence wasn't great in a number of areas, there were areas such as chronic pain, where there was strong evidence and so we need to find out more. And I'm particularly concerned because the advocates for medicinal cannabis and our local state legislatures and various other groups are presenting medicinal cannabis as if it's a panacea. I mean, there's almost no disorder that's not on a list somewhere of disorders that can be helped by cannabis. And it's just that we don't have research evidence to support that.
Schuyler Lawson 24:15
Do you know if any of the recreational cannabis legislation will protect against that type of marketing that sort of touts cannabis as being a cure all?
Dr. R. Lorraine Collins 24:26
So the law does include regulations about marketing. Here's my concern. The current guidelines literally say for New York State, that a practitioner, and there's a relatively small list of practitioners right now, but let's say physicians, physician's assistants, I think it's gone to nurses, dentists, their health professionals, that they can prescribe cannabis for any disorder, "they believe" it can help. Belief is not science. And to me, to have that language is reinforcing the notion that it can treat everything when we know it cannot. And it also leaves the field wide wide open to, for want of a better word, charlatans and snake oil salesmen who can say, well, I believe this is going to help you, and sell whatever the product. It's just not good.
Schuyler Lawson 25:40
In that review for the National Academy of Science, was there any evidence that looked at the effect of cannabis on serious mental illnesses such as schizophrenia?
Dr. R. Lorraine Collins 25:52
Well, that is one of the findings that we reviewed, and I teach a cannabis course. And I mentioned that in the course, and students are always intrigued by it. But yes, people who have a family history or personal history of mental health problems, especially if it involves hallucinations and other kinds of psychotic symptoms, should not use cannabis. It's as simple as that. It seems to exacerbate their symptoms. And although there are, to my knowledge, no deaths that are directly linked to using highly potent cannabis, there definitely are folks who had to be hospitalized because of psychotic episodes, linked to using highly potent cannabis or just not realizing how much they were using, and then not being able to manage the cognitive and physiological changes that they experienced.
Schuyler Lawson 26:56
I thought about that, because you described the arbitrariness of how practitioners can just prescribe medicinal cannabis to mix with whichever condition they deem requires it, and depending on who it is, and they don't have to have a knowledge of the patient's mental health history, it could be, potentially, a public health issue.
Dr. R. Lorraine Collins 27:18
It's a huge public health issue, and even more disturbing, the way the medicinal cannabis works in New York, it's not a direct prescription. So, the health professional can essentially write a script that says, this person could benefit from using cannabis. That's it, they don't really specify anything. Potency, mode, they just make a general statement. That patient then goes to an outlet that provides medicinal cannabis. And I will say New York State has done a really good job of regulating that. But anyway, they go and then it's the people at that - it's not exactly a retailer, but at that distributor dispensary, I think, is probably the right word. It's up to the staff at that dispensary to choose what the person should try or should use. And I worry about what kind of training those people get. In New York State, a pharmacist needs to be involved. But it's still kind of scary, unknown, what they might get for their so-called disorder. One of the things we learned...So that National Academies Report was published in 2017. It's still being downloaded at a fair clip, because it's over 400 pages long and has a ton of information. And we've heard through the grapevine that there are dispensaries that use that to help their staff to train. So, I'm pleased to hear that it's being put to that kind of use. But there's nothing in that report that's prescriptive. It's just, you know, we review the literature and here's what we found, and this has strong, and this has weak. So, I don't know that, although it's a great starting point, I don't know that some of the people who work in these dispensaries, other than the, "Oh, if you use the sativa bud, it will help you with...", or "If you use the indica tincture, it will..." I just don't know the basis for some of the recommendations. And then, although we probably don't have time to get into it, there's a huge, huge, huge proliferation of CBD products. Those don't have to occur in a dispensary. You can buy CBD at Wegmans. But that's another completely unregulated space, where because it's not officially a supplement, lots of claims are being made, and the Food and Drug Administration has not really gotten in there to regulate.
Schuyler Lawson 30:25
Okay, so it's the wild, wild west when it comes to weed.
Dr. R. Lorraine Collins 30:28
It's wild, wild everywhere.
Schuyler Lawson 30:32
Okay, so getting back to recreational, how do you think the New York State's recreational cannabis approach compares to other states that have done similar legislation?
Dr. R. Lorraine Collins 30:42
So New York did a wise thing in trying to learn from best practices and failures in other states, and I think because of that, our regulations are pretty decent. Again, I still don't know what's going to happen with implementation, because that's a work in progress. If we can implement in a way that addresses some of the issues that were raised in that working group and some of the issues that continue to exist, then I think New York will be doing a pretty good job. What I worry about is the legislature, the fact that even people who've been appointed to some of these committees and boards to regulate cannabis, don't know much about cannabis. You know, in teaching that cannabis course, one of the things we do is to break down how complicated a plant we're dealing with. And everybody doesn't understand that marijuana is not marijuana, is not marijuana. It's hundreds of different products. It's hundreds of different interactions in the body. It's very complicated in ways that, for example, alcohol is pretty straightforward. How do most people use alcohol? They drink, end of story. How do people use cannabis? They smoke it, they vape it, they drink it, they put it on their skin, they eat it in gummies and brownies. There are so many complicating factors. And I'm not sure that that's as well understood as it should be.
Schuyler Lawson 32:34
I guess, what would you say are some of the pitfalls that other states before New York experienced in their recreational cannabis legalization?
Dr. R. Lorraine Collins 32:43
Oh, wow. Where do we begin? A big one is marketing. There are states - Nevada comes to mind - where cannabis products are labeled and marketed to look like food products, to look like candy. They're plays on names of legitimate products that are given to cannabis products. The wrappings are colorful and flashy. And it really is just completely unregulated marketing. There are billboards, there are two for one sales. So that's a huge, huge problem that I don't think we'll have in New York. Potency's another one. I'm not sure what the upper level of potency will be in New York, but I know that there are states, again Nevada comes to mind, where you can buy concentrate that's 90% THC. Well, that's not a good thing. 90% THC is setting you up for psychotic episodes and some of the other problems that we know can occur. So those are two, I think, really good ones. There's a lot of regulation of the cultivation of cannabis, the processing of it, the retail outlets that not many, well, some states failed to do or now are backtracking to try to do. We recommended no vertical integration of the cannabis industry. So, if you grow it, and process it, then you can't own the retail outlets. Because when you own all of that, that's called vertical integration. And what it means is that companies, as we call them, Big Marijuana, they can come in and do what Big Tobacco did. And so, New York is trying to lessen the occurrence of that kind of integration. New York does have a social justice component that I hope will work. We just heard a few weeks ago that the governor okayed cultivation licenses, and they had to do that because the planting season is about to begin, and if they had waited, that would have been missed. And you want to have product for the likely opening of retail outlets in 2023. So anyway, in applying for cultivation license, one of the things that companies have to do is to include kind of an internship training component, where folks who have not been in the industry, but are interested in coming into the industry, and I think there's a provision for folks from disadvantaged backgrounds or backgrounds that have suffered as a result of New York drug laws, as well as women and other groups that have not fully participated in the industry, can start to learn. And so, if all of that comes into play, it will help.
Schuyler Lawson 36:09
Yeah, that actually got into my next question. So, the War on Drugs has disproportionately impacted communities of color, particularly African Americans, with respect to experiencing serious legal consequences for possession and sale of small quantities of cannabis. So, what has New York State done to address the social justice issue of dispensaries selling a product that not too long ago contributed to the disproportionate arrests of New Yorkers of color? I know you mentioned having priority for underrepresented groups for licenses but are there other policies that have been proposed as well?
Dr. R. Lorraine Collins 36:41
So one of the things that happened is that New York reiterated in 2019, a decriminalization law that had first been passed, I think in the late 70s. But anyway, there had been decriminalization of cannabis in New York, and it went nowhere. No one paid attention, I'm not sure of the details of the law. In 2019, a new version of that law was passed. And as a function of that law, having smaller amounts of cannabis is no longer a felony, it's more something that you get a ticket for. And the limit is less than two ounces of flower, which is the law, which is a lot because it doesn't weigh that much. So that has helped. And related to that, there has begun and continues to be process of expunging laws, or at least people who suffered from laws where they were arrested for having on their person or having in their possession, small amounts of cannabis. The last I looked at the data, New York has expunged about 200,000 records. There's another 200,000 to go. And what expungement means is that their arrest for cannabis gets removed from the public. It's no longer accessible to landlords or employers or really most entities, in some cases, it just is gone. There's a difference between just possession and for example, selling larger amounts or committing a crime where gun is involved, those will continue. So, expungement is important because now that the records have been expunged, there are people, many of them, most of them African American men, who can apply for student loan, who can live in public housing, who can apply for jobs and so forth. And so that provides an opportunity for them to get on with their lives and not be hampered by the burden of being caught once with, you know, three ounces of cannabis. So that's really, I think, very, very good. There are also provisions where licenses, I'm thinking it's 40% of licenses, will go to folks from communities, often African American communities where there was a disproportionate negative effect from things like stop and frisk policies, where a lot of African American men were kind of caught up in police raids and hauled off to jail. So, if we do that, that all sounds good. I worry about how that will work. I mean, we know that in construction and in other areas, there are firms that are minority headed, but when you kind of look deeper, minorities are not fully engaged in reaping the benefits. So that's something that I think we have to keep an eye on. The other thing I worry about is retail licensing that predominates in lower SES, or minority communities. The situation with liquor licenses in New York is an abomination, it's criminal. You can go to the east side of Buffalo and find a corner where you've got three alcohol outlets, there's a liquor store, there's a bar, and there's a corner store that sells alcohol, and you just kind of walk 20 feet and you go from one to the other. That's not a good thing. And if we do retail licensing of cannabis, the way we've done retail licensing of alcohol, we're going to end up in a similar situation. Now there was an opportunity for communities to opt in or out of retail outlets, as well as kind of social use clubs. And that's been interesting. And I don't understand it all. But you know, you can have villages within towns saying no, but then the town's saying yes. And so, I did a piece on this in one of my lectures, and Hamburg comes to mine, in this area. So the village of Hamburg said no, but the town of Hamburg said yes, something like that.
Schuyler Lawson 41:36
Does that supersede what the village declared?
Dr. R. Lorraine Collins 41:42
I don't know, I've never understood how New York is organized. Many people don't. It's one of the most convoluted that I'm aware of, in the entire country. And so anyway, we have this opt in/opt out feature and surprise, surprise, higher SES communities, or communities that want to maintain "their traditional lifestyles" and kind of sense of selves are opting out. The opt ins are motivated in a lot of ways by tax benefits that they hope will come, and some by jobs. Although when you come down to it, it's probably more the taxes than the jobs. But anyway, it's going to be interesting to see what happens with all of this licensing, because it could go really well. Or it could be a disaster.
Schuyler Lawson 42:46
So speaking of taxes, have there been any talk about where the recreational cannabis tax revenues are going to be put towards?
Dr. R. Lorraine Collins 42:54
Oh, of course, a sizeable proportion. And again, I don't want to quote percentages, but I'm thinking 40 to 50(%) of the tax revenues and benefits are to go to disadvantaged communities, or communities that have disproportionately suffered as a result of the past drug laws. I'm not sure how that gets handled. Does it go to City Hall? Does it go to businesses? I'm not sure how that will be apportioned. One of the drivers of the social justice components of this law is Crystal Peoples-Stokes, who is from Buffalo, and who really, over many years worked hard to get cannabis regulation in New York State. And she is very purposefully driven to make sure that communities will receive benefits rather than harms. And so, I'm thinking with her keeping an eye on things, that it could help, but so many details have to be worked out. And some of them we really won't know the consequences until after they're in play. And then the challenge will be, how do we fix that? How do we fix the problems? What kind of tweaks or out note changes do we need to make?
Schuyler Lawson 44:31
Yeah, so it's going to be an ongoing project, it seems.
Dr. R. Lorraine Collins 44:34
For a few years, yes.
Schuyler Lawson 44:35
So from a scientific perspective, what would you say are the advantages and disadvantages of recreational cannabis legalization?
Dr. R. Lorraine Collins 44:45
So what I've mentioned before is safety. Kind of knowing the product that you're using. I mean, if a product says 10% THC, and we take it to a lab, the lab should tell us Oh, it's 10% THC. Right now, in some states, the label could say 10%, and the lab could say zero, or the lab could say 30. I mean, people don't really know what they're using, and I think it's important that people know. Moving people away from the illegal market is, I think, really important, not just from the perspective of generating taxes, but just the elements that benefit from that market are not elements that we want to support. So, I think that that's really good and useful. The other thing to understand, the harms of alcohol, in many areas are probably worse than the harms from cannabis. It's kind of strange, that other than that blip of prohibition, alcohol has been readily available for centuries, and cannabis has not. So that kind of makes some sense.
Schuyler Lawson 46:03
Yeah. I suppose I would also put tobacco in a similar sort of situation to this illegal product that's caused quite a bit of harm.
Dr. R. Lorraine Collins 46:11
Well, the interesting thing about tobacco is, I'm not aware of any benefits. It's fully harmful. With cannabis, we've talked about medicinal benefits, and it really does seem less prone to egregious negative consequences than alcohol for sure.
Schuyler Lawson 46:37
So before we conclude our interview, is there anything else you'd like to share with our listeners?
Dr. R. Lorraine Collins 46:43
I think it's really important to advocate for public health education. I continue to be disappointed that that is not happening. And I think it's important to advocate for the removal of cannabis from Schedule I DEA designation because, until that happens, research is going to be stymied. And I think that it's important to learn from best practices elsewhere. So, in the marketing realm, for example, Canada, all plain packaging, no billboards or marketing. You go into a store retail outlet, and it's very, very austere, as compared to walking into an outlet that looks like you're in a Vegas casino. So, they're best practices, not only among other states in the US, but other countries. And we might want to learn from them as well.
Schuyler Lawson 47:43
All right, well, thank you again for taking the time to be on our podcast. We hope to have you on again to discuss future issues, as the cannabis situation in New York is, like I said, it's going to be constantly evolving. So, is there a way that our listeners can learn more about your cannabis research?
Dr. R. Lorraine Collins 47:58
I have a web page. It's under CHHB (Community Health and Health Behavior). I do have a web page. I suppose you could do a search for my name.
Schuyler Lawson 48:10
Yep, for Dr. R. Lorraine Collins, and also probably Google Scholar, to type in your name.
Dr. R. Lorraine Collins 48:17
Yeah, my name gets weird on some search engines because I use a first initial, I will just caution that, but yes. If you do, Collins probably stuff will pop up. So, thank you very much, Schuyler, this was interesting. I tried to pack a lot in - I hope it isn't overwhelming. But this is such an important and timely topic. I'm glad that you chose to focus on it with me or with others, because there are a lot of folks at UB doing cannabis research.
Schuyler Lawson 48:51
Thank you. Thank you. Thank you again for being a part of the podcast and providing this valuable information on a very complicated topic.
Dr. R. Lorraine Collins 49:02
Schuyler Lawson 49:03
You're welcome, and I'm Schuyler Lawson, and thanks for listening to another episode of Buffalo HealthCast. Take care and be well.
This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US and around the globe.
Attitudes around disability are constantly evolving. Buffalo HealthCast co-host, Dr. Jessica Kruger, speaks with Dr. Sue Mann Dolce, who currently serves as the Associate Director of Accessibility Resources at the University at Buffalo about accessibility in public spaces and how we can adjust our attitudes to make the world a more welcoming and accessible environment for everyone.
Hello, and welcome to Buffalo HealthCast, a podcast by students, faculty and staff of the University at Buffalo's School of Public Health and Health Professions. We are your cohosts, Tia Palermo, Jessica Kruger, and Schuyler Lawson, and in this podcast, we cover topics related to health equity here in Buffalo, around the US, and globally. In this first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US, as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You'll hear from practitioners, researchers, students, and faculty from other universities, who have made positive changes to improve health equity and inclusion.
Jessica Kruger 0:47
I'm Dr. Jessica Kruger, and our guest today is Dr. Sue Mann Dolce. Dr. Mann Dolce's PhD is in Rehabilitation Science, and a clinical background in occupational therapy. She is a Certified International Yoga Therapist, and we're happy to have her on the show today.
Sue Mann Dolce 1:07
Thanks, Jess, thanks so much for inviting me to be part of this.
Jessica Kruger 1:10
As we get started, we're going to start with an exercise that Sue would like to have everyone participate in.
Sue Mann Dolce 1:19
So, if you're listening to the podcast, wherever you are, unless you're driving, or operating machinery of some kind that you can't stop, I'm going to invite you to join me in a centering. So, it's a very simple practice. And you can do it in any position, sitting, lying down, standing, so you choose. And the very first step is choosing the position that you're going to be in. And the next step is to take a moment to notice your body and feel where it's supported. So, for example, if you're standing, feel your feet against the floor. If you're seated, feel your feet on the floor, wherever they are, feel your legs and your hips and your back. And no matter where you are - and if you're lying down, obviously, you're going to be feeling a lot of contact. So, feel what you feel. And then just slowly allow your arms to relax, your shoulders, your neck, and your jaw. And come into the space, noticing the sensations in your body, not trying to change them or judge them, just noticing. And then once you've done that, notice the breath, your inhale as it comes, and then your exhale as it leaves. Again, no judgment - we're not trying to change it. Just becoming aware. And if you're able to breathe in through your nose into your belly, and then release from the belly and out through your nose, you can choose that. But if for any reason that doesn't work for you, that's fine. Breathe in the way that does work for you. And then three full breaths this way. No hurry, taking your time. If you get distracted, that's fine. Just notice it and make a choice to come back, to being present in your body in your breath, to the degree you can. One more full inhale and exhale in your own time. Beautiful, thank you.
Jessica Kruger 3:47
Thank you for that. Today we're going to talk a little bit about disability and learn about the definitions. So, Sue, could you provide us with a definition of disability and the different interpretations it might take in different settings?
Sue Mann Dolce 4:05
Sure. And I also want to start out by saying there's many definitions of disability, and different groups are going to talk about this in varying ways. And I'm always going to defer to the group that is speaking, because they may have a unique experience and interpretation. And that's pretty much an overall approach when we're talking about disability, because disability means and is experienced in a number of different ways for different people. But I'm going to go back to the definition under the Americans with Disabilities Act, which was originally passed in 1990, and then the Amendments Act that was passed in 2012. And the definition, the simplest part of that definition, is that disability, or a person is considered to have a disability, if they have an impairment that limits them in a major life activity. So, you have to have both an impairment, and then be limited significantly - limited is the language - in a major life activity. And you can go to ADA.gov, and look this definition up, and there's also some other information there about that. So, I am really interested in this concept of impairment, Jess, because that languaging denotes something wrong, something less-than, something different, certainly. And difference is okay, I like the idea of difference, or I would agree that most of us can appreciate that there's a difference, but not the kind of value laden idea of impairment. So, we often think of it as variance, that you have a variability around something. So, the way you see, the way you hear, the way you feel emotionally, and/or physically, the way you think or process information, the way you move, the way you move certain parts of yourself or other parts. But it also can denote chronic health conditions, whether they're chronic intermittent health conditions, or other health conditions that are pretty chronic all the time, that limit your ability to participate in a major life activity as designed. This gets to a tricky part, I'm not sure if you want me to jump right into this. But a lot of the issues that come up is because of how we design programs, activities, spaces, technologies, and virtual environments. So that's the definition that we work from, in our office. I work in the Accessibility Resources Office at the University at Buffalo. So that's the definition that we're working from. But I also work with a lot of community groups and other groups that are interested in exploring these ideas and concepts.
Jessica Kruger 7:20
I think you brought up a really important point about language and how we discuss disability. I love the idea of the variance and changing that language right there. Instead of saying an impairment, I think that just has a totally different feel than what we're used to talking about. So, speaking of language, how does language influence our ability to provide individuals with disabilities equitable access to services and support environments?
Sue Mann Dolce 7:54
Well, that's such a great question, and that, in of itself is a very long time, it might be a course. But anyway, where I immediately go to that is, the way we use language is really an expression of how we think about an issue, a person, etc. And then those influence how we behave in those situations. So, for example, and probably the most prominent example within public health is, do we think that a disabled individual, an individual that describes themselves and identifies as a disabled individual, has insight and knowledge about how they experience the world? Or do we think, as a public health professional, that we know better? So, if we are thinking about this individual as impaired in some way, and we're the trained professional, we don't tend to have a lot of professional humility, and really listen to how people talk about themselves and their experiences. And because of that, our programs and our spaces, all spaces, aren't necessarily designed so those individuals feel welcome in the space and valued in the space. So that's important. Another thing that comes up a lot is, should we say, "people with disabilities," or "disabled people"? We use person choice language. So, if the individual identifies and strongly identifies as "I'm a disabled person," I'm going to use that language with them. In many professional programs, we're trained, or we're training people, or educating people to say, "people with disabilities," with the idea of you do the person first, and then the disability, as if just there's something bad about being disabled, as opposed to a lot of people that are choosing to use - a lot of disability advocates choose to lead with disability. Not that they think that the disability is located in them. But they're saying, "I'm disabled, by the way things are designed, I'm a disabled individual." They see it as a statement of advocacy, calling out the culture per se, that they are disabled, even though they're human, just like the rest of us, have something to offer, just like the rest of us, can contribute to the day-to-day life of the community, the university, etc. Not to mention offer as much in the way of innovation as and excellence as any other individual that's perceived in any other identity group. So how we're thinking and talking about these things, I really think a lot of it goes back to people being able to express what they need, and be heard, and/or seen, whatever that means, whether it's through hearing or through text, etc., or being seen, being described, etc. So we'll see this all the time, and so getting used to your feelings about these things, noticing your language about these things, is a really important first step in getting curious about situations and starting to think about how you're choosing to use language in different situations, and not from the place of having to know, but having the ability to ask, in a way that doesn't put the other person on the spot. "How do you prefer to be referred to", it's kind of like, I would say, "I'm Sue, and my pronouns are she/her." So, it creates a space for someone that may not use the same pronouns to know that I appreciate that. So, we're creating spaces. And there's these ways that we can do that, that are really important for all of us.
Jessica Kruger 12:41
I love the way that you're talking about creating that space and creating that opportunity. Because in public health, we really want to be centered on the individual, working to make people feel welcomed, supported in any sort of program or activity that we're doing. And bringing up that humility aspect, we talk a lot about cultural humility, but not so much humility in this aspect.
Sue Mann Dolce 13:10
Well, yes, but disability is a culture. There's a huge disability culture and we need a Disability Cultural Center at the University of Buffalo. We have the IDC, the Intercultural Diversity Center, which is amazing, they do amazing work, but they're not resourced to do disability culture, and there's plenty to celebrate in disability culture. And there's a lot of art, there's a lot of innovation, there's a lot of technologies, there's just so many things to celebrate. So that's a thing to think about when we're thinking about cultural humility. Why aren't we including disability within that, right? So, because disability goes across all other identity groups, no matter what race, ethnicity, orientation, etc., there are going to be disabled individuals in that group, whether it's visible or invisible. So, I think that's an important thing. Then the other component, I had an experience with a friend/colleague, where they needed a ride to get vaccinated, because the vaccination site wasn't near public transportation, that they could easily get to the site. So, this individual doesn't drive, they have a physical disability. They also don't use a power chair or a wheelchair of any kind, or even a mobility device. But they do get around a little bit differently than what we would think of as temporarily abled people. So, I said, "Sure, I'll take you." So dropped them off at the site. Okay, there's a curb, a significant curb. There are steps going down into the site, there's no handrail. And then one of the public health workers comes out and starts talking to my colleague, who by the way, has a PhD in disability, in American history and disability studies, and starts talking to him like he's an insect. "Oh, honey, let me help you," and being somewhat, I would argue, patronizing - it would be like the most generous term I could think of. And I'm cringing, because, you know what we felt like going into get these vaccines. It was not comfortable anyway. Could you imagine that, on top of it, so physically unsafe for him, and then being treated that way? So, what is that individual thinking? That's my question, because I know they didn't intend to be, in any way, inappropriate. Their intention was to be helpful and welcoming. I know it wasn't perceived that way. And then the design of the site; why is it not right on public transportation? Why is there an entry that's not fully accessible? Why would an individual who moves differently need someone who clearly can get around without support if it's designed appropriately? So those are the kinds of, it's so simple, once you see it, right? So, the whole point here is to get people to start thinking about these things and seeing it. So, when you're in a position where you can make a design choice, that you're doing an informed choice. And when you you're not able to do a design choice, and let's say you do need to have someone welcoming people, that they treat people with some respect and dignity. So those would be my main points about these things. So, it all goes back to attitudes, awareness, which circles me back around to this term. Ableism. Do you mind if I talk about ableism?
Jessica Kruger 17:29
I'd be happy for you to talk about ableism. But first, you used a term that some of our listeners might not be aware of: temporarily abled. Could you explain that?
Sue Mann Dolce 17:39
Yeah, temporarily abled. I would suggest that most of us will experience being disabled at some point in our lives, whether it's temporarily, we have an injury, or a surgery, or a health condition that's resolved, so we experience that. So that can be a temporary kind of disability, or as we grow and experience the world, we may have some things develop that are more chronic, and then we become limited. So, a lot of times, I think, probably 15 years ago, we would be at meetings, things people would say, "Oh, they're just a TAB." So Temporarily Able-Bodied, right? But, within the disability advocacy communities, and there's many, they focus on individual disabilities, and then overall disability. There's an awareness that these things are fluid, there's a movement to them. And I think most of us and our listeners have experienced that. Whether it's you or someone you love and care about. Once someone has experienced these things, you tend to be more aware of them and appreciate them in a different way.
Jessica Kruger 18:58
That's so true. I personally, was injured recently and had to go get a handicap parking permit. And in the city of Buffalo, that's a real challenge when you are on crutches, because it's in an older building. And that older building, there are stairs. It's at the lower level.
Sue Mann Dolce 19:16
In City Hall, right?
Jessica Kruger 19:18
It is in City Hall.
Sue Mann Dolce 19:18
Down that long corridor...
Jessica Kruger 19:20
Long corridor and very back corner of the basement and that tells you something.
Sue Mann Dolce 19:28
Tells you a lot.
Jessica Kruger 19:32
So circling back to ableism, can you describe that and its prevalence in today's society and where we see it?
Sue Mann Dolce 19:40
Yes. I first heard this term at UB when Leslie Freid, who's an amazing disability advocate and among other things, an excellent mutton dancer, yoga teacher, etc. She was here doing some scholarly talks and other work and she did a talk about ableism. And ableism is essentially thinking that everyone does things the way you do. So, you're ableist in the way you design things. So, you're designing for able-bodied people, typically-abled or able-bodied people. And when I say able-bodied, I don't just mean physical, I mean sensorially, psychologically, motorically, all the different aspects of living, and of course, multiple aspects of that wants to for a lot of people. And so how are we ableist? So, it's like a lot of the other isms. It's just actually like that. So, for those of us who experience the world as designed, in general, what does that mean? We turn on our computer, we can access it through a mouse, we can see it, we can navigate the screen by seeing, we can choose to leave and get up and go get something to drink, we can leave the building and go up and down stairs, we can see the controls on the elevator - we just expect all those things. However, if you move differently, see differently, hear differently, that's not your experience of the world. But that's still how the world is designed. And the world is designed that way, because most of the people designing the world are typically abled. So, they're being ableist in their design, as opposed to using universal design or inclusive design, which is very interesting. We have a whole of the Inclusive Design Environmental Access, here at UB over in the School of Architecture and Planning, which is amazing. Go to their website, beautiful, amazing work. We have a whole center that's been funded for years, is known internationally, but we still don't design things for access. We're much, much better than we've ever been. But it takes time. But the single most important thing, and this goes across every research study that I've read, and I've read quite a few, is it's the attitudes towards people, disabled people that have the biggest impact. Design is essential. But of course, the attitudes feed the design. So, attitudes always come first. It's like when we were talking today, I said, I think we need to start with attitudes, because it is the biggest barrier. And so, doing the work that we can do to explore this on our own, to reflect on how do we think about this? And again, not in a judgmental way, but in a getting curious way. Like if I'm working in the office, and someone comes in, that moves differently or sees differently, do I resist that in some way? Do I go, "Oh man, this is going to be such a drag, or "I don't know how to do this," or "We don't have an exam table for that," or, you know, fill in the blank. In some way, we then project that back onto the individual, and they don't feel welcome. Even though the design issue is on our end, you know, maybe not us personally, we didn't design the office, but we work in that space. So, working with our colleagues to say, "Hey, I noticed this today, are there some things that we could do to address this?" Often, there's not a lot of real material things we can do. But we can shift practices, we can shift how we're approaching it, how we're thinking about it, we can schedule differently. So, we can take more time in a way that doesn't make the provider feel rushed, and then that gets projected onto the individual, like there's something wrong with them, because it takes them twice as long to walk to the room. That it takes them, you know, fill in the blank. So, these are all amazing opportunities, but it starts with us reflecting on, when we get that feeling of going underneath it and thinking about okay, why am I feeling this way? Why am I apprehensive to work with this individual? What kind of support do I need, or does our space need to create change around this? And no, it will take time. You don't have to do it in a minute. But getting curious, this is always where we're going to create the most change over time.
Jessica Kruger 24:40
Really challenging biases and pre-existing thoughts. Speaking of that, we see so much media every single day. And in that media, it seems to influence part of that ableism that we're talking about. Could you speak to that?
Sue Mann Dolce 24:58
I could, but there's someone who could speak a lot better to this, who is Beth Haller, H-A-L-L-E-R. And she has a book called "Disability in the Media." Excellent, highly recommend it. She also has a few blogs and different things that she does about disability in the media. Beth was here, did a public talk here at UB on South Campus, pre-COVID. She's quite an activist. So, in terms of disability in the media, the short answer to this is pay attention to media. There's two primary tropes or ideas that we'll see in the in the media, about disability. It's disability and in disabled individuals, and the charity model. "Oh, these poor people, we need to take care of them." And then the other is the "Super Crip." Look at this amazing individual, disabled individual, and what they accomplished. They're amazing, right? So, what we don't see often is just day to day people, living their lives, just like everybody else. Disabled people are part of our community every day, all day. And we're not necessarily seeing those people represented in the news. So, thinking about, what is that about? Part of it is over half the people with disabilities have invisible disabilities. So, you may be seeing people in the news and hearing about people in the news who are disabled, but they're choosing to not disclose that, which is fine. But a lot of the reason that they don't disclose it is because of ableism and negative attitudes and the stigma of being perceived that way. So, I have a personal experience of this. So, pay attention to what happens when I tell this story, for yourself as you're listening. So, I went undergrad for OT at the University of Buffalo. I love OT and I love the University of Buffalo. When I was an undergrad, I had a fairly significant mental health issue. And this was a long time ago, we didn't have the same supports that we have now. And I didn't have a lot of support in my personal life related to this for a variety of reasons. And so, it was very, very difficult for me for a while, but I figured it out. It's actually when I found yoga. So, I've been doing yoga and meditation for years because it was a huge help. But I also found support through professional providers and medication, etc. So, I was very lucky that I had access to these things, and so figured that out. And for years, I never disclosed that; that I have a mental health disability because I have a history of it. So, the fear of disclosing and being overlooked in for promotion, hiring, etc., is very real. And I can see when I'm talking to individuals if I choose to share that. And often people will say things to me, like, "Oh, I'm so surprised." And I'm not, you know, sometimes "I'll say what does that mean?" And they say, "Well, you don't act like you would have a mental health issue." And bingo, it's like, what does that mean? What did people with a mental health issue act like? Someone has an idea of that. The person has an idea of who that is. Right there. That's the underlying issue related to ableism, attitudes, stigma, etc. So, getting underneath...now, I disclose all the time if it's relevant. But how did you feel, listening to that? Knowing I have a PhD, knowing I work in this area, I mean, unless you've heard me say this before, disclose before. So how we think about people, the assumptions that we make, are merely that. They're assumptions. And we all know what assumptions get us, right? So going underneath, thinking about it, and until more people can really claim their full identity, because we've created a culture where that's okay, where you're not going to be retaliated against in some way. So, these are really important concepts to think about and to explore. And again, I can't emphasize enough, the people that I was just referencing who would ask those questions, I totally understand. It's not like I'm judging them, I understand where they're coming from. But them having that moment and noticing it, and my gently calling attention to it, hopefully, is the beginning of them exploring to create change, because if we're all doing this, we will continue to create change. Some of us have the luxury of having an invisible disability, but many, many people don't. And they don't get to choose, they're treated, they have to be ready at any moment to be treated disrespectfully or not be included or not feel welcome in a physical sense, or in an environmental, attitudinal sense.
Jessica Kruger 30:58
So it sounds like there's a lot that all of us can do, getting curious, challenging our biases, thinking about how we're feeling as we're interacting with any individual because we don't know if someone has a disability.
Sue Mann Dolce 31:14
Right, exactly. And asking, but not asking so that the disabled individual has to do all the work. The burden is not on the disabled person. And we need to be cognizant of that, too. So, this is the other big thing that comes up a lot, is the over ask, you know, can I help you with that? Can I do that? Can I do this? I did it Saturday, I was with a friend at a market, and they had a couple bags, I had a couple of bags, but we encountered some stairs we didn't know we're going to be there, because there was no signage telling us. And I immediately just turned around and said, oh, let me take your bag. And they were like, I got this. So, I was like, Okay, great. So, you know, back off, and I could really hear them and appreciate that, right? So, the over ask - implying that someone's not able. That person hadn't asked me, they weren't struggling in any way, there was no overt need. But I stepped in immediately. I have to own that. And acknowledge it, "Sorry about that." "No problem." So, it's not like these big things. It's these ongoing little things. And I make mistakes every single day. Like I just expect to make mistakes, I don't love it. But I do it. And then I repair it, without it being a burden on the other person, meaning not calling them out on it, not making a big deal about it. None of those kinds of things. And we hear these same concepts in other conversations about other people who do things differently than we do, for whatever reason related to identity.
Jessica Kruger 33:05
Well, it all comes back to humility. Really thinking about how you can learn and grow as an individual, and be okay to make mistakes, because we all do. We're human, right?
Sue Mann Dolce 33:18
I agree. And then as professionals what we uniquely can offer, but not having that professional identity override the humility, right? So, the number one thing about health care disparities, disabled people tell them, one thing they say is, "Listen to us." Right? Listen to our experience of this. But you hear the same thing about the maternal health of black women, like the white version, not listening to our experience, not listening to what we're telling them, etc. So, we hear this, it's the same thing we hear over and over and over again, for people who systems are not necessarily designed for, quote, unquote.
Jessica Kruger 34:00
Speaking of that, thank you so much for being part of this podcast and for all of our listeners for listening, learning, challenging, and getting curious. Any last words?
Sue Mann Dolce 34:12
Just thank you so much. And thank you to all of you who did the beginning centering practice with me. I appreciate that too. I could feel you out there.
Jessica Kruger 34:23
Thanks so much.
This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.
Buffalo HealthCast guest host and MPH student, Kellen Montanye, speaks with Life and Transition Coach, LGBTQ Activist, and Motivational Speaker Landon McNee about transgender health services in the United States, and the barriers trans individuals often face when receiving health care.
Introduction: Hello and welcome to Buffalo HealthCast: a podcast by students, faculty, and staff of the University at Buffalo’s School of Public Health and Health Professions. We are your cohosts, Tia Palermo, Jessica Kruger, and Schuyler Lawson. In this podcast, we cover topics related to health equity here in Buffalo, around the U.S., and globally. In this first semester of the podcast, we’re taking a deeper look at racism and health. We’ll be talking to experts around the U.S., as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You’ll hear from practitioners, researchers, students, and faculty from other universities who have made positive changes to improve health equity and inclusion.
Kellen Montanye: Landon is a 21-year-old Life and Transition Coach who owns his own company, LKM Coaching. He uses social media as an influencer to educate others on topics of transitioning, hormones, and surgeries to the public. Landon is a resident of New York and is also here today to speak on the medical issues that transgender people face within the health care system. Okay, our first question is: What are some of the health issues or barriers to seeking care that transgender individuals face?
Landon McNee: As a trans man myself, I feel like the biggest issue has been finding educated health care staff that is willing to treat my gender dysphoria. Ultimately, it comes down to the fact that there’s such scarce knowledge, and there’s not really as much culturally competent care for everyone that most medical professionals preach. It’s just more of a new topic that’s still being discussed and rehearsed within the medical field.
Kellen Montanye: No, that’s great, I completely agree. Do you think that this comes down to the training that medical care professionals receive in their schooling, or do you think that it’s the lack of keeping up with that medical education training later on, after being in the profession, in their jobs and their careers?
Landon McNee: I think it’s a combination of both. If you think of it within the last decade, there’s been so much progress that’s been made within the trans community. Even within the last few years, if you said “trans,” some people didn’t even know what that meant. Now, you say “trans,” and everyone knows what the means. I think that this is an overall new topic that’s being discussed in society, whereas before, it was way more taboo, just even a few years ago. Going back to training and bringing in people within the communities (the trans community, the LGBTQ community, etc.), it’s an area that’s still being discovered. Having people such as a professional, like me, as part of the trans community, can be a huge asset to medical professionals. For example, I was working with my local hospital in order to create culturally competent care for all. It was an LGBT resource team that I worked as a community committee member for. I think those things can be huge towards making really big transitional pivots in the medical field. I am happy that there are big changes that are being made. Even 7 years ago, for instance, when I first started hormone-replacement therapy, I had to give a urine sample. This was a gender clinic in New York City, and I had to give a urine sample, and they didn’t have a gender-neutral bathroom. I was not male-passing at the time, and I had a near-panic attack trying to figure out which bathroom I was going to go to, and this was an appointment towards my transition. Those little things, and creating awareness about those things, and creating spaces, is huge, and the first step towards making progress. I feel like I’m going all over the place, but ultimately, those all connect.
Kellen Montanye: That’s a great point – I totally agree. I think it’s great that you had the opportunity to be part of the committee to create culturally competent care for people who do identify within the LGBTQ+ community, specifically trans, because that is something that is very lacking in our society. So, our second question is: When you came out as trans, how did that impact your ability to seek medical care and treatment, initially?
Landon McNee: I’m going to be 22 in a few weeks – I came out at 14, so it’s been about 7 years. Coming out at a really young age, especially when transitions were not really talked about at all, a lot of health care providers were in question of whether or not to take my transition seriously. Luckily, my parents were able to commute an hour and a half to New York City – luckily, I live that close to one of the greatest cities in the world – where there’s a lot more progression and a lot more resources. They took me to a trans adolescence health care center in New York City, through Mount Sinai Adolescent Health Center. They did think that they were taking me to a conversion therapist because their ignorance was so strong – their acceptance was there, but their understanding wasn’t. They thought I was too young to make any sort of changes – that this is something that just needs to be talked about and ultimately, I will grow out of it. When it came to going to college, I went way up north in New York. Things changed a bit. All psychiatrists and therapists seemed to focus on my trans identity as my cause of depression and anxiety when in reality, that was already being treated for the last few years. Between the ages of 14 to 17; 14 and 15, I was very much so told “You’re very young – you need to talk about this in-depth before any permanent changes are made.” Then, I was diagnosed with gender dysphoria within my therapist’s credentials. They were like, “It would be best, at the age of 16, you could start hormone-replacement therapy”, so I did. And then I graduated high school at 17. When I went to college, way far up north, where health care is totally different than it is in New York City, they just kept focusing on the fact that my identity was the cause for my mental health being in shambles. I would say, once again, a lack of knowledge-pushed me to educate my doctors and look for another health care provider willing to listen to all of my needs, rather than just focusing on an area that is more taboo and seeking more interest.
Kellen Montanye: Wow, that’s a great explanation. To see the differences between the quality of health care within a city population and more of a rural area in Upstate New York just goes to show how different the medical care is on the receiving end and also how that lack of education and communication within the medical community is not equal across the board. So, that’s a great thing to share, thank you. Our next question comes to, how do you believe that the medical field is failing the transgender community?
Landon McNee: The thing is, I want to reflect this back to whoever may be listening to this. I’m speaking on behalf of my own experience, so every other trans person in the community has their own opinion. For me, I think overall education and willingness to listen to their clients is the overall issue. At the same time, I know that a lot of other trans people feel that you shouldn’t have to advocate for yourself. I completely agree, you shouldn’t have to. At the same time, if nothing is being said and no one is speaking up, no progression is going to be made. There needs to be this light that doctors are still human beings that need to be just as open-minded as any other person, and you grow as an individual. That is just a part of any profession, any human being – you grow, and you learn. It’s just a part of the contract you sign when you are a part of society – constantly learning. Just because a doctor is viewed as the elite in care doesn’t mean that they are versed on how to best support each client. I think, opening their ears and listening to what their patient needs can be very huge because I can very much attest to the fact that there are doctors who will simply just not treat me because they are not comfortable treating trans clients (patients). If I walk in, and I’ve been on testosterone for 7 years, there is no reason why a doctor cannot do simple bloodwork and prescribe me my testosterone right off the bat. Just being overall more open-minded to working with a diverse population can open a lot of doors.
Kellen Montanye: Yeah, that’s also a great point. I think, especially, because some people, like myself, have to travel multiple hours away just to get the quality care that, not only we need, but what we deserve. I think that pointing that out, that every person’s journey within their transition, is different, and so are the different things we have to do in order to get that quality of care. I think that’s a really great point because there are multiple ways that the medical field is failing the transgender community, it’s not really just one. I think that’s a great point that you make. Our next question is, when it comes to insurance approval for medical transitions, what barriers did you, or do you currently face?
Landon McNee: One thing that really came up in regards to insurance – when I first started my medical transition, clearly, all my insurance paperwork had my birth name, and my sex assigned at birth. Whenever testosterone was being filled, I would have to deal with a pharmacist. So, I would get this long list, the first time I was prescribed testosterone, I got this really long list from the pharmacist. He was an older man, probably in his early 50s, and he’s working alongside a younger woman pharmacist. He kept asking all these questions and he said, “Is this girl pregnant?” He didn’t notice that I was the person that was going to be taking this testosterone. He thought that it was for somebody else, and he was trying to say, “Is she pregnant? You need to make sure!”, and the woman standing next to him was like, “No, no, no.”, being aware that this is clearly something different, this is being used for transition purposes, and there was a lack of knowledge there. That was pretty unfortunate and pretty uncomfortable, sitting there, and they are reconfirming all of the things that you wish you didn’t have and the reasons why you’re transitioning is to feel more comfortable, and to stray away from that female identity, and my female-assigned sex at birth. Fortunately, my testosterone has been covered through insurance – I've never had an issue with that. My top surgery was not. That was considered cosmetic and paid for out-of-pocket. At the same time, I needed a mental health professional to sign off on my gender dysphoria in order to follow through with the procedure ethically. It seemed very, very contradictory, and to this day, I still have an issue finding a provider that is well-versed in hormone-replacement therapy in my area. It’s left me to self-educate and work with my primary health care providers. To this day, I just work with my primary. I get my bloodwork taken every 3 months, and then we go from there. I don’t even work with a specialist. My insurance hasn’t really had an issue. I will add that for surgery, the surgeon I picked was a well-renowned surgeon, and having surgery almost 5 years ago, I think insurance has come a long way. As far as I know, a lot of trans guys’ top surgeries are being covered nowadays. But during that time, it was not covered for me.
Kellen Montanye: I completely agree how the insurance is making that revolution, very slow, but it is making that revolution towards catering to transition procedures for trans folks. For myself, luckily, I did get my top surgery covered. I was very thankful for that. I did have some barriers with my testosterone, and being able to get it, but I do think that you’re 100% right, that it is slowly coming through to have a little more light addressed, and being able to, not universally be covered through every insurance, but it is coming through to be able to be a little more accessible for people who may not have that resource right away. It’s a great point that you make there as well. Our next question is, the Electronic Medical Records (EMR), are very binary when it comes to documenting patient health information. In addition to a section for a preferred name, gender identity, and pronouns, what other information could be collected to prevent discrimination and barriers within transgender patients.
Landon McNee: I actually have a tiny story that happened a year before COVID. I was at work and I cut off a little piece of my fingertip. I had to get an X-ray, and going from person to person, like you would in the ER, everyone is looking at your medical records. Each person you go to, they ask the same questions. There was one guy when I went to go get an X-ray for my finger, and he looked at my documentation and goes, “Hm, it says that you’re female in here, it looks like it’s a mistake, I think we got to change that.” I’m just sitting there, laughing a little bit, and I didn’t even bother to explain. Whatever, if he wants to change it to male, change it to male. Now, looking back at that, there should be some sort of documentation because, the thing is, I haven’t had bottom surgery. In regards to whatever complications that may come up in the ER, I feel like there would be an issue with insurance wanting to cover a hysterectomy if my sex says that I’m male on paperwork. Having information that says I identify as male, but also, I was female-assigned at birth, can avoid a lot of those issues. I think there is no real, proper education for trans people in the system, and there should be a quick summary about how the person identifies and some overall general info on what it means to be trans. Say that, a speaker comes in one day, and the X-ray technician was not there that day. Missed the whole big education aspect to treating trans people. Well, there should be some sort of backbone or backup. There should be some sort of summary underneath to help treat trans people. It should also be allowed for the patient to choose whether or not the provider can see past medical records that show their sex assigned at birth, due to safety issues in today’s society. That is really unfortunate. I do feel that, working in the medical field, that it should be separate – your opinions versus treating someone with respect. I think those are very huge. Keep your opinions outside of the workplace. When it comes to treating everybody equally, there is a right way to respect someone and that also has to be with trans people. It goes back and forth - medical professionals should have the right to see all medical records, at the same time, I understand the safety issues with that as well. I’m sure with time and further education...If there is a more instilled overall medical – I don’t even understand how I would word this – but, school laws in New York State: all schools have to follow such-and-such for discrimination, right? The same thing should have to do with the medical field. I’m not sure if that goes as far as that, but I think that would make a big difference if that even makes sense?
Kellen Montanye: No, I actually do understand that. When I used to work at a hospital, locally here in Buffalo, we did have to do LGBTQ compliance, but it didn’t ever go into how you would continue to give care to somebody related to their gender identity, or specific types of medical needs that may come with sexual orientation – different things like that. I think it’s covering part of what somebody needs to learn, but it’s definitely not thorough and it’s not delivered in an applicable way that you could say, “Oh wow, from this training, I could probably do this here for this individual, who identifies as trans.” It’s there, but it’s definitely not where it needs to be – it's much subpar. I completely agree. This leads into our last question here, which covers: What other trainings or interventions for health care providers can additionally help prevent discrimination and barriers for transgender patients? This does go a little past my explanation right there, with potentially making the LGBTQ competency training, that is annual, a little more in-depth or applicable. Just wondering what you think any other trainings could do, as per preventing discrimination for trans people?
Landon McNee: I think, as you said in my bio, I have made it my specific career path to educate those around LGBTQ issues and equality. I think it’s super important to reach out to specialists in this field. What better resource than to go to the community themselves, and for people who have made it their mission to make massive change? Continuing education and regulations need to be put in place in all health care systems to overall best provide for all communities, not even the trans community, but for all diverse communities. I think that’s very, very huge.
Kellen Montanye: Continuing education and regulations – that's a great topic to go on, and I know I could probably go on all day about that. Landon, I want to thank you for coming today. I think that this is a very educational and forward message to anybody listening to this about the transgender community and how the medical field is not where it needs to be for trans folks, and their health, and their transitions. I just want to thank you for coming today.
Landon McNee: Yeah, of course! Thank you for having me, Kellen. I think that having this conversation in general is going to open up a lot of discussions, and ultimately, that discussion will lead to some positive change.
Outro: This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.
Buffalo HealthCast co-host, Dr. Jessica Kruger, speaks with the CEO of Peaceprints of WNY, Cindi McEachon about incarceration and its effect on the health of those who were recently released from a justice setting, and what Peaceprints of WNY is doing to bridge the gap in disparities.
Hello, and welcome to Buffalo HealthCast - a podcast by students, faculty, and staff of the University at Buffalo's School of Public Health and Health Professions. We are your co-hosts: Tia Palermo, Jessica Kruger, Skyler Lawson, and in this podcast, we cover topics related to health equity here in Buffalo, around the US, and globally. In this first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US, as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You'll hear from practitioners, researchers, students, and faculty from other universities who have made positive changes to improve health equity and inclusion.
Today's guest is Cindy McEachon, who is the CEO of Peaceprints, a local organization helping individuals who are justice-involved and recently released from a justice setting. She holds a degree in Health and Human Services from the University of Buffalo. Welcome, Cindy.
Great to be here.
Could you tell me a little bit more about Peaceprints and what they do for folks in the Western New York area?
Sure, Peaceprints is a reentry organization that has been around since 1985. We have all sorts of facets of programming, working with all sorts of individuals from all walks of life. The common thread is that there is justice involvement on some level. So, we work with every jurisdiction level: local, state and federal. We have housing programs, we have intensive case management models, so more community-based, we work with young people, families, and we have our food pantry. So we do a lot with folks both inside the facilities as well as out in the community.
That's excellent. It's so great to hear that folks are working with individuals in all sorts of settings. Now, can you tell me a little bit more about the background of scale of incarceration in the United States?
Yeah, we are certainly number one in this space. We have over 2.3 million individuals that are incarcerated on some level. So, whether that is local, state or federal, and another four and a half million that are out under community supervision actively, so we definitely incarcerate at the highest value. We are, putting it another perspective, only 5% of the world's population, but we incarcerate 25% of those incarcerated, here in the United States. So incarceration, mass incarceration, mass supervision is a way of life here.
Wow, it's amazing to think about not only people who are physically within a facility, but under supervision in some way, shape, or form. That's a lot of individuals, and I'm guessing this affects the communities. Can you tell us a little bit more what you see?
Yeah. So, you know, you figure 2.3 million people are currently behind bars, but 95% of those individuals are coming back into our community. So, they make up what is now that number of four and a half million that are currently under supervision, but that's not counting the individuals who have satisfied that supervision, who are no longer under or may have gone to jail but are back out and did not have supervision. So, we have this plethora of people that aren't even accounted for in this mix as well, but the key here is that 95% of the individuals who are incarcerated will come out likely under supervision back into their community. And that in and of itself, causes huge ripple effect because you've extracted somebody for an extended period of time, and then placed them back into the community where they have to assimilate. On top of that, there's a ton of research to show that there is an increased or an elevated rate of chronic disease, of substance abuse, of mental illness, of health-related concerns when an individual is incarcerated. And a lot of that has to do or is fueled by environment. And then we're going to release individuals, right? 95% - that's our number - back out into the community when we've already increased some risk. So it's a very overwhelming system.
I'm so glad you brought up the challenges with chronic diseases among folks and as they're released back into communities. Can you tell me a little bit more about some of those health challenges in which people are facing after they've been released?
Yeah, I mean, when you're talking about chronic illness, we've had individuals that have had pretty intense surgeries. So, we're talking heart conditions, we're talking about things like that, that health ailments that have helped, or happened while they were incarcerated, because they're also older in age, right? We have an aging prison population right now. So, we're not talking about as many young people, not that that really makes a difference, as it still impacts your health overall. But we have seen how the effects of mass incarceration for decades. And what we have is an aging incarcerated population, who's now going to come out into the community. So, they're already older in age, you have naturally occurring diseases and illnesses that we see in the community often happen, a little bit later in life, happening earlier, because they're incarcerated. So, you will have diabetes. You will have, unfortunately, we've seen a lot of folks with cancer coming out more recently. You have individuals that have had kidney failure, or the amount of medications individuals tend to pass through our doors, carrying with them, and then that's not counting where they stand in terms of the mental illness, right? If there is trauma that's been experienced, they're battling depression, or they do have a serious mental illness documented, and there's medications and/or treatment required in alignment with that. So, we have folks that kind of run the gamut when it comes to what the need might be. What we find to be most overwhelming is that when an individual returns, they don't have a history, per se, of having a family doctor, or their health history documented, that is available to agencies in the community once they're released. That information stays in prison, and so it stays in the facilities and doesn't come out with them. That's very overwhelming; we find that they have a very limited supply of their medications made available to them. Sometimes individuals don't even have active Medicaid when they come out. And so, if that's not already activated, pre-release, we're starting behind, right from the onset of release. And that's only if we're lucky enough to have an individual pass through our doors and we become aware. We certainly do not work with everybody that returns from incarceration that comes back to our community. And when we talk about these huge numbers of releases, we have, unfortunately, a lot of individuals who fall in the cracks who are not necessarily connected with services or don't have somebody to try and connect them with appropriate resources.
Wow. So, when we say incarceration as a public health problem, this is really hitting on so many levels. Not only while individuals are being incarcerated, not only communities but also this can impact their health as people are released, not knowing their medical records coming out, possibly sicker than when they came in. And so, this is something that we really need to talk about within the public health community more than we do now. What would you like to see if you had a magic wand and could change the system after someone was released? What do you think would be the ideal way to help people kind of go back into their communities?
I would say with my magic wand, we would have increased accountability and communication. Those two things, I think, would shift one's access, and what it looks like to connect with resources from inside to outside. Unfortunately, what we find is that communication is stunted at release. Sometimes it's nonexistent or incredibly limited at what's made available or what the person is bringing with them. You also have such unique stories person to person. So, if an individual was incarcerated when they were 18 years old, and is now being released at age 55, their entire adult life has very little record outside of what happened in the facilities. That's a really difficult space to start and to be able to connect somebody with resources. But then on the outside, that's really where I think accountability is huge, is that we do have a multitude of providers, of helping spaces. Another area where we struggle is that there is zero accountability on the side of providers. So, when you talk about social determinants of health, you talk about access to services, you talk about this as a public health crisis; accountability plays a role because service providers also realize that there's little happening prior, so there's little expected after. And with that mentality, sadly, being at the forefront of what fuels a lot of this, individuals and their families are set up to fail every step of the way, and then are blamed for it. But in fact, we've made it incredibly difficult for them to access what they need. It's very frustrating. So, I would say communication and accountability on both sides, you know, certainly necessary. And I think that would improve things a lot.
I can't imagine spending the majority of your adult life in a criminal justice setting, and then being released, and not knowing how to navigate the system, possibly even how to advocate for yourself. And going through that with a chronic condition could be incredibly challenging for individuals. So, tell me a little bit more. When an individual’s typically released, do they typically have Medicaid? Are they connected with a primary care doctor? What is that communication, or maybe that communication gap between release and during release?
In a perfect world, yes, they have Medicaid already activated pre-release. We know our world is not perfect. Sadly, it's kind of a toss, right? We really don't know upon arrival, if somebody is one of the lucky few that did have their Medicaid activated prior to release, or if they fall into the group that did not. I will say, we see more and more that fall into the "did not get connected", unfortunately. I think there's multitude of reasons. For a while, the state was pushing, on a larger scale, connecting individuals prior to release. I was seeing change. As an agency, we were noticing that at release, more folks were coming out with their Medicaid activated. However, policy changes, COVID, all sorts of shifts to the way we were doing business, has changed a lot of the way things were operating. And so now individuals are getting out faster - individuals who didn't think they were getting out and had more time, all of a sudden, don't, and are eligible for release because of law changes and policy changes that have happened, and sweeping reform that has come in without prior planning to ensure that they don't fall through the cracks, because there's not an ability, on the system side, to catch up or prepare for that in advance. Sometimes it's happening in incredibly short notice, and so we have seen over the last 18 to 24 months, sweeping changes in New York State and its impact on pre-release planning, and what that looks like upon. So, already, not great, has become incredibly difficult. And when you break it down, I truly do believe, and I spent a lot of time going inside state facilities prior to COVID, you have some awesome people that do work in these facilities that are working towards the greater good. But facilities by design are in rural communities, are not typically connected to spaces where the majority of individuals are going back, and it is difficult on the side of the staffing, even, to have updated information, be able to access service and advocate for an individual prior to release, even in the old system. Because it just wasn't created to make it easy. I think COVID took that and dropped it on its head, on a whole different way, because all these agencies, whether we did great business or poor business, all of us were impacted by COVID. Many agencies shut their doors, changed the way they were doing things, shut down particular services or programs, and there's no way for information to transfer to the 50-plus facilities across New York State. And that's not even counting the jails - that's state facilities, right? And so, this is a big deal. When you're talking about pre-release planning, when you're talking about access to information and connecting an individual for post release service, it's become even more difficult.
Yeah, I know many of us really want reform in the criminal justice system and really want to change the way things are being done, but you're right. We're not thinking about some of those other ripple effects that this has, especially on the individuals who are being released and not having that planning and that opportunity to get things in line or even communicate to organizations in which they may be going to, or working with.
Right, when the primary method of communication is a typed or handwritten letter, and I mean, typed from like a typewriter, or handwritten letter. It's a needle in a haystack - you throw it out there and just hope, whomever you sent that letter to, to offer or ask, is still around. And not only are they still around, that they open your letter, and then from opening it, that they actually respond to you. These are all things, that, in our world today, in our society, we don't really do that. We want instant, even as providers, so we want to be able to email, we want to be able to pick up the phone, worst-case scenario, and call. But sadly, you got to take the time to handwrite or type a letter response back. And that's how information is passed. And that's pretty difficult, right? When you're prepping for a release.
Wow, it's like time traveling to a different world. So, these are a lot of really heavy topics that I don't think a lot of folks think about on a daily basis. So when you think about what your organization does, and the impact that you have on individuals, could you tell us a little bit about some success stories that you've had and what your organization is working towards in the future?
Absolutely. You know, I've been doing this for about 11 years now, and sometimes, just getting connected with services will be success, right? Or it could be, you have a complicated story, and it's taken three staff and a phone call for me, and constant letter writing and bothering people to get you a birth certificate. And sometimes it's that, right, and we have to celebrate even the tiniest of wins. But on a large scale, when we find folks satisfy the terms of their supervision, take it to that next level - they've got a job, they've rekindled relationships with their loved ones, they're driving, they own their own vehicle, some of them have their own places, whether that's an actual house that they've purchased, to opening their own businesses, right? It depends on the person because it's so highly individualized. But when you hear, each step of the way, these little successes that compound into something larger, because they beat the odds. I think that for us is what fuels us to keep going. I mean, we're all human. There's not one of us that doesn't wake up some days and just not want to do something, feel unmotivated, or make, maybe, not the greatest decision. We all do it. That's the beauty of it. That's actually life, that is not being a good or bad person, that is not being incarcerated or not. That's truly life - we all experience this, and the individuals we work with are living just like we are. And so, we look for all of these little wins. And in some cases, these larger ones, of where does this take us? Where does this go? We had one individual pass through most recently. He actually was highlighted in our annual appeal this year, but Eddie is his name, and Eddie has gone through our Bissonnette House transitional program. So fresh out of the facility, graduated, moved into our Hope House program. He's off parole, he's working, he owns two vehicles at this point. He is thriving. And he's so excited. He's even advocating for people to make donations to us, right? I mean, this is just mind-blowing, right? When you think of these wins, and for us, it's these stories, right? Another young lady that, I don't know, from when I met her five years ago, to now she's working two jobs. She's in her own apartment. I mean, she's doing great. And she's off supervision, right? These are the things that, and we remain in contact, we have conversation. She has her ups and downs, life still happens. But these are the stories, and I firmly believe it's access to that opportunity. And unfortunately, this particular industry in the space often denies access, truly denies access to individuals and then blames them for not persevering or trying to push past what we denied. And when you just offer that little bit, that opens up access, and people just move with it. And it's pretty amazing to see.
Thank you for sharing those stories. I mean, I'm sure you have hundreds and hundreds more of the successes that you find with all the individuals that you work with, and your staff works with. It's been really interesting to learn more and more about incarceration in the US and see some of the disparities with things that you have talked about, whether, who's been incarcerated, but also the access. Could you speak to that a little bit?
Yeah, you know, over the years, I think what was one of the most eye-opening for me - and I identify as a white female, I grew up in a suburban town, and I come back, I move into the city, and I start working with individuals and people of color that are justice-involved. And what I started seeing was the inconsistencies of individuals passing through my services, this is all walks of what I've done. So, all the spaces where I've worked in, participated, or volunteered time, and depending on what they look like, what I draw from them in terms of their conviction, or the amount of incarceration they've done, vary greatly, simply by the color of their skin. And this is, before we were, sadly, even recognizing it. It just happened to be something I was noticing - that I could talk to a young man who's in his 20s, who's white, and this was his first time incarcerated, and he only was in for, you know, a year and is now out on parole. Then I look at a young man, same age, who's Black, who, in my opinion, has a lesser conviction, but was incarcerated for a longer period of time, and also got a longer sentence attached to him, which was fascinating to me. I could not wrap my head around how or why it was happening. And I was newer into the industry, you know, at that time, but it was just fascinating to me how no one talked about it. No one recognized that as a concern, or an issue, and truthfully, that the majority of the individuals I served were people of color. That was the majority of the individuals. Why was that? Why is that? I am thankful that we are moving in a direction of acknowledging it now. I think we have a long way to go. But we're at least recognizing that there's some error there. But it's very real, and so it started to come down to communicating with individuals and just pointedly saying, it's not fair. It's not right. But we need to use the fact that I am a white woman, and I'm a CEO, to break barriers. It's not fair and it's not right that I have to use that. But I want you to know, I recognize the privilege that I have with it. And I need you to share with me what's happening, and together, we will go through this until the world shifts enough that we don't have to do this and that your voice is heard. But our choices are get angry, and have no change, nothing happens, or go through this together. And that has been my motto and the way we've gone through things, and I think that's rippled out through the agency, and become ingrained in the culture of the organization. Would love to see full-scale change, and I can give you countless stories of where we've had to use our privilege, where I personally have had to in situations, and it shouldn't be that way.
Yeah, I think you bring up a great point in the fact that we really need advocacy on this issue from all levels. And, sadly, at this point in time, we do have to use our privilege to speak for others who are not heard as much as others are in this world. And hopefully, I'm right there with you, I can't wait to see change continue. And I think by spreading awareness about what's happening as people are being released, and even the disparities in which are occurring in and out of the criminal justice system, I hope to see that, and I am so glad that there are so many passionate people like you working on this project and many projects like it around the US. So, I thank you so much for your time, and before we go, I would love to know what's next for you and the organization.
Well, we are looking to keep moving and grooving, challenging the status quo, and hopeful that we will bring about some new housing opportunities, hopefully, sooner rather than later. But that's a difficult thing to maneuver through, in terms of the politics of it, but we're really excited just to grow as an organization. So, we'd like to extend our housing accessibility, and really start paying attention to, I think I'd mentioned earlier on, the aging incarcerated population. Well, if you are older while you're in, you are even older when you get out, and finding suitable housing for individuals that are older in age, and appropriate housing, if you will, that is clean, safe, and affordable for somebody. We are looking to fill a gap that we're seeing or recognizing, trending higher here locally, which I'm assuming is happening nationally. And then our in-prison program, we have a collaboration with the local jail with an innovative program called Project Blue. And our goal is for our program that has served just over 300 individuals over the last couple years, could expand to become a jail-wide program and so, hopeful that that's on the horizon, and we'll continue to move. That program is currently being followed by a team of researchers from Georgia State assigned to us from the federal government, so the Department of Justice and the Bureau of Justice Assistance gave us a grant to actually collect data points on this program and determine if it could be a national best practice model that we could see implemented in other spaces. So kind of cool - happening here in Erie County.
That's fantastic. I can't wait to see where you go, and the organization goes and helping others. We'll link in our show notes to Project Blue and some other information about the organization. I'm Dr. Jessica Kruger and I was joined by Cindy McEachon today, the CEO of Peaceprints. Thanks so much for tuning in.
This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.
MPH student Rachel Wenner speaks with University at Buffalo PhD candidate Kate Rogers about gender-based violence among adolescents and the work of Crisis Services of Buffalo and Erie County to combat this problem throughout Western New York.
Rachel Wenner: Hello, and welcome to Buffalo HealthCast - a podcast by students, faculty, and staff of the University of Buffalo's School of Public Health and Health Professions. I'm your host, Rachel Wenner. In this podcast, we cover topics related to health equity here in Buffalo, around the US, and globally. In the second semester of the podcast, we’re taking a deeper look at health inequities with a broader lens - focusing on a wide range of health topics. We’ll be talking with experts around the US, as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You'll hear from practitioners, researchers, students, and faculty from other universities, who have made positive changes to improve health equity and inclusion. I'd like to note that today's episode focuses on sexual and domestic violence prevention and includes discussion around topics on this matter. The team and HealthCast recognizes that these topics may be difficult for some listeners, and we encourage you to engage with this podcast in a way that is supportive of your needs. Today, our guest is Kate Rogers, a current PhD student in the Department of Community Health and Health Behavior within the School of Public Health and Health Professions here at UB. Kate is also a graduate of the Master of Public Health program, and former Sexual Violence Prevention Coordinator at Crisis Services Erie County, and Erie County in Buffalo. She is currently working with the organization doing a hospital response. Kate, thank you for joining us today.
Kate Rogers: Thanks so much for having me. It’s my first podcast.
Rachel Wenner: Mine as well. To start, do you want to give us a brief overview of some of the work that Crisis Services does to prevent violence, and some of the roles you've played in your time with the organization and at UB?
Kate Rogers: Yeah sure, you did a great primer with your bio. Crisis Services is the area county’s crisis response agency, so we offer a lot of different services. The department that I worked in is called the Advocate Department, and we are responsible for both prevention and response work in the domestic and sexual violence arena. Fun fact: we are Erie County’s only Rape Crisis Center and basically what that means is that we partner with every hospital in Erie County to do response. If someone shows up at the hospital, we will be paged out by a provider to offer advocacy services, help with law enforcement. If someone has questions about that, we offer court advocacy - all the things that go along with reporting or experiencing domestic or sexual abuse. I currently work for crisis services in a per diem capacity, doing just hospital response, because those PhD demands got to be a little too much, but I was the Sexual Violence Prevention Coordinator for quite a while. I actually had a number of different roles in the agency. I started as a case manager, working with domestic violence survivors, and moved into a campus advocate role which sort of straddled domestic and sexual violence advocacy, case management, and prevention work, and we have a really unique prevention program. We would do a lot of bystander trainings, we’d enroll the community and the broader social ecological model of folks, if you will, who can help with response and prevention of sexual violence. And then, once I left the campus advocacy role, I moved into the role of Sexual Violence Prevention Coordinator, managing a grant that worked on sexual violence prevention, primarily in adolescents, so our focus was 8- to 24-year-olds, but really on our project we worked with high school populations in Erie, Niagara, and Monroe counties. Obviously, all of that work has rolled over into my studies. When I was working on the MPH - my first day of the MPH program was also my first day working at crisis services - so it was a lot of new things starting back in 2018. It was just really cool to see in real time, things I was learning from the program play out in my day-to-day life. I can remember looking at the social ecological model in a health behavior class and I'd be like, “Oh, oh wow, this is also in a prevention presentation that I'm learning about,” and all of the factors, and brief crisis advocacy, and domestic violence tends to fall a lot in the social work realm. But I was fortunate - I had supervisors who were public health folks, and we really took a public health holistic approach to this work, particularly in prevention and it just synced up so amazingly with the program and ultimately, it's kind of what drove me to want to get a PhD in it, too.
Rachel Wenner: That's incredible, thank you for sharing. I know that from personal experience just having real world, real time public health experiences, whether it be volunteer or field training, while simultaneously taking classes really helps to connect the dots between what you're learning on paper and what's going to be applicable once you're done with whatever program, so that's awesome that you've been able to get a wide range of experience within your specific academic interest as well. Could you tell us a little bit about the background on teen dating violence prevalence and how it's a problem today in Erie County and Western New York region?
Kate Rogers: How much time do you have Rachel? We could do that all night. Yeah, so basically an overview - teen dating violence is essentially intimate partner violence experienced by adolescents and teenagers. It tends to show up a little bit differently than it does in adults, but essentially, it's a power disparity in relationships. Somebody in a relationship has an upper hand and they’re taking the power away from someone else in the relationship. The way that it manifests in adolescents, a lot of the time, especially younger adolescents, is a lot of emotional, psychological, verbal abuse, interestingly. From a gender perspective, I feel like a lot of us tend to think of intimate partner violence in general as something that men perpetrate and women experience. In adolescents, it can tend to manifest the opposite, so adolescent girls - there's been a lot of studies, where they are meaner to their boyfriends and more emotionally abusive to their boyfriends, but as they get older there tends to be more of the aggressive forms of abuse - physical abuse, sexual abuse, that are perpetrated by men to adolescent women. It's estimated that one in four teens does experience teen dating violence. I would say, take that number with a grain of salt because it's also highly underreported. Adolescents, as a whole, don't really want to talk about this stuff with anybody, but especially they don't want to report to adults. There's a myriad of issues that happen with reporting that can prevent someone from wanting to report, and so we know that these numbers are probably lower reported than what's actually happening. And we've seen that, going back to this as a harp on the social ecological model, we've seen that when there is a lot of rape culture and victim blaming culture in a school - again, the experience I have is doing this in school settings - if the faculty and the teachers and the adults in the school have that very heteronormative, victim blaming, rape culture - a rape myth acceptance vibe, if you will - the students tend to mirror that in a lot of ways. That stuff that happened at the community level tends to trickle down to the relationship and the individual level. A lot of the goals in teen dating violence prevention will get not only talking to the teens themselves, enrolling the entire school- it's an easy space to do it because most adolescents are in school - enroll in the whole school, instead of saying, “This is what we're seeing, these attitudes and rape myth acceptance, victim blaming/victim shaming attitudes are not great.” Some people are not even aware that they're doing it because it's so embedded in our culture, and by working with both the teachers, the faculty and the students sort of simultaneously, the intention is to create a safer environment.
Rachel Wenner: Awesome, so you touched on the different level factors that affect adolescents’ willingness to seek help and support if they're experiencing something along these lines. How does this translate into negative outcomes, either in adolescents, with their health status or their educational attainment, however that translates, later into adulthood?
Kate Rogers: There's so much research about this. If anyone is unfamiliar, I highly recommend just googling the ACE study (Adverse Childhood Experiences). It was a groundbreaking study - I won't go into too much detail about it because I’m sure a lot of listeners are already familiar, but essentially, the crux of it is that we know that if an individual experiences violence in childhood, whether that's community level violence, so if you live in a place that there's a lot of gun violence prevalent, or just other community violence or domestic violence in the home, it internalizes violence as a conflict resolution mechanism, and normalizes it as a way to handle conflict going forward. So, interestingly, a lot of adolescents - we know adolescents are very influenced by their peer group - it's a time when gender norms are being solidified and worldviews are coming together, and there's been some really incredible studies that have shown that peer groups that normalize violence as conflict resolution tend to have more violence happening in them, and often the victims of violence are not actually even aware that what they're experiencing is violence, because it's been so normalized. So, case in point, again, this is very prevalent with adolescents, because of the ubiquitous use of technology in the form of our little computer - pocket computers or phones - I thought that made me sound really old - but there's a lot of coercive sexting that can happen, or pressure to send nudes or to do something that they're uncomfortable with, and a snap of yourself nude or something like that. A lot of times, adolescents don't even recognize that as problematic behavior, because it's just something that all of their friends do, all of their peer group does, and being pressured to do it seems like it's par for the course. This is abuse that's happening because we know that once that happens in the technological space, it's more likely that abuse is going to happen offline as well. Even if it doesn't transfer offline, there's a whole host of issues happening with technological sexting stuff, if you will. But it's so normalized – it’s part of what adolescents do with each other - they don't know that it's not okay to have someone pressure them for that. Sorry, I got a little bit off on a tangent there, but basically, all of this to say that once this behavior is normalized, you're more likely to see this power disparity and see these kinds of coercive tactics as normal in future, adult relationships, and the long-term impacts of abuse…It usually starts off with technological or emotional or psychological abuse, and then moves into physical or sexual. It may not, but usually it starts off with the things that are not noticeable to other people, and then gets more into the sphere of things that may or may not be noticeable. What ends up happening is that, as we move into adulthood, you have all these chronic stressors of gaslighting, all the markers of psychological abuse, where one person is controlling another person and that manifests in really negative health outcomes like depression and anxiety. Depending on the level of violence in the relationship, PTSD can be really big issue. Being victim to abusive relationships in the future, if you normalize that this is what happens in a relationship when you're young, it's probably how they're going to happen in a relationship as you’re older. And those negative health outcomes - all that chronic stress, ultimately can lead to risky sexual behavior, unwanted pregnancies. The risk is pretty high to not preventing or understanding dating violence as a teen.
Rachel Wenner: Thank you, you touched on some of the ways in which this translates into health outcomes. I was just wondering - I know that your specific area of interest has been in young adults and the 8 to 24 range, but have you noticed any disparities during equities relating to the prevalence of violence in different racial or ethnic groups or different socioeconomic statuses among schools?
Kate Rogers: Yes, I feel like anecdotally, a lot of the schools that we've worked with - that we were able to have access to - were mostly affluent middle class, predominantly white student populations. The prevention work that has been done in a lot of these arenas has been done in affluent upper middle class white populations, but all the literature and all the evidence show, that particularly black adolescent girls are some of the most at risk for experiencing intimate partner violence, so there's a huge disparity in the prevention research and what the response on the ground research is telling us. We also know that any gender non-conforming LGBTQ+ folks are at higher risk for experiencing sexual violence in particular. Most of the prevention research has been done on heterosexual students, so there's a disparity in the way the research is being done. I can't say for sure why that is because I haven't done any of the violence prevention research, per se, that has led to these programs like Green Dot and Bringing in the Bystander. All I can say is that everything that I have read has said more research needs to be done in different communities to see how this holds up and I think that - I could get on my soapbox for a second - that's a really important thing for us as researchers to be looking into. It's easier to gain access, sometimes, especially if researchers are working at a college and the college has a good relationship with a local high school, they can just slide into that. There's a number of barriers to researching minors as anyone who's tried to do research in that arena has experienced, but it's not an excuse, and we need to figure out how these prevention programs can both reach and be tailored to populations that are not that heterosexual, white, cisgender population that has been studied so much in all of this.
Rachel Wenner: Absolutely, and you mentioned how there was different barriers that students face, whether it's in the relationships, like their teachers or authority figures, and I know that you had done some work to study how different policing practices or even the youth attitudes in the schools or the school policies that are in place, can help to either promote and facilitate violence within schools or kind of work against it. How might some of these be evident, either within the schools you're working with, or in other programs across the area?
Kate Rogers: The most important thing is, as I was saying earlier, when there is higher level of rape myth acceptance, and to clarify for folks who aren't familiar – rape myth acceptance is a scale that was developed in the late 90s, I think, but don't quote me on that, and it essentially measures how much a community is willing to accept victim blaming. So, it has things on the scale, like “I think if a girl gets drunk, it's her fault that she’s sexually assaulted,” or “if a guy drinks too much, it's not his fault if he rapes someone,” - those kinds of things. And I think that the way that - the research plays out the way that my experience has played out - when those rates are higher of rape myth acceptance in a school or in a community setting, it's more likely that there's going to be some victim blaming that happens, so that's a huge barrier to coming forward. You’re a 16-year-old kid - you're afraid that if you come forward to your teacher and you say, “Hey, my boyfriend has sexually assaulted me - I don't know what to do” and your teacher says, “Well, you were at a party and you were drunk, what did you think was going to happen?” That's an enormous barrier to reporting. You don't want to feel that kind of shame. I think in the larger setting, in general, police response - it can be very officer dependent. You can have an officer who gets it and who has gone through a lot of cultural sensitivity training and who is wonderful. And you can have an officer who may have seen this person report multiple times, multiple rapes, and they're just like, “I don’t believe this person anymore.” So, unfortunately, at the response level – it’s pretty individual. Overall, community to community, it's more individualistic than it is as a whole. I can say, “I'm going to go to this police department and they're going to respond great.” It's very dependent on the officer that you get. I think in terms of making it better, what schools could do specifically - is train their staff, train their faculty. There's something called disclosure training, where someone from a Rape Crisis Center will come in, and they'll basically say, “Here's how to do this in a trauma informed way.” So, I've done some trainings with various security officers at different campuses, and I get it, you know? A law enforcement official or security official’s job is to figure out what happened. My job as an advocate is not to question someone. It’s just to believe them because I'm their advocate. I'm not - my question needs to hold up in a court of law for them - I'm here to be their support network. But if you're a police officer, you need to figure out what's going on, so you can bring a case to the DA’s office. You may have to ask them questions that are going to be a little different than what I'm talking about as an advocate, and so a lot of what that disclosure training looks like is ways that you can make it more trauma informed, more sensitive. So instead of saying, “Oh yeah, you were really drunk. Why'd you take that sixth shot?”, you can say, “You were drinking - do you want to tell me a little bit more about what happened when you were at the bar?” So, it's not an accusing way - it's, “I need to understand what you drank, for whatever purposes,” but I'm not going to ask it in a way that says, “You were drunk, so of course it's happened,” if that makes sense.
Rachel Wenner: Yes, thank you, and the work that you've done on the grant within Crisis Services focuses on the Bringing in the Bystander curriculum, which works to integrate some of these different concepts that you've mentioned into supportive environments. How has this been effective in preventing violence, and do you mind just touching a little bit more on what the program encompasses?
Kate Rogers: Yeah, so, bystander intervention training - there's several different programs. The one that I'm the most familiar with is Bringing in the Bystander. It was developed by Soteria Solutions. There's another one called Green Dot, which is very similar. They both have college campus and high school level and community level bystander training. It originated with college campuses after there were very high rates of sexual violence on campus. And then, once they saw the success of that, it was adapted for adolescents. So, there have been many iterations of many programs that have worked up until this point. I'm personally partial to Bringing in the Bystander because I'm the most familiar with it, but they're all good. It's interesting - the evaluation processes for a lot of them - so my entire cumulative project - is that what they're calling it now for the MPH? It was called something different when I got it, but my whole project was basically evaluating these programs and sort of evaluating their evaluations. By and large, they've done great work showing, while the program was implemented, rates of sexual violence have dropped. Particularly extensive research on college campuses, which is great. There's not really longitudinal data to show what these attitudes look like, once the program has stopped being administered, so the way that Bringing in the Bystander is structured: it's a seven-week program for adolescents. The college one looks different, so we'll focus on the high school one here. It's a seven-session [program], I should say, and it can be administered across seven days - it can be administered across seven weeks. Typically, in my experience, it’s been administered across seven weeks, and then it gives a little bit of time for them to percolate on the information they've been given. There's a pre-test given at the start, and a post-test given at the end - very classic evaluation mechanism. It just assesses what they've learned, it assesses their attitudes, and that's about it. We know in that seven-week time frame, typically generally speaking, attitudes have shifted a little bit from the start. Someone will maybe say they'll agree with something that's a little more victim shaming and by the end they'll say, “No, I understand that that's not the right way to do it anymore,” which is great, but there's a lot of testing bias that happens in that, because at the end of the seventh session, this stuff is really fresh in your brain. You’re probably going to remember it better than if we tested you six months from now. There is a lot of social desirability bias, so people know how they're supposed to answer these questions, for the most part. The data is maybe not as reliable as it could be, and really, we don't know how this information continues into later adolescence and adulthood, because we're not tracking anyone. It would be an enormous undertaking, but it would be a really important thing to learn, to see how this programming sustains long-term violence prevention and there's not really a good answer for that, that I'm aware of right now.
Rachel Wenner: How does the curriculum work within norms in place within a school, whether this be gender norms, injunctive norms - that work to promote a healthier environment, or provide a barrier for one?
Kate Rogers: This is a tricky question, Rachel. There's a lot of different dynamics that play when you're working with the school, and some more conservative school districts don't love it. There have been instances where parents don't want their kids involved. Typically, the school will say, “We want this programming to happen,” and then the Rape Crisis Center will go in, but parents have to be notified that the kid is receiving this. A typical model would be coming into a health class because it's an easy place to slide this topic into. Parents have the right to refuse their kid this education, so they could pull their kid out. You have to notify the parents. If you're in a - not to stereotype - but if you're in a really conservative district, or a space where people aren't comfortable talking about sex, this is a very taboo topic. It can either result in some kids not getting the education, it can result in a lot of really interesting pushback from the students. The administration can sometimes use it as a way to check a box and say, “We did this violence prevention, cool,” and then they don't necessarily want to involve the rest of their staff or faculty There's a lot of different situations when the greater school, as a whole, doesn't want to be involved, it doesn't really work. We're just giving this education to the kids and we're saying, “This is what a healthy relationship looks like,” and “This is what healthy gender norms look like.” It's great for them, except if the whole structure around them is still supporting a more patriarchal, heteronormative view of things, it's not reinforcing what they've learned, and if they're going to feel ostracized, it's just not going to be effective. It works better when everybody wants to get on the same page, and everybody wants to learn. We recognize that these are hard things to talk about, and they are still, in 2021. Talking about sex isn’t normalized, and talking about gender roles and gender disparity isn't normalized the way that it could and should be to really make this task easier. It's a heavy lift.
Rachel Wenner: When you're working with these schools, who might be experiencing some sort of prevalence of teen violence, and you provide them with this data, whether it be the pre- and post-test results, or some of the findings that you've come across through working with the students themselves. What are some suggestions that you might make to the schools themselves, or the parents or the students within the classes that you're teaching to bring this information that you're bringing to the students, beyond just the seven-week period, or create more of a community or institutional-level changes, you might think?
Kate Rogers: The model is, of course, meant to be really holistic. It's the same concept - you want to go in as the guide, but you're not the one making the decision. Essentially, if I'm coming in and I'm implementing bystander training somewhere, I can say, “Here's the information we collected - what are your thoughts on this?” I can offer my recommendations, but I think working with any community, like any good public health strategy would do, you let the community decide what those findings will dictate, and sometimes schools are ready, and sometimes they're not. Sometimes you'll have a few faculty who are so genuinely excited about it and so jazzed about the work, and you know they're on the ground and they've seen a lot of things, and they really want to be able to support their students There are administrations that, for whatever reason, aren't ready to buy in, and that's okay. It's not something that can be forced, and I think if you don't have the buy-in from the top, it's very, very difficult to get things rolling on the ground. The best practice is that administrators and school boards, and all the decision-making stakeholder powers that be are really bought in and really involved. I've worked on some college campuses where that's happened, and it's been phenomenal. You've got people at the top, who are just firing off stuff and “This is great - we want to have presentations, we want to have better support services, we want to have this, that, and the other,” and it's wonderful. I worked in schools where it hasn't really gone over that great, and it puts a lot of burden on the one or two faculty members who are very excited to do it, and they're always restraining against their administrators. Ultimately, it's the institution's decision whether or not they want to do anything with the information that we've provided, and if they do, we're here, and even if they don't, we're still here. There's a lot of instances where they're not ready for the prevention portion, but you know we're here to back up any kind of response that anybody needs. It’s tricky.
Rachel Wenner: Yes, and that is a perfect example of probably something we both heard multiple times, and the key component, engaging stakeholders, and the complex events that occur between trying to communicate data and guide some sort of action, whether it be implemented or not, but I think that the educational work that you guys are doing is incredible. As a society, whether it's on a college campus, or something we could do to support the students and the adolescents in our local communities…What are some steps that we can take as individuals or groups to try and break down some of these more traditional normative beliefs and facilitate a more supportive environment?
Kate Rogers: I think the best way to do it, and this is one of my favorite things to talk about, is to work from the bottom up. We like to call it the “Pyramid of Violence”, where the base of the pyramid is all the norms that uphold the stuff in a society that makes things like gender based violence okay. The bottom of the pyramid is racist jokes, sexist jokes, homophobic jokes - things that are normalized in our culture as “funny,” (air-quoting ‘funny’ because they're not funny). Calling those behaviors out with our friends is hard to do when we're living in a very politically and emotionally charged time around all of this. For the better part of the last two years, a lot of us have been having really hard conversations with people we love when we have differing views. Whether you're talking about the coronavirus vaccine, or you're talking about sexual violence, it's kind of the same thing, and calling people out when they make jokes or say things that are maybe inappropriate, that are quote unquote “funny”, is the best way to do it. Once we start to normalize that that stuff's not okay, it makes it harder and harder for this up the pyramid. That objectification of people who are different from us, the othering of people who don't look like us, or behave like us or sound like us. It makes it harder for that to be okay. I think that's the best way to do it, really, it sounds cheesy, but truly be kind to each other and look out for each other.
Rachel Wenner: That’s an awesome message, thank you. Is there anything that you'd like to share, about your work, either within the school or professionally, or advice you'd like to give us as we wrap up?
Kate Rogers: Oh boy, I don't know if I'm qualified to give anybody any advice. I think I’ll keep my message the same: just be kind to each other. I feel like that's something someone famous says… I think, at the end of the day, everything that we do, and most of everything that happens in public health, is hard work. We certainly don't do it for the accolades, and we don't do it for the awards, but I think the most important thing is, whether you're working one to one with someone, or with a big community is public health officials and public health folks - we're not the experts in that. The people who live the experience are, and I think the more we listen, and the more we really work to understand the populations that we are working with, the better the outcomes will be, and it might sound cliché, but I really believe that. I guess that would be it - my advice would be to listen and be nice. Thank you.
Rachel Wenner: Well, thank you so much for joining us, and I know that it must be absolutely crazy busy this time of the semester as you're going through your PhD program, so thank you so much for taking the time out of your busy schedule to talk about this important health issue and shed some light on the ways in which it might be affecting our communities in ways that we might not even know.
Kate Rogers: And I really appreciate you all having me on as well, and I would say to offer support. Crisis Services does have a hotline that's 24/7, so if any listeners need anything: 716-834-3131.
Rachel Wenner: Thank you, and we'll be sure to link any additional resources with the episode description as well, in case anyone would like to know more, or is looking to get some support themselves or share it for friend, for that matter. Thank you.
Kate Rogers: Thank you, Rachel.
Rachel Wenner: This has been another episode of Buffalo HealthCast produced by the University at Buffalo. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.
Debora McDell-Hernandez of Planned Parenthood & Prof. Lucinda Finley of University at Buffalo discuss with host, Tia Palermo, abortion access, cases pending in front of the Supreme Court & implications of abortion restrictions for poor individuals and pregnant people of color.
Dr. Palermo: Hello and welcome to this episode of Buffalo Health Cast. I'm your co-host Tia Palermo and today I'll be discussing inequities in abortion access with my guest, Deborah McDowell Hernandez and Lucinda Finley. Welcome to you both.
Deborah McDowell Hernandez : Thank you for having us.
Dr. Palermo: Debora McDowell-Hernandez is the senior director of public and community affairs at Planned Parenthood of Central and Western New York, where she's worked for the past three and a half years.
Lucinda Finley is the Frank Raichle Professor of Law at the University at Buffalo. Her areas of expertise include reproductive rights and justice, gender and the law, tort law and First Amendment free speech. She is the author of several books and many articles in leading law journals. She has also argued a major case concerning the clash between the right to safely access abortion services and the right to protest before the U.S. Supreme Court. She also has handled numerous cases in the federal courts of appeals.
I'd like to start today with Deborah. Can you tell us a little bit about the geography of abortion access in the United States?
Deborah McDowell Hernandez: All right, certainly. First off, I would just like to say we're in. We're lucky to be or fortunate to be in the state of New York, which has a very abortion friendly legislation or law. We have the Reproductive Health Act, which was passed in 2019, which protects our access and right to abortion. But I don't think a lot of people realize how inaccessible abortion is in many parts of this country.
And although abortion is still legal in the US, if it's not accessible, what's the point of it being legal? And according to the Guttmacher Institute, thirty four percent of women or I can say individuals ages 13 to 44 live in states that are supportive of abortion rights, whereas 58 percent of people ages 13 to 44 are in states that are hostile or extremely hostile to abortion rights.
Dr. Palermo: And when you say supportive or hostile to abortion rights, can you just tell us a little bit what you mean there?
Deborah McDowell Hernandez: Right, so when I say supportive, I mean states that have created legislation to protect access to abortion. They don't require patients to jump through hoops to get an abortion, a state that might be hostile, although abortion is legal in that state. They might have all of these laws requiring a person to get an ultrasound and then return 48 hours, 72 hours later for another appointment and perhaps require that they have biased counseling that isn't medically accurate. But just making them go through these hoops for the sake of shaming them and just making having the actual abortion difficult.
Dr. Palermo: And you mentioned individuals of reproductive age, so realizing the importance of inclusivity and how diverse our community is. What can you say about people who have abortions?
Deborah McDowell Hernandez: Well, we can say that everyone who has an abortion or who is pregnant or has the ability to become pregnant might not necessarily wish to be identified as a woman. There are many people who have children, raise children, or choose not to have children, but they are. They identify as non-binary or gender fluid. So, trying to look at this from the lens of diversity and inclusion and not excluding anyone, I might refer to folks as individuals or persons instead of always women.
Dr. Palermo: Thank you for clarifying that for us. So, Deborah, can you give us a little bit of a background on the types of individuals who get abortions, some of the statistics and characteristics of people getting abortions in the U.S., right?
Deborah McDowell Hernandez: Most of us probably know someone who has had an abortion. One in four people in the US, will have an abortion by the age of forty-five. 59% percent of people who have abortions already have one or more children, so it's not something that is highly unusual. 75% of abortion patients are poor people of all races and ethnicities, and of a variety of faiths make a decision to have an abortion. And as far as race goes, white women make up the highest percentage of abortions at 39%, Blacks at 28% Hispanic or Latino at 25%, and other races account for 9% of abortion patients.
More than half of the abortion patients in this country are in their 20s, and they are in adolescence also make up 12% of patients.
I just I don't want to drown you with statistics. Abortion rate in 2017 was 13.5abortions per 1000 women aged 15 to 44, and that was down eight percent from 14.6 per 1000 in 2014. And 18 percent of pregnancies in 2017 ended in abortion.
Dr. Palermo: Thank you for that very comprehensive overview. Drilling down a little bit, can you tell us a bit about the abortion procedure? So, when during pregnancy, do most individuals seek abortion and how risky is an abortion procedure?
Deborah McDowell Hernandez: Well, first off, abortion is a very safe procedure. It's one of the safest medical procedures. anti-abortion folks or anti-choice folks will have you believe that abortion can cause cancer and all of these other things that just are not true medically and scientifically inaccurate. But very few people have complications or serious health effects as a result of having an abortion.
So, it's a fairly simple medical procedure to have. Two-thirds of abortions occur at eight weeks or earlier, and 88% occur in the first 12 weeks. And again, as I said, there no relation between breast cancer and abortions, even though people will try to create these false narratives. People, if you can, we have there are a couple of options. Surgical abortion is one option. Medical abortion, which would involve ingestion or taking a tablet medication, is also an option for patients.
We recently had someone from the state of Texas who visited one of our health centers and was unable to get the medical abortion. But we called out to another health center in the Buffalo area, and they were able to make space for them to get a surgical abortion.
Dr. Palermo: So, you mentioned that an overwhelming majority, so 88% of abortions occur in the first 12 weeks of pregnancy. What are some reasons women seek abortion after the first 12 weeks?
Deborah McDowell Hernandez: Well, abortion is a very personal decision. So, there are a variety of reasons that people have this as their final decision. And sometimes it's just a matter of, you know, could be for emotional reasons, financial reasons. I've heard people who decided to have an abortion because they would have felt trapped in an abusive relationship. They were being emotionally or physically abused and knew that was one way that this partner would have kept them if they were forced to have a child.
So, some people might make a decision to have an abortion simply for their own mental and emotional well-being. There are times when people might opt to have an abortion because of financial limitations. Maybe they don't feel like they have the financial means to care for themselves or another person could be other things happening in their world. Medical reasons a person might have some health condition that would make it very risky for them to continue with the full-term pregnancy and deliver. Or there could be an issue related to the fetuses’ health. So, I think there's just a variety of reasons. But the biggest thing at Planned Parenthood, we try to always respect that it's a personal decision for the individual or anyone else they want to include in their circle, be it a faith member on family and friends.
It's their decision to make and we want them to have the right to make that decision without feeling shamed or stigmatized or anything like that.
Dr. Palermo: How do people pay for abortions?
Deborah McDowell Hernandez: And again, you're going to have a variety of ways, depending on the person's own financial background. Some people are able to pay completely out of pocket if they have the financial means, they might do so in their home state outside of their home state, even outside of the country. People who don't have the financial means might do so with some government assistance.
There are states that are very hostile and you won't be able to get any support from them, but people are able to access abortion sometimes even with the help of their home state, the help of private funds There are many abortion access funds throughout the country that are funded through the generous support of
Individuals, or organizations who want to make sure that abortion is accessible to those with limited means and those with means in between. So, you have a variety of ways in which people pay.
And then if you have an organization like Planned Parenthood and many other organizations throughout the country, they might honor a sliding scale system and different people might pay different things, be it for it could be some sort of family planning, type of service or STI treatment.
So, it's not necessarily one size fits all. A lot of it, depending on where you are, the state for county in which you live in the health care provider that you are visiting might have some flexibility and understanding what you can't afford.
Dr. Palermo: So, you mentioned state funding in some states for abortion. Can you clarify for us whether federal dollars can be used for abortion coverage?
Deborah McDowell Hernandez: Well, with the Hyde amendment that prohibits the use of federal funds for abortion, but even in New York State, New York State supports costs for abortion if someone needs that. So again, when I say about depends on where you live, the state in which you reside, it could be just, as I said, an abortion supportive state like New York. Or you could be in a hostile state which might not offer you much, except for a lot of hassle.
Dr. Palermo: So, I'd like to turn now to Professor Finley speaking about payment and access and coverage.
What can you tell us about what the Affordable Care Act says about insurance and abortion coverage and how does this vary by state?
Professor Finley: The Affordable Care Act does not require that insurance plans cover abortion, it requires that insurance plans cover maternal maternity care. But not abortion.
Again, some states, including New York, have state laws that require that insurance plans within their state have to offer coverage for abortion, but that that New York law is currently under court challenge by employers who are using religious objections that they don't want to be forced to provide insurance to their employees that covers abortions. So, you know that that's a potential barrier to the law any laws that require private companies to provide insurance coverage to employees that covers abortion.
Dr. Palermo: Can you take us back a little bit, Professor Finley, and talk about maybe give us a quick overview of cases important cases in the U.S. with respect to abortion?
Professor Finley: Sure. I'll concentrate on the two main ones because there are way too many to talk about in this podcast, but you know the case that everyone I think knows by name, but few know what it really said is Roe v. Wade, which was decided by the U.S. Supreme Court in 1973. And in this case, the U.S. Supreme Court held that there was a fundamental right of a woman to choose whether or not to carry her pregnancy to term or to terminate her pregnancy, in other words, to have an abortion.
And the U.S. Supreme Court said that this fundamental right was based in constitutional notions of sort of life and liberty that included a right to privacy and the privacy of one's mother making decisions about one's own body. And that was a 7 to 2 decision of the US Supreme Court. You know, people tend to forget that, you know, once upon a time, the idea of abortion becoming legal was not as controversial in this country as it as it is now.
And then in the early 1990s, the other significant case is one called Casey v. Southeastern Pennsylvania.
Planned Parenthood and Casey involved a challenge to whether numerous types of state restrictions on abortion were constitutional or not. Under Roe, the restrictions involved in Casey included a waiting period where a woman had to first consult with the health care provider, then wait a certain period of time to rethink and then come back. It included a requirement that minors have to get the consent of their parents.
It included a restriction that women who were married and want an abortion had to get the permission of their spouse.
In the Supreme Court, Casey struck down the requirement that a woman has to get the permission of the spouse. But it upheld the other restrictions and it changed Roe in a significant way that made it possible for state laws going forward to become more restrictive or hostile, as Deborah said. So, Casey said that although women had a fundamental right to choose whether or not to have an abortion, the state, the state, the government also had its own right to protect potential life. And in balancing those two rights, the court said the state could put limits on abortion that were intended to protect health.
Such as you might regulate any medical procedure, but it also said it could put limits on abortion. As long as they didn't pose an undue burden on a woman's right and they defined an undue burden as a law that either had the purpose or the effect of putting a substantial obstacle in the way of women, and the court went on to say just because you make it more expensive. Just because you make it take, we have to wait longer, just because you make women have to travel further. Those aren't substantial obstacles.
So, Casey really unleashed decades of state laws in the hostile states where they said, OK, we're going to try to come up with every restriction or, as Deborah said, hoop to make women jump through that we can and see how many of them we can get away with under this new undue burden standard. And they've gotten away with a huge number of restrictions. The Supreme Court really has only found two or three types of restrictions so far to be an undue burden on a woman's rights.
As I said, the spousal consent provision that was in Casey and a couple of years ago, in a case from Texas and a similar case in Louisiana, the Supreme Court found that a requirement that an abortion clinic have to have a physician on staff that had admitting privileges at a nearby hospital was also an undue burden, one because it was utterly unnecessary. You don't need your physician to have admitting privileges to get an emergency patient into a hospital, and because you know, no hospitals in those state would grant admitting privileges. So, it had the effect of shutting down clinics. But everything else, the Supreme Court, under this undue burden standard is said, is just fine. You can, as the world said, you can impose waiting periods,
Mandatory ultrasounds, prohibitions on telemedicine requirements that the state can force you to have a vaginal ultrasound, requirements that the doctors have to give you medically inaccurate information intended to scare you out of having an abortion and, you know, try to basically force you just choose to carry the pregnancy to term. So, the current legal framework actually allows for quite a lot of restrictive laws that all these hostile states have taken full advantage of.
Dr. Palermo: So, you mentioned how Casey kind of set the stage for allowing increased restrictions that states can put on abortion access. What does the current trend surrounding related cases indicate for the future of abortion rights in the US?
Professor Finley: I think the current trend is actually rapidly getting us towards overruling Roe and Casey and perhaps allowing states to outright prohibit abortion. I should clarify the other key part of Roe that Casey kept in place was that prior to the point at a pregnancy that it's viable whether the fetus is capable of living on its own outside the womb, prior to that point of viability, the state simply could not ban abortion.
But now, several states and a very deliberate strategy to try to create a case that would force the Supreme Court to overrule Roe now that the composition of the court has changed under with the appointments of President Trump and the death of Justice Ginsburg, they started passing some laws, basically banning pre-viability abortions, knowing that under Roe and Casey, those laws are unconstitutional.
But hoping that the cases would get to the Supreme Court and the new composition of justices they hope will overrule Roe and eliminate viability is the point before which the state can't ban abortion. So right now, pending before the U.S. Supreme Court, in a case that will be argued on December 1st, is a case from Mississippi called Dobbs.
And so Mississippi passed a law that permits abortions up to 15 weeks. Last menstrual period, gestational age but after 15 weeks bans abortion unless necessary to save the life of the woman. Excuse me, of the pregnant person because obviously a pregnant man would not be able to have an abortion either through the Mississippi law. So that and the Mississippi specifically asked the Supreme Court to take up the question of whether, you know, the Roe should be overruled, and states should be allowed to ban abortions pre-viability.
The other case that's working its way up, Supreme Court comes from Texas, everybody's been hearing a lot lately about this Texas law. Texas passed a law basically banning all abortions after six weeks post last menstrual period, a time at which most pregnant people do not even yet realize that they are pregnant.
And Texas came up with a very devious, sort of shockingly devious way to try to prevent any federal court from declaring this law unconstitutional.
Normally, if the state passes a law, they designate some state official, you know, like the attorney general or somebody to enforce the law. And so, then if you want to challenge the law as being unconstitutional, the way to do it is to bring a lawsuit against the public official who has the power under this state law to enforce that law. But what Texas did with its new statute is it specifically said no state official can enforce this law at all.
We, the state, have passed along. We're saying we are going to enforce it. They said any citizen, any person, anywhere person in New York, the person in Florida person, California person in Timbuktu, it doesn't matter any person can, you know, go after any doctor in Florida who provides an abortion post six weeks and they can sue anyone who helps anyone try to get an abortion in Texas after six weeks. And that includes helping them pay for it, helping them arrange an appointment, driving them to the appointment. And so, they said, well, no one in advance of the law going into effect will be able to sue the stop law because in advance, nobody knows who the person who might try to enforce the law against them will be. And you can't bring a lawsuit against a hypothetical person. You need an actual person who's trying to enforce the law against you to bring a lawsuit.
So, so currently, the Supreme Court let that law take effect. So currently in Texas, all abortion is banned post six weeks pass the last menstrual period. But the U.S. Supreme Court just, I believe, just last week quite recently decided that they would at least take up the issue of whether the United States government can sue the state of Texas to try to challenge this law, or whether no one can challenge Texas law.
So those are so right now. And so, in fact, in the next few weeks before the end of 2021, there will be two major abortion cases argued before the U.S. Supreme Court. And we may see from the questions of the oral argument some insights into what direction the court may be going. But we probably won't have a decision in those cases until sometime in the spring or early summer of 2022.
Dr. Palermo: Professor Finley, can you tell us a little bit about how this Texas law that you've been talking about might impact women and individuals of low socioeconomic status and people of color who are seeking abortions?
Professor Finley: Yes, we've already seen the impact in Texas, by the way, know Deborah, when she mentioned that Planned Parenthood of Western and central New York has already had at least one patient from Texas come to New York. I, it might have been someone who was just visiting, but I wouldn't be surprised if he was someone who was just trying to get someplace where the state law would permit them to have an abortion. So, a law like Texas or the Mississippi law, if it's upheld or any of these restrictions fall disproportionately most heavily on poor women and unfortunately, women of color are disproportionately represented among poor women.
So, you know, these laws that restrict abortion fall more heavily on poor women for multiple reasons. First, the Texas law, in order to be able to afford to travel to another state, you have to have the financial resources to do that. You have to have the ability to take extra time off from work in order to now not just travel 100 or so miles, but to another state or even to fly to a state, you know, far, far away. You have to then have extra resources for childcare, for lodging at the place you are going to travel to. And you know, all of those things cost money. And, you know, many, many lower income women are in jobs with the least amount of flexibility for time off, the least amount of ability to afford childcare or extra childcare.
And also, you know, then the extra time it takes to arrange to find a provider where you don't have all these hoops to jump through often pushes the abortion procedure later into pregnancy, which increases the cost. So, you know, women of women of means women who have flexible jobs can take time off, have private insurance or private money are always going to be able to travel somewhere to get an abortion. But women who don't have those financial resources and flexibility in their life won't be able to.
The Texas law also falls very disproportionately heavily on undocumented women. Women in prison. Women in in ice detention centers, immigration detention centers. They don't have the option of traveling to another state. And even though the federal government is obligated to provide them with an abortion if they're in a federal immigration detention center, the federal government is not obligated to pay for them to travel to another state to get it. Nor is the Bureau of Prisons obligated to take a prisoner to another state and young women, very young women who now in addition to all of the hoops they would have to jump through in getting, you know, either a, you know, a judge to approve their abortion. If the parents won't, they now, you know, just say to them, Oh fine, the judge approved it.
“Now just get in your car and drive to Oklahoma.”
“Excuse me, I'm 16. I'm not allowed to drive.”
And if their grandmother, aunt or mother helps them drive to Oklahoma, they're afraid they might get sued under this Texas law. So, it is. It is an absolute tragedy for poor women, young women and women living in carceral facilities.
Dr. Palermo: Those are some really sobering points that you're making right now. Deborah, is there anything you'd like to add about how these different state restrictions on abortion access affect lower income individuals and people of color disproportionately?
Deborah McDowell Hernandez: Well, I'll just I think Professor Finley did a great job in describing the dynamics of excess or inaccessibility, given the different states. But when you think of geography, there are other things you can think of. There are some cities. 27, to be exact, American cities are considered abortion deserts because people who live in that city have to travel one hundred miles or more outside of that city in order to find an abortion provider.
So, I mean, 27 might not sound like a lot, but within those 27 cities, if you're thinking that some of those women or the folks who are needing the abortion might be black, LGBTQ and the disabled 100 miles is a long way to travel, especially if you don't own your own car and you're trying to, you know, cover transportation by train, bus or plane and get time off from work.
So again, depending on which county you call home, you might be traveling quite the distance. And chances are, you know, if you're undocumented, documented and Latina or Latinx or Black, there still might be the possibility that you might not be able to get time off from work or have the money to get to where you need to be. And then, you know, if you're a young person, you don't have that type of savings necessarily or a credit card or a job to help fund you to get you from point A to point B in the right amount of time before you exceed limits.
So, you know, when I think of the dynamics of someone who lives in a very rural area, maybe you're in a very rural county or the counties that surround you are all quite rural and you might have quite the distance to travel before you come across a medical provider. And then on top of that, a medical provider that even performs abortions is willing to are qualified to perform abortion services. And many patients who see Planned Parenthood, not just New York State, but in other states, Planned Parenthood is the only medical attention that many patients have because they don't see a doctor regularly or because they live in such a remote area, a rural community, and that might be the only time that they are getting any type of medical exam.
Dr. Palermo: Professor Finley, I want to turn back to some of the cases you were talking about, you mentioned the Dobbs case. Can you tell us about that? What is the likely?
Professor Finley: So, it's currently on the Supreme Court docket. What's the likely outcome and what would this mean for access to abortion in the US?
Well, it's always difficult to predict how the Supreme Court is going to rule, but I think in this case when you look at. The fact that there are already four justices that in previous cases have said they think Roe versus Wade is unconstitutional. And have been looking for to take a case where they could make that the majority opinion. And then you look at the fact that, you know, two of the two of the new justices added by President Trump, Justices Kavanaugh and Coney Barrett in many previous writings have expressed.
Let's just say, either in Justice Barrett's case outright, you know, moral and religious adamant opposition to abortion and injustice. In Kavanaugh's case significant legal skepticism as to whether the Constitution protects abortion.
You know, simple counting that seems like, you know, five or six votes to either overrule Roe completely or to substantially change it and permit states to ban abortion prior to viability. If the court says that states can ban abortion prior to viability. You know, that's going to open up all kinds of questions will do. They have to always allow an exception for women's health, or do they have to allow a rape or incest exception? Do they or do they only have to allow an exception when you know, several medical providers say the abortion that the woman carries the pregnancy to term, she will definitely die, and no medical provider in advance will rarely be able to say that she will definitely die if she carries the pregnancy to term. And by the time seer, the serious health complications of pregnancy arise, such as with pre-eclampsia or gestational diabetes. At that point, it may be too late to say, oh well, let's have an abortion.
You know, at that point, the severe damage to the woman's health is already done. And here I think it's also important to link, you know, whether there will be any kind of an exception to a ban on abortion to protect women's health with health equity issues for facing women of color. And for women of color, it is just tragically appalling that the well-documented serious risk to their health that carrying a pregnancy to term can entail.
So that's another way in which any change in the law that permits states to further restrict or ban abortion is going to have a significantly disparate impact on the health of women of color because pregnancy is a far more dangerous than an abortion. And its pregnancy is particularly dangerous for women of color in the United States.
Dr. Palermo: Thank you for reminding us of those morbidity and mortality statistics, and as you point out, the U.S. has among the highest rates of maternal mortality for high income countries, and the disparities between groups within our country are very stark. Turning to New York State now, Professor Finley, can you tell us what legislation has New York State passed or do we have pending to safeguard the right to abortion? And how will these laws interact with the potential erode vision or overturning of Roe?
Professor Finley: New York State has, as Deborah mentioned earlier, the Women's Health Act, which I believe was passed in 2019 and it essentially codifies in New York law the holding of Roe versus Wade, namely that prior to viability, a woman has an absolute right to decide for herself whether to have an abortion, and the state cannot ban it. In New York, law post viability, if the abortion presents a risk to the woman's life for serious health impairment, the state would have to permit her to have an abortion. And yes, that that's protected by statute in New York. So, if the Supreme Court overrules Roe, it would have the immediate effect of saying it's up to each state what they want their law of abortion to be.
So, New York has already said what it wants its law of abortion to be, and that is that women have the right to choose whether or not to have an abortion and prior to viability, the state cannot ban it.
But something to keep in mind. And you know, we can't forget federal politics here and the composition of the federal legislature. If you know, in any upcoming election, whether 2024 or whatever, if Republicans control once again, as they did under a little bit under Trump, the White House, the Congress, the House of Representatives in the Senate, there's absolutely nothing to stop them from passing a federal law that bans abortion in the entire United States. And then because federal law is always supreme over state.
There’s really nothing that would stop a federal government with a Republican in the White House, Republicans controlling the Senate, Republicans controlling the House to pass a federal law banning abortion and federal law is always superior to state law, so the federal law would supersede and make void and unenforceable, New York's law saying in New York, we want women to be able to have the right to decide whether to have an abortion.
So, you know, I relate this to the big filibuster debate in the Senate. You know, the only thing that would stop a Republican controlled Senate, House and White House from banning abortion throughout the entire United States would be the filibuster in the Senate. If the Republicans control the Senate with less than 60 votes, you know, so right now everybody's saying yes in order to secure voting rights and do other, you know, in climate protect the climate and other crucially important things, they want the Democrats to get rid of the filibuster. But I always say, well, OK, but remember, you get rid of the filibuster now when the Democrats are in control, just think what's going to happen when the Republicans are in control again?
So, it's a really complicated issue.
Dr. Palermo: Turning to you, Deborah. Can you tell us a little bit about what Planned Parenthood is doing to ensure access to abortion in New York state as well as other states?
Deborah McDowell Hernandez: Well, I think if I could give them all the would be actions, labels, I would say advocacy, lobbying and education, education and advocacy are very important, especially now because I think many people who aren't necessarily in this circle of reproductive and sexual health or maybe who are not activists really don't realize how great of a threat we currently have in losing access to abortion across the country. So, education is very important in getting the word out to other coalition members.
Our partners in the community, our supporters, be the donors or volunteers or activists getting out there, meeting with our elected officials to let them know how important this is to us and ensuring that we can offer our patients and the community in general, the care that they count on and realizing that many of the people that we are supporting are already in a vulnerable state, not limiting the discussion to abortion, but just simply having access to family planning, care, birth control, contraceptives, sex education in general, you know, testing for sexually transmitted diseases and treatment and things like that.
So, we take special care and making sure that, yes, we continue to provide health care to our patients, but we also need to educate the community on the on abortion, the importance of abortion access, lobby as needed to try to continue to get support from the elected officials because we realize that the true change occurs when policies change. So, we need all of the energy out there. We need our cheerleaders, attending rallies, going to marches and things like that. But we also really need the people, the cheerleaders, who can sign those bills and make them laws on our side to help support the cause.
One of the things that we're supporting right now, all of the affiliates in New York State Planned Parenthood affiliates is an abortion access fund, which would allow the average citizen to designate a portion of their income on their tax return form to abortion access. And then those funds would be distributed to different nonprofit organizations in the state of New York to help people who need funding support to pay for abortion services. So, something like that is a very basic lift.
If we can just simply have that as a box on your tax return to check off. It seems like it would be a win-win. We also inform our supporters of other abortion access funds across the country. We've even done campaigning or fundraising locally to help support many of those access funds in Texas, since the checks in patients are having the biggest struggle or threat right now. So, you know, fundraising as we are able to help Texas and other states, other hostile states since we're using that word elect. And education again and advocacy, those are some of the big things that we're taking on patient advocacy.
Dr. Palermo: Thank you for that you've given us so much to think about today. I wonder. Before we wrap up, is there anything that either of you would like to add, maybe starting with Professor Finley?
Professor Finley: I think I want to underscore something that I just said that I think don't think most people really realize how the right to a safe, legal abortion is under threat to a far greater extent in this country than it's ever been since Roe versus Wade. That is, as I said, when you ask, what did I think was going to happen in the Supreme Court, I think that, you know, by the end of by mid-summer 2020 to the U.S. Supreme Court is highly likely to have said either that Roe is completely wrong or that as long as they, you know, safeguard women's health, states can ban abortion almost at any time. And I think I particularly want younger women to think about this, what this would mean for them because younger women never lived in the pre-Roe world.
They don't know women like I do that or like my mother, you know, who had to go and get illegal abortions and what it was like and how degrading it was and humiliating and dangerous it was. And you know, just what a sort of basic aspect of your humanity gets taken away from you when the government says, you know, basically, we can conscript your body and force you to bear a child that you feel at this stage of your life you can't properly care for or support or to have would risk, you know, the safety of you and your other children because you're in an abusive environment. So, I just want to echo Deborah's call for saying, you know, education and advocacy.
If the Supreme Court overrules Roe, abortion will probably become one of the hottest issues in electoral politics at the state and the federal level, and it's going to take sustained commitment and activism from people who care about women's fundamental humanity and dignity and right to make their own decisions to fight for it. And in the states that are currently restrictive to elect people who do respect women's dignity and humanity and right to make their own decisions.
Dr. Palermo: You raise some really important points there about how common abortion is now and how we take for granted that abortion is health care, and it hasn't always been that way in the US. And as Deborah told us at the beginning of the episode, one in four U.S. women will have an abortion by the age of forty-five. So, it's very common and it's a very safe procedure, and that's something that we kind of take for granted now. But it's something that hasn't always been that way and may not always be that way. But still a very common procedure that women will continue to need in the future. Deborah, are there any final comments that you'd like to leave us with today?
Deborah McDowell Hernandez: The only other thing I'd say is we're very grateful for the support that we receive from the faith community.
Planned Parenthood Empire State acts has a Concerned Clergy for Choice Group, which is a group made up of supportive clergy members from across different faith sectors, and they join Planned Parenthood and other community coalition members in advocating for sexual and reproductive health and safe and legal abortion. So, I think it's pretty powerful when you're able to have a reverend, a rabbi and minister joining you during a legislative visit with an assembly person or a senator to explain why they want the people in their congregations to be able to make the decision and not have it be made for them by a politician.
Dr. Palermo: So, thank you both again to Professor Lucinda Finley and to Deborah McDowell Hernandez for being with Buffalo help cast today. Really appreciate your time and all of your insights on this important issue.
Thank you so much for being with me today. Thank you.
Professor Finley: Thank you. Yes, thank you for having me and for bringing attention to this very important issue.
All content © 2022 Buffalo HealthCast.
Co-host Natasha Allard interviews First Lady Charmaine Geeter and First Lady Narseary Harris from the National Witness Project, along with Dr. Ermelinda Bonaccio from Roswell Park, on their efforts to overcome breast cancer screening disparities among African American women in Western New York and on racial discrimination in health care setting.
Hello and welcome to Buffalo HealthCast, a podcast by students, faculty and staff of the University at Buffalo School of Public Health and Health Professions. We’re your co-hosts, Tia Palermo, Jessica Kruger, Schuyler Lawson, and in this podcast, we cover topics related to health inequity here in Buffalo, around the US and globally. In this first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population, health and well-being. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health, equity and inclusion.
Natasha: Welcome to Buffalo HealthCast. I'm Natasha Allard, a Ph.D. student in the Department of Community Health and Health Behavior here at the University at Buffalo. I'm joined today by an amazing group of women I have had the honor of working with in my past role at Roswell Park Comprehensive Cancer Center. I've seen firsthand how passionate they are about reducing health inequities, especially among Black women here in Western New York. So, I knew we had to have them on the podcast to discuss. Today, we have First Lady Naseary Harris and First Lady Charmaine Geeter, both from the National Witness Project and Dr. Ermelinda Bonaccio, Chair of Diagnostic Radiology at Roswell Park. It is so wonderful having you all here today. So, let's start with some introductions. First Lady Harris, can you tell us a little bit about yourself and your role as a first lady?
First Lady Harris: My role with the National Witness Project is chairperson for FLOW, which is the First Ladies of Western New York. So, I do a lot of work with recruitment, educational programs, navigation and getting the word out to our community about the importance of early detection of breast and cervical and colorectal cancers.
Natasha: That's wonderful. Thank you so much. And for anybody who isn't aware, can you explain what a first lady is and why we use that title for you?
First Lady Harris: Yes, it simply means that we are the pastor's wife. That's how we are addressed in our congregations.
Natasha: Wonderful. Very important role. First Lady Geeter, can you tell us a little bit about your role and who you are?
First Lady Geeter: Hi, my name is Charmaine Geeter. I'm also a pastor's wife. I work alongside with First Lady Narseary Harris. She brought me in to the National Witness Project, working alongside of her with the First Ladies of Western New York. I do the same thing. I help her recruit. I help her give seminars on helping to educate women on getting their breast examinations, make sure that they know what to do on how to give their self-breast examinations, make sure they get their checkups. Also educating, also educating men on making sure to let them know that they, too, can get breast cancer, colorectal cancer, HPV. We do whatever we can to educate. Our community is wonderful.
Natasha: It's quite the heavy task you have taken on, but it's so wonderful. And the work you do is so important. Dr. Bonaccio, tell us a little bit about yourself and your role at Wrestle Power to thank you for having me on.
Dr. Bonaccio: So, I am the chair of diagnostic imaging at Roswell Park. But the reason I'm here today is also for the past twenty-four years, I practiced as a breast imager, reading mammograms, doing any of the images, guided biopsies, MRI, ultrasound. So that's my clinical role, although I've taken on this administrative role and screening mammography has been a big part of my mission here and bringing that to Roswell.
Natasha: Wonderful. Thank you so much. So as many of us know, October is Breast Cancer Awareness Month, and one of the most critically important aspects of awareness is understanding how a disease affects different communities. So today we will address disparities in both breast cancer and breast cancer screening, particularly in the African American community. So, First Lady Harris, I'm going to ask you to dig a little deeper into what the witness project is and why this exists.
First Lady Harris: So, I really got involved when I was introduced to the Witness Project by Detric Johnson, who is now actually the national director. What really caught my attention is the fact that they were addressing all of the concerns about African American women, why they weren't getting mammograms, why they weren't going in for their pap smears. But what really caught my attention was that they were actually coming into the community, coming to where these women are and stressing the importance of early detection. That just really got my attention after finding two breast tumors of my own. There was nobody in my life to navigate that for me. There was nobody that I could talk to, and I was reluctant to talk about it. It was like the it was like sharing that information was taboo or, you know, I know I wasn't contagious, but it was just the fear of the unknown about breast cancer and then having friends who actually had breast cancer and died. So, it was the fear factor. It was. Not knowing, not having somebody to talk to about it, the friends that I had who actually had breast cancer, they were reluctant to talk about it. I guess it just happened to be because of being a pastor's wife, they were more safe to talk to me about it. So, this organization happened. I thought, this is amazing. And what an opportunity to share this information with other women and help navigate them and guide them through the process that I felt so afraid of and intimidated by.
Natasha: That is wonderful. I really appreciate you sharing your own personal story and your passion just shines right through. So, we really thank you for sharing that. First Lady Geeter, do you have anything you want to add about why the witness project is important to you or the work you do?
First Lady Geeter: One thing that was so amazing. The one thing that, we use a term in the church, was meeting people at the point of their need. It was like we come to you. We don't wait for people to come to us. So church is a big gathering place. It's like the family is already there. And so, it's almost like a place of trust. And the one thing that I find out, find out about our culture, we don't tend to share. So, we don't tend to find out if my grandmother or my auntie may have cancer. So that is a big factor to know what is in your blood line. So, if grandma may have had cancer, then it's good to know that I need to have a mammogram earlier than 40. So, education is the key. So, when we can bring these educational seminars or educational talks to the church, to the place where they already are, then that is the key. The key is to educate so that we will know these things so that we could do better. So, I just felt like it was just phenomenal to know that we can bring these things to where they are. So, like we say, we'll go to your family reunions. We will go to your apartment complexes. We will go to wherever you are. We will bring these things to you.
Natasha: That is amazing. I love your point about knowing your own family history and your personal risk. And you both have just made such a great point about going to where women are or where people are for screening. I think that's such a wonderful approach. So, let's transition a little to understanding disparities within screening for breast cancer. Many different studies over the years have found different racial or ethnic and socioeconomic disparities in actually utilizing screening mammography. This has changed over the years. There's been some great headway is made, but of course, our work is never done. So, we're going to spend a few minutes first diving into what breast cancer screening is and why it's important. So, Dr. Bonaccio, we see studies and health communications use terms and phrases like mammography, annual mammograms, breast cancer screening somewhat interchangeably and different ones in different places. But in an effort here today to potentially overcome health literacy barriers, can you boil down what those words mean?
Dr. Bonaccio: So, a mammogram is a type of X-ray. It's a very low dose x ray of the breast. And in general, when we talk about screening for breast cancer, we are talking about mammography. And it gets very confusing because 3D mammography or tomosynthesis or other terms that you might hear, and those are essentially a newer, improved mammogram. So, we typically talk about screening mammography when we're talking about screening for breast cancer, because that is the test that has been proven in multiple different types of studies, randomized controlled studies, case control studies over the years to lower your risk of dying from breast cancer, up to 40 percent decrease in mortality with women when women are screened with mammography. There are other screening tests for breast cancer usually reserved for women who are at high risk for breast cancer, such as screening breast MRI or for women who have dense breast tissue such as screening ultrasound. The key part of screening is a test we do on a regular basis in this case annually to look for cancer that's not symptomatic. So, we're trying to find a breast cancer before you can feel it. That is the ultimate goal of screening so that we have better chance. preventing death from breast cancer.
Natasha: That was a great explanation, it makes it a lot easier to grasp on to, I think. Can you briefly tell us what are the current mammography guidelines? So, who is supposed to get one and when?
Dr. Bonaccio: So, for average risk, women, women who do not have a family history or any of the mutations in mammography should start at age 40. And we follow NCCN guidelines, which is the National Comprehensive Cancer Network that we belong to as Roswell Park. So annual screening mammography beginning at age 40. We follow those guidelines because frankly, that saves the most lives. But as First Lady Geeter referred to, it is important to know your family history and women who have a strong family history of breast cancer or women who are known to be mutation carriers, then we will start screening mammography at a younger age and potentially do one of those other screening tests that we were I just mentioned.
Natasha: Thank you, First Lady Harris and First Lady Geeter. Do the women you meet in your work with witness project typically know these guidelines?
Natasha: Do they know they're supposed to have a mammogram but just maybe aren't getting one or do they not even know? Is the awareness not there yet about the age you're supposed to get screened?
First Lady Harris: So typically, I think the I think the awareness may be there in a lot of cases. I think the trust, but I think the fear factor. I think the lack of insurance sometimes and if there has been a family member who had it, the fear of finding out that they might have it, and that is a death sentence. So, I think knowing that mammography is helpful, the importance of it sometimes, I think is not there due to the lack of education about what why it's important and the possibility of early detection not being a death sentence for you. So, it's a combination of things. But I think by and large, mammography, the word if you say what is a mammogram and who gets it, that knowledge is there, I think more often than not. But the navigation of getting one, the importance of knowing that could possibly save your life is not always understood in its entirety.
Natasha: Got it. That makes a lot of sense.
First Lady Geeter: I also think that sometimes they get mixed signals. I think lately I've also been hearing that a woman should get their mammograms at 50. I have heard that. I've actually heard it advertised on TV. I also don't think that they always know that, that if there's a history of breast cancer, that they should get a mammogram earlier. So sometimes I think that sometimes there is different things that are being said and that causes even more of a distrust when everybody not always saying the same thing. And that's where you get that distrust -- when they hear several different things.
Natasha: Very eye-opening I could definitely see that being an issue.
Dr. Bonaccio: And the family history piece, I think is very important. More recent data has been showing that there appears to be an increased incidence in the BRCA and mutations in African American women. So, knowing that family history and potentially if it's significant, getting tested, I think is really key to potentially starting younger and doing more than an annual screening mammogram, potentially having an MRI. So that information is really very important as well.
Natasha: It's interesting. First Lady Harris, you mentioned the fear associated with if a family member had or died of breast cancer. I was just listening to a different podcast; Freakonomics episode called The Ostrich Effect. And they were talking about how specifically in African American women, but many other women as well. Studies have shown that having a close loved one who has breast cancer or even dies of it, kind of just the opposite of what you would think. It makes you not want to get a mammogram. Can you explain that a little bit?
First Lady Harris: Because, again, we go back to education and navigation. If people when they hear that, they automatically assume. So, remember early on when I said how I got involved with that, with the witness project, I found two tumors in my own body, in my own breast.
The first thing that you think is, oh, my gosh, this is a death sentence. So, when a family member is diagnosed with breast cancer and they die, people tend to…My experience has been they don't want to know they got it, if they got it, they're going to die. So let me just live my life and just the way it is, because I'm going to die of breast cancer. So, there is a fear of the unknown. There's an assumption that if a family member dies with breast cancer, that's what's going to happen to them. So, they just kind of accept it as this is the way it's going to be, which again, is why it is so important. The work of the National Witness Project, getting to those women, getting to those younger women, giving them the gift, giving them knowledge about breast feeding. We know we've learned through the different opportunities of being educated, even through Roswell and the opportunities that they've given us, understanding the importance of early detection, understanding how breast feeding in our and our community changes the risks of breast cancer. So, all of these things are important and helping them to navigate the system, understanding why it's important for you to get a mammogram, understanding that because your loved one died of cancer does not mean it's a death sentence to you if it's detected early.
But the fear is, if it happened to Betsy, if it happened to Grandma June, I'm going to die, too.
So why bother?
Dr. Bonaccio: I so agree with First Lady Harris about the importance of navigation and education. And it's not just for the screening piece of it, because a lot of the data surrounding survival disparities in breast cancer for African American women is actually even after the mammogram gaps in care following up on an abnormal mammogram, making sure that they receive adequate treatment and complete all the treatment. And when you read it, how we can improve this now, it always seems to come back to navigation, culturally competent education, exactly what you're saying. I mean, what the work the witness project does.
Natasha: Great points. I was actually just going to bring up a statistic from the American Cancer Society that Black women are 40 percent more likely to die of breast cancer than white women and are twice as likely to die if they're over 50. So, I'm really seeing that statistic kind of come to life, as you all are discussing, because you have Dr. Bonaccio, who has some of these medical facts about the importance of early detection, and then First Lady Harris and First Lady Geeter—your passion is really to get those facts to your communities and make sure people know that early detection means breast cancer doesn't have to be a death sentence. First Lady Geeter, you've brought up mistrust a few times. Do you want to talk about that a little more? Can you explain that a little more, what you see?
First Lady Geeter: Yes, our community has a lot of mistrust and it's very we're very apprehensive about taking part in studies. And I think that if we were able to get our community to take part in studies, we could probably gain and know a lot more. But because of things that have happened to our African American community in the past, it is so very hard to get us to take part in studies because as we know, that has not always been the case about African Americans having breast cancer or dying in breast cancer. We were not always the leading and death of breast cancer. If we could just build the trust in our African American community, I think we could see a change in those numbers. So we're just hoping through the National Witness Project that we can start to build trust in the African-American community to take part in studies so that we can start to see these numbers change.
Natasha: Thank you for sharing that. Here at UB we have a health disparities class within the School of Public Health. And one of the things we discuss is how race is often acknowledged as something that contributes to disparities when in reality racism should be discussed and some of these historical and current contextual reasons for this. So, would you agree that that's something you're seeing with the women you work with?
First Lady Geeter: Absolutely.
Natasha: Absolutely. So, I want to circle back a little. Everybody has brought up navigation a few times. I'm looking right now, it's a Susan G. Komen list of some various barriers that are current and tangible that they have identified existing for mammography. So, I'm just going to quickly run through some of these and then I invite anyone to weigh in, and if you have seen these as a barrier and how different organizations or policies that you have worked with are trying to overcome these. And we've mentioned a few already. So, we have cost concerns or lack of adequate insurance, lack of having a primary provider or an OBGYN to make referrals, different health literacy or educational issues, childcare issues, not being able to take sick leave or miss work, fear of bad news, fear of a painful mammogram, cultural or language differences, and then a lack of education, which we have discussed greatly. So, what does the witness project do for some of these maybe like insurance or missing work or transportation?
First Lady Harris: So as far as transportation, we provided it free of cost, free of cost.
If there is no insurance, we help them to get insurance, literally walk them through the process. If they need help with childcare, we make that happen for them, free, free of charge. Everything that we do through the project, it is zero cost to that family. We will educate them. If there are five people, we literally will do a witness project, educational program for a family. You've got your aunt, your uncle, your aunts, uncles, your grandma, your nieces and nephews, your children. We will do a live program for you. And now, because of COVID, we will even do it virtually. If they don't have access to Zoom, we use our own personal zoom to bring them in, to educate them and to navigate them. We will literally hold their hands and take them to an appointment, make the appointment and take them to the appointment. If there is a fear of that they have a bad experience with a primary care, we will assist them with finding a primary care doctor. If there is a breakdown, if somebody drops the ball with their OBGYN, we are there to navigate and help them find someone that they will feel comfortable with. So, we try to eliminate whatever the barrier is. Once it's brought to us at once, it's brought to our attention. We will seek out a way to eliminate that barrier.
Natasha: So, you really do it all. Full suite of services.
First Lady Harris: One stop.
Dr. Bonaccio: Just a couple of things to add as far as the cost concerns, even separate from our partnership with Witness, we're actually able in New York State, we have Cancer Services which will cover a mammogram for uninsured and underinsured women. So, if you call for an appointment at Roswell and you don't have insurance, we can connect you with cancer services program, which is a wonderful program. And for those that are insured in New York State, there's not even a copay for a mammogram, for an annual screening mammogram. So, because those 10, 15, 20 copays can add up. So, I think that's one thing to keep in mind. And you don't necessarily need a primary care doctor to come and have a mammogram here. So, I think that in general, we're trying to remove as many barriers as we can for screening.
Natasha: That's so wonderful. Actually, I was just going to ask this. Can you explain briefly how is Roswell connected to Witness Project?
Dr. Bonaccio: Oh, my gosh, we have such a wonderful long history with Witness project. So, Deb Erwin, who was she's a Ph.D. who was the co-founder of Witness Project in Arkansas, was recruited by Roswell to come here and then set up that program here. So, it's been a long partnership, but when we opened up our community screening program in twenty sixteen, our partnership grew and that we now navigate women to Roswell for their screening mammogram. We will have designated screening days for when this project this summer in the weekdays and summer on Saturdays to again improve access, decrease barriers. But it really has been a long and wonderful partnership.
First Lady Harris: And we certainly appreciate that. We appreciate that. And the fact that they have partnered with us for the One-stop with Roswell has been a true blessing so that we can eliminate the fears. Don't forget women that we were working with, they had a fear of going to Roswell because the only thing they thought when they thought Roswell cancer, that's where people go who have cancer and what this partnership has done, and to partner with the witness project, has changed a lot of that concern with the women in our community. Now, we have women when they find out that they can go to Roswell for a mammogram. They're eager to do it, they want to do it, and especially because of the partnership that Roswell has with the National Witness Project, see our community trust the witness project. They trust us. And so, when we say, oh, yes, you can go to Roswell, we will take you there. And then Roswell’s commitment to our community, to the people that are underserved, who don't have protection, who do face a lot of fear and a lot of rejection when it comes to the medical arena. They are helping to eliminate some of those fears and doubts about where they can go. And are they going to be treated with respect? It's a big difference. And so, we're grateful, the Witness Project. We're grateful for our partnership with Roswell and this beautiful doctor she has…
Let me tell you let me just tell you, when we went there for this last event for Channel four and Roswell, that partnership, she told me, she says, Lady Harris, I would be so honored to be a part of your presentations that you do with your congregations and with the people that you are going out to do the educational programs with, to share some more of the information and to dispel a lot of more of their doubts and fears about cancer and about Roswell and getting more educational from that in, you know what I mean, to put a friendly face to the medical side of it all. So, we are truly grateful to her. She's an amazing partner.
Dr. Bonaccio: Thank you so much for the kind words and I mean every one of them. I'm really looking forward to presenting at any of the programs where it would work for me to join. I really, I'm really looking forward to that.
Natasha: So, this is wonderful. Community partnerships like this really are encouraging and inspiring. And I love to see groups like this get together and share their passions, especially because … kind of the flip side of this. I have another American Cancer Society stat that a third of African American women have reported experiencing racial discrimination at a health provider. First Lady Geeter and First Lady Harris, is this something you are aware of? Have you seen or heard from women?
First Lady Geeter: I have heard on different occasions where they feel like they have been treated differently, don't feel comfortable. So, they just they just do not go to a doctor.
They choose not to. And it's just not a good feeling. And I mean me myself and this happened to me where I feel like I have had to change to a different doctor, especially now when I've gotten to more of a mature age where my doctors have retired, and I have to go to choose another doctor. And I don't like the way I have been made to feel and have been on the hunt for a doctor. It's very disheartening. And, you know, you know, the feeling is just something that you feel in your gut. And it’s there, it is just there.
First Lady Harris: You know, I had an experience as well with one of our friends who went to go to her OBGYN and then with, I think, her primary care as well, an African American sister, she told the doctor that she found a lump and wanted them to check for her to check for it. And they didn't do it. They told her, oh, you're fine. I couldn't believe I was actually hearing her say that. She went back again, and she said, I have a lump in my breast. And the doctor still refused to examine her. She went back a third time and said, I need you to examine me. I feel a lump in my breast. So finally, she said, Can I show you where it is? And the doctor says to her, according to her pointed out point, the area where it is, she did that. And then the doctor touched her breast and found that there was a tumor there. When I heard that, it almost brought me to tears because this happens a lot more frequently than we even know, because instead of saying something about it, the person, the woman, she just clams up and just says, I'm not going to be bothered. Why bother? And so that's very, very disheartening. And this young lady, this happened to her about a month ago. I'm not talking about something that happened last year. I'm not talking about something that happened a couple of years ago. This happened 2021. And it happens.
Natasha: First Lady Geeter and First Lady Harris. I really appreciate you sharing those really personal and honestly horrifying stories. And I'm sorry, and I thank you for bringing awareness to that and for speaking out.
First Lady Geeter: I have had an experience where I had a lump in my breast, and it ended up being fatty tissue and I actually had it removed. And when I when I had it removed, I was told that it was a possibility that it would come back, and it came back, and it was and the removal was very it was very painful. And it did come back. And I went back to the doctor because it came back so quick. And his response to me was, it's because of the kinds of food that you all eat. And I, I mean, when I talk about it tears of well, up in my eyes. Tears welled up in my eyes and I asked, did I ever give you a list of the food that I eat? I said, you don't know what I eat. And I was insulted.
First Lady Harris: I guess so.
First Lady Geeter: And I never have gone back and, you know, and it's still there and hasn’t gotten any bigger. But at this point, if I ever have to have it removed, I will search out for another doctor because I was just so insulted because I felt like he was telling me it’s the food that African Americans eat that is causing this fatty tissue.
Natasha: That is heartbreaking and unacceptable. And I honestly don't have words. I have chill as you're telling that story. It's truly an atrocity. It's truly an atrocity. When we look at addressing racism and discrimination, it's hard to even know where to start. But Dr. Bonaccio, what role do health care providers, at a bare minimum, play in addressing racism and discrimination in a medical setting?
Dr. Bonaccio: Well, first, I'm so sad to hear these stories, but unfortunately, I'm not surprised to hear these stories. I mean, I think with any problem, right. First thing we have to do is acknowledge it and talk about it. And that's why I was so glad we're having this conversation.
And I do feel like that we're having more of these conversations over the past two years in the medical community. And that is going to be a huge piece of addressing it. It is going to take time. But we talked a lot about educating African American women to have a mammogram. But we as medical care providers have to educate ourselves to learn how to address these issues to teach young physicians and practicing physicians and providers about unconscious bias, about culturally competent conversations. I mean, we have a lot of work to do. But I am heartened, as disheartening as these stories were, I am heartened by the fact that we're talking about it more so than I've been practicing for twenty-four years. And the intensity of the conversation that we're now having in the medical community brings me hope that we will then start moving towards solutions.
Natasha: Absolutely. Talking about this is so important.
Dr. Bonaccio: First Lady Geeter’s point about it's not just clinical trials, but we need research in this area as well. I was sort of as I knew this podcast was coming, was doing some research and focus group research is important, too. There was one study that showed, for example, that African American women require more education once they're diagnosed with breast cancer, more information than potentially on non-African American women do. And it makes sense to me, right. If you're not trusting of the system, if you're worried about racism, you're probably going to have more questions in the information. So, getting that information out to providers I think will help to as we get more research in this area.
Natasha: Thank you. As we come to a close today, I'm going to ask each of you to just share one final message that you would want to send either to women of breast cancer screening age or this podcast is listened to by a lot of public health students and faculty and professionals. So, either people in the field or women who need to get mammograms, what is a final Take-Home message you want to send? First Lady Harris, we can start with you.
First Lady Harris: OK, so what I would like to be able to take home with them is the importance.
Again, we can talk about early detection, how important it is to get that mammogram, how vitally important it is to talk about it in your family. It is so important. And if we could just get that message out there for the screening of breast cancer early, I think that it would help to change all. So, the statistics will change greatly, I think if we could just get that information out, the education out there about early detection.
Natasha: Thank you, Dr. Panopto. I'll have you go next and then we'll close with First Lady Geeter.
Dr. Bonaccio: One message I always like to get out when I'm have the opportunity is that most women who develop breast cancer actually don't have a family history of breast cancer. So just to remind people that our biggest risk factor is being a woman so that even if you don't have a family history, you should have your annual mammograms starting at age 40. But I like to say that along with the fact that it is still so important to know your family history for the reasons we've talked about earlier, so that potentially you can get screened at a younger age and with other studies in addition to the mammogram. But that's an important take home message for me.
First Lady Geeter: Mine is always if you're proactive now, you won't have to be reactive later.
Natasha: I love that. It's powerful, succinct, and it sums up everything we've talked about. Well, everyone, I truly appreciate your time. This conversation was powerful and insightful, and I really think it was valuable. And I hope, I know, that everyone listening to this podcast will feel the same. So, thank you very much. And I hope everybody has a wonderful rest of your day.
First Lady Harris: Thank you for having us.
Dr. Bonaccio: It's such a pleasure working with both of you. Every time I have the opportunity.
Natasha: This was wonderful. Everyone, I really, really appreciate it.
This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US and around the globe.
All content © 2021 Buffalo HealthCast.
Co-host Tia Palermo interviews Dr. Myron Glick, Founder and CEO of Jericho Road, a community health center in Buffalo, on their work attending to the health care needs of refugee populations, including coordinated efforts of Jericho Road with Buffalo's refugee resettlement agencies to assist Afghan evacuees. To donate to their efforts, visit wnyrac.org.
Hello and welcome to Buffalo HealthCast, a podcast by students, faculty and staff of the university at Buffalo School of Public Health and Health Professions, we’re your co-hosts, Tim Palermo, Jessica Kruger and Schuyler Lawson. And in this podcast, we cover topics related to health equity here in Buffalo, around the US and globally. And the first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population, health and well-being. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health, equity and inclusion.
Tia: Hello and welcome to Buffalo Health Care. I'm your co-host here, Palermo, and I'm here today with the doctor of Jericho Road. Welcome, Dr. Glick. Thank you. Here. Thank you for this opportunity to start us off. Can you tell us a little bit about Jericho Road and your role there?
Myron: Sure, yeah. My wife and I started Jericho Road in nineteen ninety-seven. I'm a family doctor. And when we started, our original purpose was to provide excellent quality family health care to folks on the West Side who needed it, whether they had insurance or not, and especially Medicaid and uninsured folks. And that was back in ninety-six, ninety-seven. So almost twenty-five years ago. Since that time we've grown a lot. And today we're a pretty large organization in Jericho and Buffalo. I'm still a family doc. See patients deliver babies and I'm also the CEO of the organization.
Tia: That's great. Yeah. Can you maybe tell us about the different parts of Jericho Road and what the different projects and locations do?
Myron: Sure. So I tell folks that we basically do five things at Jericho.
Our main thing is we provide primary health care, medical care to folks here in Buffalo, regardless of what their insurance status is. We have five health centers in Buffalo that provide primary health care and about 40 doctors and nurse practitioners. And so we see a lot of patients and many of our patients, over 50 percent, come to us as refugees and immigrants from other places. They've moved to Buffalo for whatever reason. And then we have lots of folks who grew up in Buffalo on the east and west side of Buffalo, and they become our patients.
The second thing we do is we long ago realized that providing medical care isn't really enough if we're really going to have an impact in people's lives. And so we've started a number of programs that are tied into the medical care that we provide that address or try to address some of the root causes of why people are sick and really the social determinants of health. We can't do it all. But these programs are our logit programs that really impact people's lives where they're at.
The third thing we do is we, in partnership with the University of Buffalo, have a family medicine residency training program at our site, one of our sites. So we know every year we get a three-year training program. Every year we get four new recent medical school grads who want to learn about what it means to be a family doctor. And they're here for three years with us. So like right now, we have 12 family doctors in training. And that's a wonderful opportunity for us to sort of give a little bit of our DNA to other doctors. And some of them may work for us in the future when they graduate and others will go other places and make a difference and take a little bit of what they learned with us to those places.
The fourth thing we do is we run a homeless shelter called VVA. And this homeless shelter is specifically for asylum seekers who have come to Buffalo, come to this country, mostly crossing through the southern border. Many of them have had harrowing journeys that have lasted years to get here. And they're looking for a home for their families, either here or in Canada. So every night we shelter probably one hundred to one hundred and forty people at VA and we provide medical care, trauma-based mental health care and legal advice to these folks in addition to shelter and the physical needs that they have.
And then the fifth thing that we do is one that I mean, they're all exciting to me because I'm involved in all of these options But we have a global health program through Jericho, where we followed some of our refugee friends back home to Sierra Leone, to the Democratic Republic of Congo and to Nepal, and we have we run we operate five health centers in those countries that are fully staffed by local folks from those countries. We provide some financial support and operational support, but it's really locally run and operated in the blood. And we're almost seeing as many patients in other countries as we see now in Buffalo. So that's sort of a quick overview of what we do at Jericho.
Tia: Right. Thank you for that. It was really great to hear you talk about the social determinants of health in our school of public health and health professions. At the University at Buffalo, we talk a lot about how social determinants of health and upstream factors really affect the access to care that people have as well as their health outcomes. So it's really nice to hear you talk about how you're bringing both sides together in the provision of health care and you're doing so many different things. It's very impressive.
We brought you here today to talk about Jericho, a Jericho Road role in the effort to assist Afghan evacuees who are now arriving in the United States. I think there's about three hundred and fifty evacuees expected to be arriving in Buffalo. So can you start out by maybe telling us a little bit about the standard refugee resettlement program? So what do refugees get when they get here? And how do refugees differ from other types of immigrants in terms of their legal status?
Myron: No, that's a good question. So refugees are folks who have had to flee their homeland because of war or some kind of horrible trauma and are now being resettled in another country. They're not choosing to leave their country. They're fleeing for their lives. Many have lived in refugee camps across the world and many have become certified by the UNHCR United Nations high command of refugees as official refugees and whereas an immigrant would be someone who chooses to come. And they're not necessarily fleeing refugees fleeing for their lives. And then you have asylum seekers who often really are refugees if they're fleeing the same set of circumstances, they just never got certified by the UNHCR. And so they have to find a different way into the country. So if you think about folks coming to the United States, I would say there's a category of refugees which are folks that the United States has agreed to take in. And when they get here and they're assigned to Buffalo, they're on a pathway to citizenship that will hopefully culminate within six to seven years of them becoming actual American citizens. And when they arrive here, they receive a significant amount of support for at least the first three to six months through the federal government. And that support is channeled through local refugee resettlement agencies in Buffalo.
We have four of them. We have the International Institute, Jewish Family Services Journeys and Refugee Resettlement Services and Catholic Charities. And those organizations get money through the federal government and through the state to resettle refugees to help them find an apartment, to help them get to the doctor, to help them apply for Medicaid and social services and find that first job. That's sort of the pathway that Jericho probably has. Ninety five percent of the folks we see from other countries come as official refugees. We step in and provide the initial medical evaluation within 30 days for these folks and then we become their medical home so that many of those you know, we're the only doctors we've ever seen and they've been here 10, 15, 20 years. We've become their home for their medical care asylum seekers. It's much different. They're coming in through a whole different pathway and they don't get a lot of the services that are offered to the refugees and then immigrants. A totally different story. The challenge with the Afghan evacuees is they're coming in on a different sort of. Under a different sort of legal status that's much more similar to asylum seekers than it is to the official refugees. And so right now they're being promised like one month of services through the federal government that will be given to the refugee resettlement agencies. So there is a real need for our community to rally around supporting the refugee resettlement agency so that they can actually provide more of a standard amount of services for these Afghan folks who are fleeing their country.
Tia: What are some examples of the medical needs of the refugees that you see in your program?
Myron: So a lot of these folks come and they maybe have had some evaluation in the last year or so, but they're fleeing situations that set them up. I mean, first of all, many countries that are coming from don't have the resources to address problems that we take for granted here. Problems like hypertension or diabetes, maybe they don't have access to insulin or medications. Some of them have had trauma because of war. Maybe they lost a limb, but they never got physical therapy or a prosthesis. Some of them, we still see people today who were affected by polio when they were kids and they can't walk or they've lost the use of a limb. So we see children that have had autism or severe developmental disabilities that never got any resources. So we see, you know, there's a real opportunity to get people plugged in to our American health care system that has more resources if you at least if you have access. And so we do that. And then we also have an obligation to screen folks that are coming here from a public health standpoint for things like TB and and HIV and all kinds of infectious diseases and offer treatment so that, for instance, you don't have someone with active tuberculosis who's in the community and potentially spreading it to other folks. And then there's just basic stuff. Getting women who are pregnant set up for prenatal care, getting folks, you know, there's children shot so they can attend school. So we it really is a big challenge for us to do that care and do it well. And given that, we'll probably be getting usually the refugees kind of come in gradually over a year basis, not 350 people at one time. So we'll be it'll be a little bit of a challenge for us, but we'll be fine. We’ll do it.
Tia: You mentioned some of the issues that you might see with people coming from different countries. So in addition, when you're providing the medical care, in addition to the language barriers, what are some of the other challenges that might be more prominent in communities that are coming to the US for the first time or that don't have that medical home that you were talking about?
Myron: You mean conditions that we see or you mean like one of our challenges to try to get them good care?
Myron: Well, I mean, I would say that probably one of the biggest challenges is helping folks recognize that the trauma that they've experienced is potentially really affecting them, maybe even causing some of their physical symptoms and getting folks to recognize what depression looks like and what, You know, post-traumatic stress disorder is. And, you know, the. From a doctor's standpoint, in many of the countries we take care of folks from, there's not a word in their language to even say what depression is like. There's not a comparable word for PTSD or anxiety. And so these folks have a whole different way that they sort of make sense of those symptoms. And so a huge challenge for us is to understand the cultural difference between how we look at mental health and how, say, someone from rural Sierra Leone looks at mental health. And if you don't bridge that gap, you're just kind of stuck because, you know, what's the use of giving them medication for and for depression or setting them up for counseling if they don't really understand the basis for it. So I think even more challenging than the language barriers is helping people understand the cultural context of the different symptoms and illnesses that we identify with. And then once I mean, once they do, then getting them good care. It's not easy to come here as a refugee or an asylum seeker or an Afghan refugee evacuee. You've seen so much trauma more than most people should have to bear. And then you're coming to a new place with a new language, you know, new weather patterns, everything's new and it's very challenging. So we see a lot of mental health illnesses down the road downstream after we start to really get to know folks.
Tia: Yeah, I think the work that your organization is doing is so amazing and important, coming to a new country and having only a few months of financial support and then having to make your way on your own and navigate new systems. It can be very confusing. I mean, I'm speaking as an American woman. I've lived abroad in another high income country. And even for me, with all the assistance and support that I had, navigating another health care system was very confusing for me. And I had a lot of support. So I can't imagine what it's like coming to a country and having to navigate that with less support.
So for your organization to come in and support these families is really amazing. One of the projects that you have is called Priscilla Project. Can you tell our listeners a little bit about what that project does?
Myron: So the Priscila project provides support to our pregnant moms, especially refugee moms who are new to this country and especially women who grew up here in Buffalo, but maybe this is our first pregnancy or there's other challenges that you're overcoming with this pregnancy. And so we surround these women with support, do home visits to make assessments, provide prenatal education, provide. Birthing classes, breastfeeding classes, those that need a doula, we provide that either in the language of the country they're from or in English, and then we provide interpreters, live interpreters at the births, which is a huge improvement over, you know, using a telephone to interpret or a family member to interpret at the actual birth of the baby. And then there's some follow-up after the baby's born. So it really is a hands-on way of helping folks navigate what can be a challenging time.
We will talk about health inequity. One of the things I've looked at over the last couple of years with our folks at Jerrica Road is because we're a federally qualified community. Health Centers are 17 measures that we have to report to the federal government on every year. And one of those measures is low birth weight. So of the babies who are born at Jericho, we deliver about four hundred babies a year. How many of them have birth weights under twenty-five hundred grams? And I'm very happy that we don't see a racial disparity in birth outcomes at our health center. So in other words. Black folks and white folks and refugees all are equally prone to having low birth weight babies for the most part, and that's not what the literature would show at large. And I believe that the Priscila project, along with excellent prenatal care and the kind of care that we give it, Jericho, we really go after people. If they don't keep their appointments, we will run them down, that kind of thing. I think that's why we're seeing the inequity overcome. I have no doubt that the racial inequities in health that we see if we were intentional across this country at providing the extra resources are more like equity, I think that, in other words, do not necessarily treat everyone equally, but put extra resources to where the need is. You can make up these gaps. And I think that's what the Priscila project is helping us make up that gap or close the gap with regards to the outcomes of the women that we deliver it.
Tia: That's such an amazing success story, it's so great to hear how you've identified this issue in the different ways that you've worked to empower women to have healthier pregnancies, and then you're demonstrating that it works with the hard data in these low birth weight indicators. I mean, it's great to see it all come together that way. And low birth weight is important not only for the survival of the infants, but addressing low birth weight can have implications down the road for the future well-being of children. So it's a really important program and really great to see the success of that program.
You've talked about what your organization does. Can you maybe take us back a little bit and tell us how you got started and why you do the work that you do?
Myron: Yeah, so I, I. Sort of had a long journey to come to Buffalo and to do this work, my parents were Amish and my wife's parents were Amish. We were born in Lancaster, Pennsylvania. I end up spending 10 years of my life, 11 years of my life in a Central American country called my parents were missionaries there is there that as a kid that I got this interest to be a doctor and I think I was because of exposure to the health needs in that country. So when we got back to the United States, still part of the Mennonite community, I didn't really sort of didn't have exposure to the way the poor were treated here in this country until I got to medical school at the University of Buffalo and specifically in my third year of medical school. So all along I was thinking, I'm going to be a doctor in another country and address the health needs that I saw there. But in medical school here in Buffalo, doing my third and fourth year, I was honestly shocked by the way the poor were treated on the clinical rotations that I did at EMC and other places where there's no question that there were basically three standards of care for folks in Buffalo. If you had good health insurance, you saw a completely different set of doctors and were treated differently. And if you had Medicaid, you saw residents, medical students in clinics across the city, mostly in big hospitals, never seeing the same person. The next visit will always be someone different. You'd have to wait a long time, handwritten notes, teaching opportunities all the time. And then if you had no insurance, basically didn't access the system at all unless you were really, really sick. And then you went to the emergency room. And it's a generalization, but honestly, that's the way it was. And I'd like to say that it's that much different, but they're still is a lot of that, you know, going on in our nation and in Buffalo, still twenty-five years, 30 years later. But anyway, out of that experience, I was like, it kind of changed me. I got basically the call to stay here in Buffalo. I went away for residency then came back in ninety-six with the vision of starting a medical practice on the West Side in partnership with the local church I was a part of. So we did that and. You know, it was that my motivation was to try to create a system where people were treated fairly and equally, regardless of what their health insurance status was, whether they're rich or poor, bring folks together and try to provide the same care. I always said whether it's the president of the United States or the Somali refugees off the plane, if they come to Jericho, we're going to try to treat them the same way. And the motivation for this is really out of my faith. I believe in following Jesus seriously and believe that at the core of my faith is this idea of I'm supposed to love God, I'm supposed to love my neighbor and my neighbor is anyone I mean, who's in need, whether here in this country or some other place. And if I, you know, as a doctor, since I'm a doctor, then that means how can I make a difference medically for this person? So this idea of loving your neighbor, doing unto others like you would want them to do to you, how would you want your mom to be treated is sort of the challenge I would give folks at Jericho. And we've really tried to lead the organization that way from the very beginning. We started out as just my wife and I part-time secretary and a part-time nurse. First week we saw three patients, a mom, and two kids, and the first 10 years were really tough. A lot of challenges financially because as a private practice, taking care of mostly folks with Medicaid or no insurance, there's not much money to be made doing that. So financially, it was a big challenge. But gradually, you know, gradually we just came together. I think, you know, some changes in Medicaid reimbursement, managed care, Medicaid, getting a bunch of other people who were mission-focused like I was to join us. And I mean, the need has always been there. There's always patients in Buffalo that need this kind of care. And so gradually we grew eight, nine years ago, we became a federally qualified community health center. And that then finally solved the financial challenges for the basic stuff that we do because we get a lot more reimbursement for Medicaid and Medicare and uninsured folks now. And so it gave us that foundation to be able to really grow. And we have so and we continue to try to go after the folks who need the care the most. And we continue to try to bring people together since we have a very diverse practice. Lots of lots of you know, our staff is incredibly diverse and reflects the community that we serve. And so. Yeah, so that's why we will be celebrating twenty-five years next May.
Tia: Congratulations, that's amazing and such a powerful story. Thank you for sharing that with us. Going back to the Afghan evacuees, Can you tell me a little bit about how the different resettlement agencies are working together and working with Jericho Road to address some of the needs that these new arrivals will have?
Myron: So I think it's really cool. All the refugee resettlement agencies are coming together along with Jericho Road, So there's five organizations who've come together and are intentionally pooling our resources to make this work, because like I said earlier, the federal government isn't providing much support for these folks when they arrive. And so the typical refugee resettlement process, it would be very truncated unless we all work together and unless the community really supported it. And so instead of competing among each other, I think it was very wise to bring everyone together. And so we're asking the community if they're interested in donating money or their time or resources to this effort to go to the website WNYC which is our five organizations together, and there they'll find resources with regards to how they can donate time or money or effort. And so, yeah, you know, our road specifically Jericho roads role will be to provide the medical care. The other four organizations will provide housing and get folks plugged into the community. And so I think working together with folks will be able to do this well.
Tia: So this is really great that you're providing this information of how people can get involved because I know our listeners are going to want to know how to help. So we will put that link up with the podcast so that people can know where to go to find you to help you and your partner organizations.
Myron: Right, so the WNYC, our ECG, would be that the right link, not so much our individual organizations with regards to the Afghan evacuees, then whoever's managing that site can can put people in the right place so that they're most successful in helping us all do this job.
Tia: Wonderful. Thank you. I know, I know people will be really excited to help.
You've talked a lot about what your organization is doing and where you've come from and how your organization has grown in these twenty-five years. Where do you see your organization maybe five or 10 years from now?
Myron: What do you see Jericho Road doing? Well, you know, I've always been motivated by the need, so I think. That's going to continue to motivate us. It's not about competition or market share, It's about are there people who need excellent primary care who are falling through the cracks and how can we make a difference? Things are much different than they were 30 years ago. Twenty-five years ago when we started, there's other federally qualified community health centers. There's a number of like-minded organizations that are now filling in more of the gaps. So I think Jericho Road will look for opportunities where there is a need and try to fill those gaps I think will continue to grow on the east side and west side of Buffalo will continue to look for ways to address the social determinants of health, either on our own or in partnership with other like-minded organizations. I don't think we have to do it all. We can work together. We'll continue to grow our global work.
We need to get better with the work that we do at VVA in terms of where we'll probably be starting a capital campaign to get a better sort of space for that work. So we have you know, we have plenty, plenty of challenges ahead, plenty of ways that I think we can grow not because we have to grow, but because there's still a need. And so once all the patients are taken care of and everyone has good doctors, and then maybe we won't grow anymore. But for now, anywhere we open a site, we start a new doctor. Within two months, they're filled. So there still is an appetite for excellent primary health care in the Buffalo region.
Tia: Is there anything else you'd like to share with our listeners about the work that you're doing or ways that people can get involved to help address some of these issues?
Myron: Well, I mean, I think it would be a whole other topic, but there's so much to be said around the inequity that we see in terms of outcomes of care and what can be done. COVID has been a prime example of that. When you see we've done so much testing, testing probably thirty-five forty thousand people in the last 18 months.
And it's even though you test white folks, black folks, refugees, you see inequity and who tests positive, you see inequity and who gets sick, who gets to the hospital, who dies. And that's just COVID. So I think that definitely, the events of the last 18 months are pushing me to think more carefully about how we as an organization can more intentionally do our part to bridge those gaps.
Tia: Well, I can't thank you enough. And it's been such a pleasure to have you join us and to listen about the work that you're doing. We will be really interested to follow up and see how it goes with these Afghan evacuees.
Thank you to you and your organization and all your partners for the work that you're doing to address these inequities in health and health. And our School of Public Health and Health Professions is here to work with you if there are ways that we can support the work that you're doing. So thank you so much for taking the time today. We really appreciate it.
Myron: You're welcome. Thank you for the opportunity. I wish you well. Yes. Let's partner in the future if we can. Thank you.
Tia: All right, take care. It's been another episode of Buffalo HealthCast.
Tune in next time to hear more about health equity in Buffalo, the US and around the globe.
Co-host Jessica Kruger of University at Buffalo School of Health Public Health and Health Professions speaks with Adam Graczyk and Sidney McFoy about the Pathways Academy in Buffalo. This program introduces underrepresented minority high school students from Buffalo to public health through hands-on experiences, campus tours and more.
Hello and welcome to Buffalo Health Cast a podcast by students, faculty and staff of the university at Buffalo School of Public Health and Health Professions, we are your co-host, Tia Palermo, Jessica Kruger, Schuyler Lawson. And in this podcast, we cover topics related to health equity here in Buffalo, around the US and globally. And the first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population, health and well-being. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health, equity and inclusion.
Jessica: Hi, I'm Dr. Jessica Kruger. And today, my guests are Adam Graczyk and Sidney McFoy. Adam, tell us a little bit about you and your program.
Adam: Hi, great to be here. I am a clinical assistant professor in the Department of Community Health and Health Behavior. And over the last couple of years, when I was still a student at the School of Public Health, health professionals had this week-long summer camp. It was basically high school students where students would come to campus and they would learn about public health, do a lot of hands-on experiences, take campus tours, that kind of thing.
I sort of became more involved this pre the previous year. We decided we wanted to make it for credit. So, credit offered an experience, the appropriate credit this school was going to pay for the tuition and fees. And then it was sort of my job to make the content more rigorous.
So instead of just sort of keep the fun part of it, but also put it in lectures about epidemiology of things.
So, this program was really for underrepresented minority high school students from the Buffalo area, first generation college students. And it was really introduced them all to public health.
I think maybe probably tell you this may have been one of her first or the first time she heard about what public health was and like how sort of broad it is.
We hung out and Zoom two hours, twice a week. We had a lot of different discussions and a lot of different guest speakers. I tried to bring some improv principles into the class rooms.
We would use different warm up activities, but I tried to bring in sort of the essence of improv, where it's an improv, there is no failure. And I really like that sort of comparison to the classroom, because in order to have good discussions and feel like everyone has input in a discussion, that has to be sort of like a safe space. And if you feel like you don't feel safe and you feel like failing is not an option, you're less likely to contribute to the discussion.
Jessica: So this Pathways programs are Pathways Academy sounds like a really great opportunity for students to learn about public health while still feeling that they can learn more about being a student.
So, Sydney, tell us about your experience and a little bit more about you in this program.
Sydney: I want it to be a pediatric surgeon. So, when I heard about this program, I was like, OK,
this would be a great opportunity for me to learn more about public health and public health and how it affects my community and how it helps my community and how I can play a part in public health. And so, when I took this course throughout the course, we had a bunch of different like people come in and teach us about like their specialties.
So, we had epidemiology, we had physical therapy, we had occupational therapy. We had some nutritionist come in and teach us about that. I think my favorite was probably epidemiology and much of because of the situation that we're in right now. And I just didn't really know a lot about, you know, pandemics and epidemics before I experienced one for myself.
And so, this program just gave me the opportunity to broaden my horizons and learn more about how I as an individual can contribute to public health and how it affects me and my community.
Jessica: That's awesome to hear. I can't wait to see you become a pediatric surgeon. That's going to be an amazing goal to reach for your journey. But it sounds like some of these skills have really helped you and maybe even motivated you.
Could you tell me more about that?
Sydney: So, I'm a sophomore in high school, so I'm not sure what college I wanted to go to or even now I don't know what college I want to go to. But this program really helped me, you know, like stay focused in school.
And it motivated me to they often talk about a lot of the people we saw. They talked about how important education is and how important, you know, like getting educated and going to school and having good grades and going to college. How important that is as far as, you know, individuals. And so, it helped me stay motivated in school and it helped me like it helped me want to learn.
I came to class wanting to learn new things. So, we had this one lady come in and she was she did like admissions for four. U.B. Laura, Laura Connel is one. That's great. She's taught us all about what we need, like SAT scores and stuff and like what we need to get into B and what we need to do, even as like freshmen and sophomores, what we can do to further our education.
Jessica: That's great to be able to know how to get to where you want to go. It's almost like a GPS on your way or a map that shows you to the Treasurer of Education.
It sounds like you're well on your way out to tell us a little bit more about how you instill some of these skills into students and how you kind of built this curriculum to help ensure students are successful.
Adam: We wanted to try to keep as many sorts of hands-on or different activities. We really wanted to have more group activity students, whether it was for a grade or not.
It's sort of engagement there. But we really wanted to have opportunities for mentoring.
So, we actually brought in all of the UB undergrad public health ambassadors. And we had this final project where each student would take your photo, a photo within their community that illustrate a public health problem.
And then they would talk about that problem and what they could do with a degree in public health, how you could address that problem. And the ambassadors signed on every week and work with them sort of in groups of two or three. Yeah. I mean, like Sydney was saying to I wanted to have not just talk about public health topics and health professionals, professionals come in, but also, I'd like the college prep and what it was like being a student. They had a lot of opportunity to talk to the ambassadors, be like, what's it like on campus?
What's it like being a student? And as much as I try, I'm getting further away from the age I was when I was an undergrad student. So, it's definitely more difficult for me to relate to that. But I think it was just. me, it was a great experience because like. I was able to sort of instill passion, I guess, or get them to get them excited about it, and that's what I really like doing, just overall teacher.
But they taught me a lot, too. And I really loved learning about their communities and what they would do to fix problems. And it was really we had so many great conversations.
Jessica: Sydney, tell us about what your project was. I'm interested to know about these projects.
Sydney: OK, so we had our final project and our goal, I guess, was to figure out a problem in our community that had to do with public health. And so, we had to take we had to take a picture of this problem and we had to write a report on it and then we had to present it.
So, the topic that I chose was the disregard for COVID in the Black community. And the picture that I had was a picture of a mask and gloves, a picture of gloves, and it was just on the side of the road. And so, I took that as it represented what my topic was about. And I just wanted to bring awareness to the difficulties between the black community in the medical community, why people aren't taking it as seriously as they should. And then I wrote about how, like older people in the Black community that they have, they're more at risk to get sick or to die than people of other colors or white people.
And Black people in general are more intergenerational. So, grandparents live with, you know, their kids and their grandkids. And so, if a six-year-old comes home and gets and is sick and they give it to their seven their 70-year-old grandfather, and then they get really sick, you know, then that's an issue.
And so, I just talked about how they can become more aware of it and be safer.
So, where mass social distance, follow CDC guidelines and then other things like taking the vaccine and a lot of reason that people don't take the vaccine is because they don't trust the medical professionals.
And so, one thing that I said was a solution for that was that we could have vaccine stations be at like local churches and local community centers, places that people in the black community trust, people that they trust.
Jessica: That was really profound finding. And that picture, I think, will stick with me forever.
And the representation is, sadly, we see that around more and more often.
But I think your solution to this problem is also quite innovative and something that we have started to see happen as we see people who are hesitant for their second vaccine.
So, you're wise beyond your years. This is great. Maybe you should come over to public help instead of going to that pediatric raveled. I'm sure Adam has tried to convert you too.
Adam, you want to tell us a little bit more about your main goal with this final project and how that this final project has maybe help students to really synthesize what it is to be a public health professional?
Adam: Right. So, I think I mean, it's pretty powerful. Obviously, you could describe we've described the photo, but the way we'll see it, it's pretty powerful. What just a single photo can illustrate. And the ways that you describe the problem and how you solve the problem that all stems from is the single photo.
But I think the most important thing is that she made a personal connection. It's in her neighborhood. And I think when you're able to do that, make it have a personal connection or make it more personal, you're really able to sort of embrace new ideas, new concepts in a different way than you would use just hearing about it in a lecture hall or something.
I think it's so important that we really have some of these immersive experiences for our students and get them to see the problems around them, because I'm sure, Sydney, as you were doing this, this was not the only problem that you saw within your community, but it begins to help you think about other challenges that your community might be facing.
Jessica: So, I have to ask Sydney, what was your favorite part about this program?
Sydney: I would definitely say the whole like getting to meet new people. And when we have discussions, I love having discussions. I love just like open discussion. And everyone's just throwing in their two cents. I love those. So just getting to meet new people, hearing no opinions, you know, like hearing new ideas and just, you know, open discussion with new people. It was great. That was probably my favorite aspect of it. That's awesome.
Jessica: And I, I bet it gives you a little bit of a different perspective about what college is. I myself am a first-generation student and I wish there was a program like this for me because I had no clue what college would be like.
Did you feel like this made you a little bit more comfortable thinking about colleges and being part of a university life in the future?
Sydney: Definitely. The ambassadors, my ambassadors, she was you know, she goes to UB and she just was so open about her college experience and so I could just ask questions and she would tell me about like classes and living in a dorm, having a roommate, being away from home. Just all of those things, things that I was nervous about.
She just explained it to me and, you know, kind of helped me kind of help ease my nerves about college. So, yes, I definitely feel like it has. Help me feel more confident about going to college.
Jessica: Fantastic. What was your favorite part?
Adam: It was really I would also say the discussions.
I was I was excited that I was able to do some of the teaching techniques that I do with the undergrad level. And I just I, I hadn't taught high school kids before. And it's not like, oh, well, I'll try to do similar things that what I do and at work. And I do feel like there was just such a lot of the students there to sort of embrace the material. And they asked lots of questions and it was great. They weren't shy to ask questions. I just think it was it was very rewarding.
Jessica: Yeah, most definitely, especially when you make those connections with students and can see that light bulb moment, I know this is faculty really live for that. And I'm sure you had a lot of those in this class.
Adam: Yeah. And we've got a lot of qualitative feedback. I do have a few numbers that I could share. How successful pathway's academy. So, to be at the beginning of the academy.
At the end, we gave a 15-question public health knowledge quiz, and it just basically asked different questions about public health.
And they were all sorts of topics that we were going to cover throughout the seven-week period at the beginning of the academy. The average was an eight out of 15. And at the end, the average was a 12 and 15. So we definitely saw improvement there.
We also looked at self-efficacy, their confidence in their ability to succeed in a public health or health profession. We saw almost a 10-point increase from the beginning of the academy to the end. Also saw a positive increase in public health attitudes, positive attitudes to public health, and we did see an increase in intentions to pursue a career in public health professions by the end. So just really, really good stuff there.
Jessica: Sounds like an amazing success in Sydney. Kind of highlighted some of those findings as we've been talking to her around her confidence and even knowledge about public health.
Now the nation knows what we do, the pre-pandemic, many people didn't. And so, I'm glad more students are interested in learning about this profession.
I like to wrap up with every episode with what's next. So, tell us what's next for you, Sydney, on your journey to your next step in education. What are you looking forward to?
Sydney: I will be starting. I'm almost done with my sophomore year, so I'll be going into junior year in a couple of months. I've signed up for numerous AP classes, so I'm excited for that. I signed up for was AP psychology.
And I'm very excited because I love learning about like humans and what makes humans humans and why they do what they do. So, I'm very excited for that class.
Jessica: Yeah, that's awesome. And that health, behavior and psychology are very closely related. So, I'm sure you're going to be able to bring some of that information that you learned into your next semester.
That's awesome. Adam, how about you?
Adam: I'm going to Disney World. No, I'm just kidding. I look forward to sort of growing this program. And year after year, we're going to have like this really large group of people. And I'd love to just have, like, summer. Events or something like a cookout or other events on campus and just sort of continue to follow up with all with all the students, see where they're at and what they're doing, I think it's really cool. Sounds like you made some lifelong connections here with students.
And I'm sure you'll watch them all be very successful to.
Jessica: Thank you very much. Today's guest worker, Adam Graczyk and Sydney McFoy, thank you very much.
This has been another episode of Buffalo Health Cast. Tune in next time to hear more about health equity in Buffalo, the US and around the globe.
Alexander J. Wright, JD is a University at Buffalo School of Law alum. He is the current President and founder of the African Heritage Food Co-Op, a non-profit organization created to address food insecurity in the city of Buffalo caused by systemic racism.
Hello and welcome to Buffalo HealthCast a podcast by students, faculty and staff of the University at Buffalo School of Public Health and Health Professions, we’re your co-hosts, Tia Palermo, Jessica Kruger and Schuyler Lawson.
And in this podcast, we cover topics related to health equity here in Buffalo, around the US and globally. And this first semester, the podcast, we're taking a deeper look at racism and health.
We'll be talking to experts around the US as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population, health, and well-being. You'll hear from practitioners, researchers, students, and faculty from other universities who have made positive changes to improve health, equity and inclusion.
Schuyler Lawson: Hello, everyone, and welcome to another episode of Buffalo HealthCast University, Buffalo's premier public health podcast. I'm your host, Schuyler Lawson. I'm a first year PhD candidate in the Department of Community Health and Health Program.
With us today is Alexander J Wright, the founder and president of the African Heritage Food Co-op. Thank you for taking the time to the interview today. Thank you. Let's go. We'll be glad to have you. And first off, can you tell us a little bit about yourself?
Alexander Wright: Yeah, I was born in Buffalo, left when I was three, came back at 12 and went away to college at 18, came back at 20, and I've been here ever since, I have a bachelor's of science business management and I have a law degree from University of Buffalo's John Law O'Brien School of Law. I've always been community-focused.
Schuyler Lawson: That's what I've heard about. People always end up coming back to Buffalo in your story kind of ties into that. I've heard that quite a bit. People leave and they end up coming back. So, yeah, my next question is, so what is the mission of the African Heritage Food Co-op?
Alexander Wright: The mission of the African Heritage Food Co-op is to eliminate food deserts and combat unemployment and price gouging, the inner city in particular.
Schuyler Lawson: And it's a that's a pretty noble mission. And that kind of leads into my next question. I'm glad you mentioned your you be your juris degree from now. UB school of law, correct? Yep. So how did that inform how does that inform the creation and the management of the American Heritage of Food Co-op that that type of education background?
Alexander Wright: I think see, law school teaches you one thing for three years for research.
Right. And critical thinking. So, I think one of the things that helped me to be successful is when I have the ability to read my own contracts, I have the ability to create and negotiate and a lot of ways that I learned it to be. But also, it increased my networking ability.
So, because I'm able to see both sides of anything, that's one thing they force you to do your first year, your third year. They make you argue size that you're four in size this year gets to enable you to be able to understand, you know. So, it allowed me to relate to folks I work with a lot of people who politically don't think like me. And I work with a lot of people who don't look like me.
But I have a skill set to where I can deal with everyone on a spectrum, whether you're, you know, if you support Trump, whether you are no matter who you are, I can sit down and have a conversation with you and find common ground.
And that's one thing I had to do, working out with local farmers. And as I'm driving out and I'm seeing Confederate flags, I'm seeing Trump support, I'm seeing, you know, don't tread on me.
And a lot of ultra-nationalism, which a lot of times translates into overt racism for people of African descent. But we've been able to get through a lot of that stuff and be successful.
Schuyler Lawson: It's pretty interesting. How did that level of background translate into kind of a major sort of a diplomat in ways you're able to sort of reach out to people in ways that others would probably find unacceptable or very difficult? You're able to can you be able to reach a common ground by understanding that the point of view of the other and then it leads to partnership with someone that you're you may be diametrically opposed to as far as belief systems, whether it be political worldviews.
Alexander Wright: One of the things is there's the person and then there's the idea. And a lot of times we merged the two because you have this ideal, you're this kind of person. And in a lot of times that isn't the case. I mean, sometimes it is what a lot of times that in the case, some people have ideas because they're ignorant to other ideas that are there. Some people have belief systems because they were just taught that they didn't do any research.
So, you know, I always start off with this is a decent person, until they cheat, they show me otherwise and then we just go from there.
Schuyler Lawson: Well, so far, this leads into my next question. Actually, I'm wondering, what are some projects that the African Heritage Food Co-op has recently undertaken? One of the biggest things is just fighting hunger and COVID we fed or about one hundred thousand families in 2020 who were really affected by losing jobs.
Or, you know, they say when America gets a cold, you know, poor folks get the flu. So COVID has been difficult on a lot of people, but even more difficult on the people who are with you had it difficult.
So, we're able to partner with organizations and projects like the Buffalo Health Equity Network, the Independent Foundation and a health foundation to Western New York excuse me, and many others. And we were able to get healthy food out to folks that didn't have it, so that's been a major focus of what we've been doing while building up our Niagara Falls store and renovating and putting together our Buffalo Carlton Street store as well.
So, it's been a very, very busy time for us. And we're looking forward to continuing to work because, you know, we receive fanfare and some notoriety, but none of that means anything if we don't really have a functioning grocery stores in areas that have been victim of food apartheid.
Schuyler Lawson: So, I'm just going to go into a little bit more detail about the Buffalo branch that's being built for the African Heritage Co-op. I know there’s one in Niagara Falls.
Alexander Wright: So, in Buffalo, we acquired through a generous donation a historically a locally historically landmark building at 238 Carlton Street. It's an air of the fruit, though some like to refer to that area as a medical campus.
But it's the truth, though. It was a fruit built before it was a medical campus through the medical campus resides in the food. And the reason I'm so specific with language there is it's like saying Columbus discovered America, you know, and people were already here right before medical campus.
What was it? You know, where people there was just this barren place that nobody, nobody was in?
No. There are people there with a long, proud history.
Right. So, I like to say that because that narrative is part of the institutional racism that that plagues our city. We received fifty thousand to restore it from the Buffalo Niagara Preservation Network. We were able to pay back some of that, which is good. We’re working with architects now. We have our external drawings. We're working on our internal drawings. Once we have internal drawings, we can start our official fundraising. Our fundraising was pushed back because of like a lot of ways you can work fundraisers is by having people come see the building, getting an understanding of what's going on, you know, and then they support one that, you know, 20, 30, 50 hundred people in the building. So that's why we wanted to wait until we had our interior designs so that we now people will be able to virtually walk through and actually see everything that's going to be there.
Schuyler Lawson: And this is this is a very ambitious project. And I think it's going to be a good location that would really benefit from that type of the type of resource you have to have a sort of an approximation of when it'll be completed or did the pandemic kind of throw things into sort of more uncertainty?
Alexander Wright: Yeah, the pandemic threw everything into, you know, we wanted 2021 what built and then go in this year. But obviously that's been pushed back. We're waiting on these internal drawings, hopefully what have them. I wanted to launch a fundraiser during Black History Month but is symbolic. It doesn't look like that's going to happen. The drawings are being perfected and approved. So once we do that, then we'll be ready to rock and roll.
But maybe we can do it in April, which people don't know. Black History Month started as a week in April. And then from there, February was chosen because of the birthdays that fall within February.
And it's a big I'm a big, big fan of Carter G Woodson and what he was able to do.
Schuyler Lawson: If I recall correctly, he's a black historian, correct?
Alexander Wright: Yes.
Schuyler Lawson: I'm glad you mentioned the pandemic. That kind of ties to another question that I had. And how is the COVID-19 pandemic impacted the way that you that you all run by African heritage. How was it had to evolve and what have you had to change to keep on providing those very essential services?
Alexander Wright: So, we've revamped our website so people can now order online pretty quickly. They can also call in their orders. We're not taking people in the stores right now because of COVID doing free delivery. So, the only thing you have to pay for is actually your items. And we deliver right to your house.
Of course, we take all of our precautions. We have visors and masks and things like that.
We are essential workers. You know, when you work in grocery work, getting food, you're essential. And one of the things that we do differently for elders, you know, we come to the door, and we see an elder there. We will bring it inside if you know, if that person wants that to happen and we'll put it on their counter for them, so they don't have to then try to pick it up. And everything we try to do with care and with a purpose, a community for.
Schuyler Lawson: And can you tell us a bit about what type of type of products you offer on your deliveries?
Alexander Wright: Yeah, and we can basically source anything. It just is a matter of how long it takes. So how specific you are, on basic peppers, onions, potatoes, things like that that's 24 hours. It's not a problem.
We're not at the door dash, Instacart level where you go in and you get it in two hours, but you have it the next day. And that's for 90 percent of items. If you want, you know, organic, I don't know wolfbane or something, you know, something like exotic why would consider exotic, but I understand for some people that's not so I'm not saying that it's exotic. I'm just saying for me it is. That may take a couple of days, you know, we've got a relatively quick turnaround and everything and delivered right to your house and this is what we've been doing because our not the force store, if it's huge and you just can't I can't risk the safety of our employees and I can't risk the safety of the community being bunched up in here buying stuff or, you know, because when you're looking at producer, you know, if not, it's not a bang, bang, bang thing. People come in, they want to pick stuff up, feel it or have a conversation about it. Like it's just a real communal body produces a communal thing and it's just unsafe right now with the size of our store to have people walking in.
Schuyler Lawson: Yeah, that's definitely understandable. But it seems like you've still been able to make some great accomplishments in spite of the limitations that have been imposed by the pandemic. But I have another question. We're talking about, you know, making accomplishments. What would you say is the has been the greatest accomplishment of the African Heritage Food Co-op.
Alexander Wright: The greatest accomplishment of the African Heritage Food Co-op has been a couple of things that I see.
One hope I see other co-ops forming. I see other people selling produce that weren’t selling produce before in areas that they were going into before. So that's very exciting to me. I don't see that as competition. I see that as there are, you know, three hundred thousand people who need fresh fruits and vegetables. I would love to service them all. I don't have the capacity to do it.
So, if you jump in with your food cart and you're making it happen and I think the black business bazaars that we've been able to institute now, we've gone away from those, you know, in the pandemic and in our sights. But I've seen people pick it up and do something like it, actually, a lot of people. So I'm very excited about that to feel a little bit like a trendsetter. You know, the beautiful thing about the black, this is bazaar as it was.
It was giving small businesses and tabletop folks an opportunity to come out and get exposure, new customers and put a focus on economics. So, I was very excited when I saw the city of Buffalo to Buffalo to a Black business week, which to my knowledge was not happening before us and before we were pushing the envelope on Black business bazaars. So, I'm really excited about people who are grabbing on and making that happen. And I think that's one of the biggest accomplishments to me, seeing folks catch on to the idea and putting their own spin on it and making it even, you know, even greater.
Schuyler Lawson: You can take pride in, you know, being the one that got the ball rolling, right? Yeah, it's like a kind of a pioneer in that respect.
OK, so I have another question for you. Can you talk more about your collaboration with the Lexington Co-op? That's a call that I'm sure many of our listeners know about.
Alexander Wright: Yeah, yeah. Yeah. Well, there's a principle In cooperative's, where you have to help other cooperative's being like, you just have to they have held true to that even from our beginning, as far as they helped us immensely with our lawyer to incorporate. You know, they helped us with half of our consulting fee. We brought consultants in.
And I reached out to the general manager to allow a bunch when I have questions or I'm frustrated and I just want to flip the table over, you know, but not just [inaudible] co-op. Like we've reached out to [inaudible] in Pittsburgh.
We've reached out to. Co-ops in Oakland, California, visited co-ops out there. That's one of the things we did. We really did research and talk to a lot of folks, you know, and anybody who's like listening to this and starting something really, really do your research and talk to people about what? About what you want to do.
Schuyler Lawson: Yeah, yeah. I didn't know about that after the principle of co-ops had to help each other. And that's really you know for sure.
Alexander Wright: And even just not just liked and didn't like the bread hive, which is toll on the grow operative, which is a co-op. You know, they have all done something to help us and other co-ops nationally. You know, somebody out there like I'll see a three hundred people donation some time from this co-op, most recently the Lexington they did for December.
I guess you can round up your purchases and raise money for an organization. They raised $10,000 for us. And what's beautiful about that money is. We were doing work with the county in the Buffalo Equity Network that covered until December.
So, we're waiting to hear. If we're going to be refunded, well, we're just a vendor in it again, and then hopefully they're funded again and they continue to use us as a vendor. But while we awaiting this, ten thousand is allowed us to keep going on in January, you know, so people didn't miss a beat while we're waiting on you hear from this funding and some other stuff, you know, to help those folks that just can't help themselves right now, OK?
Schuyler Lawson: So essentially, it's like a stopgap type of money.
Alexander Wright: Yeah, yeah. And I mean, they didn't know what to do before. We didn't know what it would before it got here. It just came right on time and allowed us to continue operations and feeding. We feed. 200-500 families, you know, and that doesn't include like our direct orders.
That's just the community stuff. And suppose that's a very generous offering.
Schuyler Lawson: I imagine it sounds more beneficial to many of the people that depend on your services.
Alexander Wright: We pull up and people are like, oh, the full people, what's going on?
Lady gave me a limbe, which is nice. If people don't know what I they are. That's flavor ice. And it's usually like for Puerto Rican and Hispanic, Latin American. Right, so we got the I got there were some photos, and the lady was like, “oh, let me I got to give you something if you like.
What's the flavor you like?” I love that you really connect with folks throughout your community.
And I think that's one of the biggest things for me. When I just walk to the hood and people are like, Hey, Alex, man, you know, we appreciate what you do, and, you know, that's it, that's worth more to me than any award, you know, and being fiscally responsible, you know, for employees who are around the community like that. It's exciting to me to be able to do that. Yeah, that's, you know, it's there's only one.
Schuyler Lawson: Yeah. OK, so I got another question for you. This one's kind of broad, so I'm not, in your opinion, what are the biggest drivers of health disparities and what would it take to eliminate these?
Alexander Wright: First thing. Give the funding to the people in the community. I think one of the biggest mistakes that we continue to make is we'll give a million dollars to whatever.
OK, now they'll take that million dollars and they need a salary, somebody else's salary, somebody else needs a salary, somebody else's salary. So, you mess around, you have 10 salaries out of those 10 salaries. They have one person who may represent the community and be your community liaison.
Right? Well, what happens is. That black face that they find, is rarely actually connected to the community. Right, and they just assume that because this person is black, that this person is going to connect with the community. You know, that just happened in Washington was black and that's kind of black person. A lot of times these companies, these organizations want to bring to my neighborhood and then they don't think like me. They don't have my same experience. They don't understand what's what. And then there's a disconnect. If people like, well, we hired a community liaison who we are a diversity coordinator, and they in the community and the community just doesn't want to work with them because we have this guy where you come from.
Why are you my face? What should happen is, all right, here's a problem that's affecting the community. Is there anyone in the community already working on this problem? So, we're going to put funds into capacity building and helping that institution, that organization or those people build out the word continue out the work.
Right. And not just on, here's a grant that's heavily restricted. Right. Here's a grant that's not heavily restricted. You're also a CPA who is also an accountant. Right. Because the other thing that people don't help you with, you know, here's a grant, but you know what I'm saying?
Schuyler Lawson: They don't need know how to manage it. Right, in these things that you need.
Alexander Wright: Right. So, you have a lot of people who are doing good work, who aren't getting funding coming out of their pocket or they get a little bit of funding? Right. But then they're trying to figure out, OK, what's the paperwork? How can I write?
So what happens if people, again, with the education, with connections, with the application for protection and they get this lump sum of funds and they use it how they see fit? A lot of times on salary, a lot of times on just things that are going to, you know, make me look not racist because I'm going to shake hands and pretend like everything is good. Right. And our institutions do this our foundations do this a lot.
And it's one thing we do. You want to solve the problem, don't you? That's really what it feels like. You know, we spend or they'll give people give a hundred thousand dollars to do a feasibility study or here's is a hundred thousand dollars to go and do surveys in the community.
And now you're paying all the students 15 bucks an hour to go out there and knock on doors.
You're paying people to do whatever. Right. So now the money's gone and you have this data, which is great, you know, for people who are becoming PhDs, which is before schools and papers and articles and that kind of stuff. Right. So now you have this beautiful article, well written. Awesome.
Who's going to be read by academics who are going to study it, have a think tank about it, get some more funding to look at it, write a book about it. And all this time, people are dying, people are starving, people are right. So we just wasted billions of dollars on an academic boondoggle.
That's problematic, is problematic. So how we how do we change it? We start being smart who's doing it? Or if no one is doing it, who can do it? There's this documentary called Solar Mamas, Women who were from the Middle East and North Africa who were illiterate. It took them to London for six months, taught them solar power to bring back to their villages. Right. They became solar engineers, people who were illiterate. Abusing those cultures in silence in those cultures and those women became engineers, so you can't tell me if you can do that.
You can't take Leroy in the Keysha who made it to high school. Right. Teach them give them an opportunity to do the same thing. Right. They can bag up produce, they can weigh produce, they can deliver produce, right. We don't need an organization to come from somewhere else into our neighborhood to do that. Put the money into the people who are already there, allow them to build themselves up. That's how you change the community and that's how in the health. Is it just. My body, if it's connected to me economically, so now, OK, he should keep his job, my daughter Keysha’s job is to do fruits and vegetables.
OK, I know that she gets paid. I'm a go ahead and get some right here because we're going to do the same things. Other people actually do the same thing. Oh, man. All right. Well, support. We got to support our own line to go, OK.
So that's one now you get grandma to throw some of those things in the pot. Whip it up right now. Oh, man, this is good, Grandma. This is what is this kale? What is what is this?
So, then you have the economic portion that you have the portion of somebody cooking it, making it taste good. Right. And you start with the fruits and vegetables that people are already eating. What happens is, is we roll up with the acorn squash boom, acorn squash or like what the what?
I don't. I don't. What is this? I don't cook with this. Right. But if you're a culturally relevant culturally, if you understood, you might. OK, what can you do? The sweet potato? What can you do with a regular white potato which everybody eats. Right. What can you do with a green pepper, which everybody how does onion. Everybody like those onions. So, there's things that everyone does, the things that are more culturally relevant. So, figure that out, which isn't hard. Call me. I'll tell you right for me, call Alice, call Rita Hubbard. Robinson, call. There are people who are doing this food work.
Right, right. So, I don't want to come off as frustrated because I'm not necessarily, well, a little frustrated. But I just see, it's like if you see the solution, right, I really feel like I have the solution. You work with the people who are here, but because those are the people that are going to stay.
Right. That's the same thing with the solar mom thing.
Schuyler Lawson: The reason for the true stakeholder's right, the reason they dealt with women, because women stay in the village, raise their family, they're going to be here. Right. So that's what the same thing you do, these folks that are here, because we're the only folks that can do it with any longevity.
What happens is you have a great executive director of a great foundation, right? And until that person runs for senator or until that person wants a family or until that person, whatever that person does, everything seems good.
But because it's not in the next person who doesn't see the community focus or what happens is there are hot items. So, one year is full justice. Next year, it's human trafficking. Next year, you know, it's STEM programs, right. So, what's hot and what's funded, you know, that goes around, but it doesn't go.
OK. Oh, we fix food insecurity. So now let's move on, nothing gets fixed. Nothing gets fixed.
Nothing. That's the problem, man, like we throw money at this thing, we take pictures, we write journals, and then we blow away as if people who were struggling aren't still struggling.
Schuyler Lawson: Yes, so I see this all essentially a lack of continuity.
Alexander Wright: Lack of continuity and a lack of proper placement of funds. You know, and when they do give someone who is in the club some funding, it comes with zip ties, handcuffs, ropes, oh, you know, oh, well, if you spend $10,000, then we'll give you $10,000.
If I had $10,000 to spend. Why would I be here? Anyway, next question, I think I've been on this, I've harped on this one a while.
Schuyler Lawson: So, this response, the kind of I mean, it's not something that can be necessarily summed up in just a few sentences, and I think that sort of passion to try to encapsulate it all, the kind of the continued failures of institutions to address the issue properly.
We thank you for your response. So, I'm hoping that at least to my last question. Is there anything else that you would like to share with our listeners? Anything.
Alexander Wright: Yeah. There are a lot of things you can do to help. But always help in dignity. People that you want to help are not children, they don't need you to change them and wipe their bottoms and come to them with a with a condescending tone or attitude. This also doesn't mean that you have to walk on eggshells. Be real, be authentic, be upfront with your ignorance, because you have some, I promise you, and be willing to learn from the people you're trying to work with as you're trying to impart whatever you're trying to impart.
Schuyler Lawson: Wise words.
Alexander Wright: So that's it. OK.
Schuyler Lawson: Thank you. Thank you for that reply and thanks again for taking the time to be on our podcast. We want to we hope to have you on again to discuss your future projects.
And is there any way, is there where our listeners can learn more about the African heritage food co-op?
Alexander Wright: Definitely can. You can check this out at myahfc.com.
Check us out on Facebook, African Heritage Food Co-op. We're the only one.
And the new initiative for Legacy Farms, where we're leasing out plots of farmland for community folks to come out and grow in. The co-op is going to purchase the stuff that they grow to do an economic infusion into those homes. And you can find out about that. Legacy farms, that or legacy farms on Facebook.
Schuyler Lawson: Again, the only one thank you for sharing that has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US and around the globe.
In this month’s podcast we have a conversation with Dr. Terri Watson about the importance of diversity and representation in academia.
Tia Palermo: Welcome to the Buffalo HealthCast, I'm Tim Palermo, one of your co-hosts. And I'm very excited to be here today with Dr. Terri Watson. Dr. Watson is associate professor of educational leadership in the Department of Leadership and Human Develop at the City College of New York. This year she is also a Center for Diversity Innovation Distinguished visiting scholar at the University at Buffalo. She holds a PhD and educational leadership, and her current research agenda examines parent engagement in urban schools and communities. Her aim as a scholar activist is to improve the educational outcomes and life chances of historically excluded and underserved children and families. I'm really excited to have her on our podcast today. Welcome, Terri.
Terri Watson: Thank you very much. Thank you for having me. I'm looking forward to this conversation. And I'm excited to be here.
Tia Palermo: So, as you know, this podcast is broadly focused on racism and health. And I invited you here because of your work with historically excluded and underserved children.
Can you tell us a little bit about this work and what brings you to this work?
Terri Watson: Well, thank you. So, a big part of the work, I guess, for us as scholars is who we are. And as a black woman born and raised in Harlem, which is a historically black enclave in New York City. My work is for and about, you know, people of color in general and black people more specifically. And my I guess my reason for being here is to bring our realities to the table.
I think oftentimes what happens in communities of color go unaddressed because the people advocating on our behalf do not live in their respective community.
And so, you know, coming from Harlem, living in Harlem, working in Harlem, I think it's important that I represent this particular reality, you know, in the K through 12 pipeline, our institutions, if you will. So that's why I'm here, to see what we can do better and more meaningfully and thoughtfully to improve the realities of all children.
But I'm most concerned with children and people of color because historically our needs have gone unmet.
Tia Palermo: That's great. Thank you. So, when you work with these communities, can you tell us a little bit about what you see in how racism and health interact in the families and communities that you work with? And how does this affect their education and their opportunities in life?
Terri Watson: Well, I guess, you know, bring it back to the personal. So, although I was born in Harlem Hospital and raised in Harlem, I spent my early years in the South Bronx. So, the zip code is a one zero four five four. That is the poorest congressional district in the United States.
And unfortunately, the asthma rates are particularly high. Gun violence premature were many of the realities that this particular community faces and others like it faces that there are health disparities that simply go unmet or unchallenged because families do not have access to health care.
And oftentimes, when you do go to the doctor, per say, let's say, you know, it's the emergency room instead of going in for, you know, annual checkups and physicals. So, the bills that are encumbered on behalf of health care usually can go bankrupt and already challenged, financially challenged family and or community and like education.
You know, many of the opportunity gaps present in education are systemic, meaning the problems are deeply rooted in the system in itself. So, there's nothing wrong with the people per say. It's the systems that we are forced to function in. That does not prioritize the health and the educational needs of our children. And so the unfortunate connect between education and health care is that in both instances, you know, communities of color have little to no to no access to no meaningful educational outcomes or needed medical attention, be it, you know, mental health, the dentist, you know, general health care like those things are lacking in communities of color across the nation, not just in the South Bronx or Harlem, but, you know, there's a Harlem and South Bronx and every state across the landscape.
Tia Palermo: Yeah. You talked about access to health care and you've talked about educational opportunities. And in 2020, we've really just seen these inequities exacerbated with parents struggling to help their children through school at home. And also, we're seeing disparities in infection rates and access to treatment. Are you seeing any of this with the communities that work you work with? And how is this playing out?
Terri Watson: Oh, yeah, I'm definitely seeing it. And in many ways experiencing it. As you know, I'm Covid-19 disproportionately affects, you know, communities of color, you know, black folks in particular. And even now in New York City. And we're in just earlier this week, many schools that were were shuttered due to Covid-19 baby open. And this is interesting, despite the fact that New York's public schools.
Over one million children are primarily black around. What we found earlier this week is that 12000 more white schools returned, I'm sorry, 12000 more white students returned to previously shuttered schools than black children.
And while, you know, remote learning was considered and is considered less than ideal for all children, many communities of color are afraid to send their children back to school for fear that not only will they get Covid-19, but let's say if they don't and they will bring it home. And as you know, in urban communities, many of our households are intergenerational.
So even if the child said she alive, you're going to infect your grandmother, your uncle, or even an older family member. So, you know, the way this pandemic has impacted education will be felt for years to come. But on the bright side, what I'm hoping to come out of it and learn from this is that even in this pandemic, communities of color have always come together because this isn't the first time this has happened.
You know, if you look at our nation's history and, you know, like 1863, 1964, those were all pivotal years in our nation's history. So, what I'm hoping is that in this pandemic in 2020, not only is it, you know, the Covid-19, but there's an attack on democracy.
And, you know, the Black Lives Matter movement is now global. I'm hoping that we come together as a nation and as a people and find some real grass roots ways to address the inequities, not just in equity, not just in education, but to address the inequities in health care.
So even now that the vaccine will soon be distributed in the United States, you know, who will have access to, you know, who's on the first line? And in many communities of color are afraid to take the vaccine. Right. So, if you think, back to the Tuskegee experiment. If you think about the side effects and the long-term impact of this vaccine that was newly developed, so many, many communities of color are hesitant to take the vaccine. Rightly so. So, I know health care providers are really trying to go out and push for people to take it in. I will. And I hope that as a people and community, we do.
But I can understand one's hesitance. And we have to find, you know, better ways to not only inform, but to do our due diligence, making sure that we are not selling communities of color, a bill of sale that we can't uphold. If those two doses. So, if you give the first dose. Make sure you give the second dose. And then how do we follow up for the long-term impact of this vaccine?
And will they give the same care to communities of color that they give to, you know, other stakeholders in this, which is, you know, by large, no white middle class America.
So, will we get the same, you know, options and priorities in this drug, in treatment, in battling not just Covid-19, but other issues that are prevalent in our community? There's so much to unpack there. Yeah. You talked about the racial disparities in the reopenings of schools in New York City and here in Buffalo.
I have to say that we're seeing the same thing. So, the Buffalo City schools, which are predominantly black and brown, have not gone back to school in person at all, while the suburbs, which are whiter and less diverse, although some of the suburbs are diverse, but much less so than the Buffalo City schools, and they have all to some extent return to hybrid or in person learning. So here in Buffalo, we see a very stark difference in the reopening of schools, which, as you have said, is going to have long term input packs for the foreseeable future.
Tia Palermo: And you also talked about a lot of these disparities in access to health care and how these structural factors really influence. So, it's not necessarily always decisions and behaviors at the individual level. Only people are being influenced by these much larger influences in their lives that we don't always recognize and name. So here in Buffalo, we have a long history of redlining, which has contributed to scarcity of resources in certain communities.
We have health disparities where we see differences in life expectancy based on which side of Main Street you live on. And there's a lot of factors at the structural level that have led to some of these disparities. And just in normal times, we see how these contribute to differences in health outcomes and access to services for help. And it's going to be really interesting to see how it plays out with the access to the vaccines.
And also, as you mentioned, the follow up for care and the two doses, interestingly enough, here in Erie County, of which Buffalo is a part we don't actually see disparities by race, ethnicity in mortality took at 19 like has, which has been seen in other areas of the country.
So that is kind of interesting and maybe speaks to the work that a lot of community organizations and Department of Health. I've been doing to ensure access to services for our various communities. So, I want to turn a little bit to some of these larger structural issues that factors that you've been talking about, which influence these outcomes at the edge in terms of education, in terms of health.
So, you were recently on a podcast with Sheldon Eakins. And it was entitled Being Kind Is Not the Same as Being Anti-racist. And thus was a leading equity podcast. You were talking about the media and the importance of seeing children, seeing people who reflect them, who look at them. So here at the State University of New York or SUNY, we are the largest comprehensive university system in the United States.
We encompass 64 institutions. And according to our University Systems Prodigy Web site, there is a pronounced gap between the racial and ethnic diversity of SUNY faculty members, where the nine percent are underrepresented minority, whereas in our student body, almost one in three underrepresented minorities. So, can you talk a little bit how this what you were talking about in terms of children and schools? How is this important in a university setting? And why is diversity of faculty important?
Terri Watson: Right. Well, diversity of faculty is really important because. You can't be what you can't see. You know, much of the work we do as a person of color, I can say is just simply showing up like in many spaces. My presence itself is liberating. Not only does it say, you know, there's diversity and inclusion literally, you know, in place. But more importantly and hopefully a diversity of ideas. And in terms of potential for young people, what you can be and see.
And so, what I found that I shared I just left the faculty meeting, you know, over 100 faculty members in the school of Education. And as I look across, kind of, you know, the panels, the lack of diversity was palpable. And when I thought about, you know, these white voids, I thought about I hope the scholarship does not mirror this meaning. Are we considering the realities of people who look different than us?
I know as a as a black woman, it's important that I put, you know, the realities and experiences of black folk, you know, in the forefront of my work and scholarship. And I wondered, you know, how often is that lost in these spaces and not just for black folks, but for diverse people?
You know, it's important that people of color are represented because as the nation browns, there will be a need to increase access and make sure that schools become equitable spaces. And I think what happens in higher ed, because, you know, in many ways we inform the next generation of scholars by sharing our ideas and perspectives.
And if they are not diverse, then we are simply repeating systemic inequities. And so, it's important that institutions, particularly one as big, big as SUNY, that we are intentional in diversifying, you know, who are students. See, because oftentimes there's a cultural disconnect, in fact, between the professor and the student. And so various realities and experiences do not go unpacked or dressed.
And students often feel, you know, alone or ignored. And you think about attrition rates, you know, who stays and who becomes successful and more importantly, who return back to the academy. As a professor, no, we won't see diverse people if we don't nurture diverse minds and talents and thoughts that are contrary to our own.
And the I guess the downside of this is that oftentimes institutions as big as Buffalo, you know, we function in silos, meaning we don't talk across the board. What happens in education doesn't make it over to the school of medicine or to the law school or even to psychology.
So, it's important that we come together and realize that the problem we have while it's in our institution, but it's also inherent in America. So how can we begin as a place of learning to write these long-held injustices like what can we do as people concerned with the next generations, not just generation, but generations of scholars? And how can we make sure that we are encouraging and nurturing and respecting diversity if we don't hire faculty members who look like our student body and if we don't nurture those diverse members of our student body, if we keep relying on the canon and, you know, like what a professor should look like, you know, an older white man in a cardigan sweater.
That's not what I see that that would never sustain or nurture me. So how do we make sure that we are meeting the needs of our students? You know, in a real and meaningful way.
And part of that is simply listening to them and having faculty that looks like them, that comes from those communities and neighborhoods. And because New York is so diverse, you know, how is that being lost in Buffalo?
What are we doing to encourage diverse people to want to come to Buffalo to do their work? Because Buffalo looks a lot like New York City and in these inequities will not, you know, write themselves if we don't take specific and targeted actions to increase the pipeline.
So, I'm hopeful that Buffalo remains the least a leader and is and really, you know, looks at those numbers from that website and ask, what can we do better? What have we done? What haven't we tried? Because the talent is out there.
But we have to have the moral and political will to make the change that we know we need. Absolutely. And speaking of making those changes, you often talk about deconstructing and reconstructing. So, can you talk a little bit about what you mean by those generally? And what would this look like here at Buffalo or here at SUNY?
I think in terms of deconstructing, looking at policies and practices that. In many ways, we're marrying theory to practice, like, you know, is one thing to espouse something. But how do you put it in action? And by doing that, we have to kind of reflect on what we do, like really take apart what we do and understand the rationale behind it and then say if we want change, well, we have to kind of you know, people talk about the system, right? We are the system.
So, if you want to change that, we have to start with ourselves. So, part of deconstructing, you know, any person, place or thing is to take it apart, to see what makes it tick, what matters. And if we say that justice matters, then we have to ask ourselves, you know, let's say as a scholar, what in our scholarship or practice, you know, embodies justice. What does justice look like to us? And if we see that although we espouse justice, but we are not doing that justice work, then we have to change the work that we do. And we can only do that by deconstructing what we do, kind of analyzing ourselves, that critical reflection that we can say, you know, we are not who we say we are.
And what do we have to do to change? And I think if you can look at yourself and say, you know, I'm not who I say I am and I need to make a change, then you have to make the change.
And if we have to do that as an individual level, you know, in small groups and then as a system. But it starts with the personal. I am part of that is, you know, I do think that we're, you know, by and large that we are morally sound and good people.
But how do our actions and practices and the policies that we uphold? How do they reflect that? And if they don't, then we have to ask ourselves, why not? So, you can't be anti-racist and be a part of the committee where, you know, it lacks diversity.
But, you know, you say you're anti-racist. You know, being an anti-racist is a verb. You know, you have to do it. You can't just be it. You have to embody. You have to act on it. And then you have to hold people accountable to being anti-racist is not just for yourself, but it's for everyone. So, we have to kind of stand behind the ideals that we espouse and in real ways, and that's it is asking a lot. I said I was in a faculty meeting earlier and I said, you know, race is oftentimes a four dirty four-letter word.
People don't want to talk about it. But if we don't address it, then it will, you know, continue to permeate, you know, systems, societies and places.
So, we have to talk about the problem. America know that the Boyce noted in 1983, you know, the I know the color line, the problem with race and how we see racist practices, you know, reinvasion and reimagined again and again and again. And we hadn't really taken the time to seriously deconstruct, you know, just what does racism look like? Like, how does it play out? And then how do we write it? How do we make sure that, you know, we're being equitable and representing diverse voices and perspectives?
So, I think it's important that we deconstruct our realities, who we say we are. And then, you know, rebuild ourselves, reconstruct, you know, because we can change but changes a lot. And it's difficult and it's it's scary. But I don't think we can continue like this.
I think the pandemic has shown us that, you know, we need one another and we know who all we know who the vulnerable members of our community are. We know who is most impacted by the pandemic, by school closures. We know who didn't have even access to health care to get a ventilator or even could afford to stay home, like we say, that are essential.
Workers matter, but many of them are underpaid and overworked. So how do we put our money where our mouth is? If they if they're essential, then how do we treat them?
No, we being just have we looked at the policies that have created this underclass. And many times it's purposeful. So how do we make sure that everyone makes a living, not a minimum wage, but a living wage, and they have access to health care.
So, when we deconstruct and reconstruct our realities, we have to make it personal. We have to look at, you know, our place in that and then we act accordingly and we stand on the side of justice, of righteousness. And that's what anti-racist is. You know, you have to act on it's not just saying no wearing a T-shirt and saying Black Lives Matter.
How do you showed up? How does your work uphold those, you know, those ideals that black lives do matter? So, I love what you're saying about the need to be critical of our ourselves and our system and the processes that we're working within and our institutions. You've given us some ideas of how we can be critical ourselves. And I like what you say about. You said earlier about 2020 being a pivotal year.
So, we're hoping that part of this podcast will help spur some of these critical takes and dialogs. And these ideas that you've been talking about are how we as faculty and how we as a as a university can be critical of ourselves and critical of us as a system. You've also in the past talking about or talked about from a student perspective that you want children to be critical consumers of their reality. So, can you talk a little bit about it from that angle? I think especially with students, we have to make it grassroots. We have to study policies that impact our lives. And when I say that, I mean that, you know, the personal that I you have to, you know, go into their neighborhoods, you know, in many urban communities. Unfortunately, there are food deserts.
You know, you find, you know, liquor stores and corner stores, you know, on every block.
So, we have to ask ourselves, you know, is there access to no fresh fruit and vegetables?
How many agencies are available to give people different options or to offer resources and what's not being provided? And so, when students can see how oftentimes their neighborhoods are meant to, in many ways know entrap them, you know, they're not given other options, meaning there's no fresh fruit, vegetables. Look at the air pollution levels. Look at even in their own schools.
How many teachers are qualified? How many teachers are meaninglessly qualified? They're not teaching in their subject area, or they don't have a master's degree or they're not, you know, content specialists like in which districts do we have, you know, highly qualified teachers?
And then where do we have, you know, teachers who lack credentials and then look at suspension rates, then look at access to health care without with that data, looks like so is making students aware of the systems that in many ways encourage in and frame their realities and giving them the tools to deconstruct it. To say that, you know, I notice in my school, you know, we only have, you know, out of 100.
We only have 50 qualified teachers. But in other districts know they're at 80 or 90 percent or even, you know, the racial diversity. We said diversity matters. And, you know, what does the teaching staff look like and why is it important that school leaders are, you know, really do their due diligence in finding, you know, diverse teachers and bringing in appropriate professional development and finding ways to connect communities to resources that are needed for those students and families.
And so is simply making students aware of, again, the school community, their neighborhoods, you know, arrest rates, just kind of like what's happening in a real in a real way that affects them. What's the crime rate like? Was the unemployment rate like, you know, who's hiring?
What are the services being provided and offered to the community? And how does that differ from what happens in other parts of the state or in, you know, in New York, see of the burrow, you know, or even, you know, in the in the surrounding states, in areas making students aware of there is an equity around us. And what will be our role in changing that? Because, you know, we're doing this not just for us before our children would be doing it for tomorrow.
And we do that today by attacking those problems head on and looking at the facts, you know, looking at the details, because that's where the devil is, you know, best where, and that's where the inequities lie. How do we address that and bring that to the forefront of our politicians and policymakers and elected officials? And that's why voting is so important. So, letting them know we know which candidates are best representing their interests that are looking at, you know, the food deserts, the crime rates, the unemployment rates.
Who's advocating on our behalf and who's not, you know, who earns our vote and who doesn't? Who do we need to change? You know, New York City, we had mayoral control. Maybe that's it in what has the mayor done? Let's hold him accountable for what's happening. You know, the hiring rates of teachers, retention rates, graduation rates. Who's moving on to the next grade level? So, we're just looking at again.
The reality is that students must contend with in giving them the tools to make sense and to know what they need to be successful. You know, you need to have algebra one. In ninth grade, you know, and even if you don't want to go to college, you have to be prepared. You should by 12th grade, your reading levels should be at a certain place. You should have a certain amount of, you know, sciences with labs. Your school should have appropriate materials and curriculum and faculty. And if you don't, then know that these schools are not created with you in mind.
You don't want to see you win it. But we're winners. And what are we gonna do about it?
You know, and that's what we have to kind of know, feed the next generation, that they are critical consumers, but also that they can deconstruct and reconstruct their own realities to bring about change because change will have to live with young people. You know, every movement started with young people. We have to remember that and give them the tools to continue to lead.
Tia Palermo: Wow. Yeah, those are some really powerful thoughts. So, what I'm hearing you say is that we as educators have a really important role in helping young people to see these realities. In terms of the statistics that you were talking about, these are things that people may not be aware of. And so how can we help raise awareness among our students of these issues?
But you've also talked similarly about reconstruction of curricula. So how at the university do you kind of see this playing into what you're talking about here and helping that next generation become more critical about their reality?
Terri Watson: Right. I think at the university level, one way to reconstruct curricula is by simply revising our curriculum. Now, oftentimes, particularly at the university level, the curriculum would require no death. So how can we introduce new and different perspectives and realities to push in and challenge students to think outside the box?
We can only do that by introducing different thinkers like an education. Yeah. Doing is important, you know. But would Dubois, who is the father of sociology. What about Edmund Gordon? Like we have some thinkers, you know, who are like Edmund Gordon, many of us, you know, are still alive, that we have to look at those people who are advocating for change, whose scholarship is founded in the struggle. And that's who we study because this is a continuation of a struggle, you know, in many institutions, particularly education, if we're free to push thinking forward, then we have to use forward thinking scholars and many, many of those dead white men we study. We're very much about upholding the status quo. You know, they regurgitate old ideas.
We have to go back. I think looking at, you know, black education and in looking at diverse scholars and I just know black books. But across the board, like, we have to ask ourselves, aren't we talking about who's missing from this, who's not at the table? What idea was contrary? You know, who said something different? And all oftentimes those people with different ideas probably look different and had different realities. And that's what we need to hear from what would have made would have made of scholars said about this. You know, what has no Hispanic scholars or Mexican scholars or just people who don't look like us?
What have they said about it? Because the problem hasn't changed, but it's how we look at the problem and then how do we reconstruct, you know, the future? And I think we have to do that with diverse ideas and thoughts. And we can only get that from diverse people with diverse experiences. So, I think the scholars we have to welcome, you know, just different trains and thought leaders.
That's what's going to show us forward. That's great. So, a call for us as educators to diversify our curriculum, to listen to scholars of color and people with different perspectives. So, thinking about how and again, this is kind of along the theme of how these are structural issues which are leading to these and equitable outcomes at the individual level.
On the podcast, what Sheldon and you talked about the structural problem of racism, but how many of the answers to the problem are proposed at the individual? So, in terms of teaching young people kindness, mindfulness, resiliency, so why are these types of solutions a mismatch between, you know, what the problem is and these solutions that are being proposed?
I think in particular, when we teach particularly kids of color and talk about teaching kindness and mindfulness and resiliency, I think in many times we are assuming that they don't they aren't kind, that they don't already have resiliency or that they're not mindful.
I think the fact that they come from challenging environments, you know, they don't need resiliency there. They got up and came to school. That in and of itself is resiliency and kindness, especially, you know. Why do you assume that young people are not coming? I know now people say kindness matters or they have. They made kindness like a, this kind of benevolence that, you know, is like you are doing an act and you're doing it for a reward.
You want a button or sticker order to check a box. But in many, particularly communities of color, we are community, meaning we trade on kindness that but to not be kind does not even into the paradigm. So, to assume that people and children of color are not kind or that's missing in their community.
And I think we do them a disservice. And again, from mindfulness, you know, it's like thinking critically examine what you do. I think the fact that in many urban households, families are struggling to make ends meet, that they're, you know. On budgets and, you know, intergenerational and even housing arrangements like, no, that is mindfulness, they've thought deeply about it. They haven't just, you know, just kind of made this a one off. They have thought critically about how to make sure that, you know, the children are OK.
So, to assume that no kindness, mindfulness and resiliency is not a critical part of who they are already, I think we do them a disservice. So, I ethnic instead, we should ask them about their realities and experiences and learn and build on that. We have to look at communities in children of color as asset rich people in contexts and learn what they're doing because that's what you know, the cultural disconnect is really palpable because we don't know enough about them to know that.
Of course, they're resilient. Of course, they're mindful. No kindness. No, let's say this. I know growing up, it was, um, I'm the youngest of three children. And so, you know, my brother often works my sister and I to school. So, he made sure, you know, we crossed this street safely. We came home together.
He waited for us. He asked us about homework like kind fullness and mindfulness and resiliency was a part of us growing up. Now, we looked out for one another. We know we took care of one another. We were latchkey kids. No. So we not only went to school and came home, but oftentimes you came cable to an empty house. We had to do our homework and have our snacks and wait for our mom to get home.
So, to assume that, you know, you need to teach us how to do that. Look at what we do already. And that's what we celebrate and reward. And maybe, you know, help us improve in some way. But to assume that, you know, it's not already there. I think I think it's simply not true, particularly in communities of color where resources are scarce, where we are forced to be creative. You know, like we are a genius people by design.
We've always made something out of nothing. So instead of assuming that we need you to teach us not, you better look at what we do already. And that's what we marvel. That's where the I think best practice should come from.
Yeah, so I think what I want to do is I want to go back to this idea of I think you've talked in the past a little bit about how, you know, students of color come from these situations and these, you know, backgrounds where they actually do have a lot of resiliency.
So how do you have any thoughts or suggestions of how, as university professors and college professors, that we can recognize those and things that we can do in our own classrooms to recognize the strengths that students are bringing to the table and maybe tailor our courses better for the diverse voices that we have in our classrooms.
I think is simply listening to your students. I think too often, you know, I'm thinking about the work of Pablo Creary.
We assume that our students are empty vessels waiting to be filled without realizing that they're actually quite full already.
And we're simply enhancing was there. So, I think we do that by simply engaging in conversation, by being transparent and telling people who we are. Like sharing, opening up, using the eye, you know, talking about, you know, your experiences growing up in and finding ways that, you know, your realities in many ways intersect.
Because what I found particularly teaching diverse students, is that I have far more in common with them than one would know that each of us probably thought, you know, on the onset.
So simply finding ways like when I said, you know, I don't know about you, but I'm the youngest of three. You know, I grew up in a single parent house. So, I'm first generation.
I know what it's like to, you know, to come home to an empty house because my mom worked two jobs. I know what it's like to tell my mom that come to the PTA meeting because, you know, she had to work.
In fact, my mother told us just the opposite. She told us that if she had to come to school for us, we'd have a problem. So, when teachers thought that, you know, oh, well, this young mother doesn't care, it's quite the opposite. Not only did she care, but she told us if we did not act accordingly, that, you know, we would have a problem. So, the good behavior that teachers saw, that was parent involvement, because I knew that if I acted any other way, that my mother would not have that.
So, I think, you know, it's looking at the inherent cultural wealth that's in every child in the classroom. Now, we have to assume that they come from loving and caring homes and that our job is to celebrate that to to make them proud so that they know that I never once the mother didn't care. I knew she was working two jobs to make sure we were OK.
So, let's celebrate my mother and in shame on those system that underpaid her, that she had to get a second job at that first job. She couldn't make a living wage to take care of us. So wasn't my mother.
But it was the system she was working against. And I understood from her, you know, resiliency, you know, kindness, mindfulness, the fact that, you know, she called us when she thought we should be home and asked us what we were doing and how she found the time and her workday to check in on us.
And she had to come home early. She did. But it was understood that she was losing money. And so we really tried to lessen the burden of, you know, taking care of us.
We knew that in school. We could, you know, we could do our work. We could be, you know, upstanding citizens. And she believed in us. So, we worked together. So, if that's not community, if that's not kindness and grit, then I don't know what is. But when teachers say that, you know, students need that, particularly students of color, that you're not looking at the cultural wealth of that child and his or her family.
So, I think the best ways for professors to kind of unpack the cultural wealth that's already in their classroom is by simply talking to their students in real ways and finding out who they are and why they are even in college and what they hope to gain from this experience. And I think once we have that relationship, then the learning can happen. But if you don't know who your students are, then how can you reach them?
How can you speak life an agency and let them know that you care about them and that we have this, you know, this community that we form? You know, the heart of that is relationship. And we do that just by listening to one another. We'll have to do that. I love how you're talking about this culture of, well, that kind of turns on its head.
Another ideology you've talked about, which is deficit ideology is where we often look and see problems. So, kind of similar to that. What do you think we can do in our own work to challenge this idea of deficit ideologies? I think we have to you know, we have to mine for gold. We have to go in assuming that, you know, all parents care about their children, that that and that kids want to learn.
And more importantly, they have the capacity to learn. Our job is just to find new and creative ways to learn and grow with them. And that while we're teaching, we're also learning and growing. And we have to be graceful, not just with our students, but with ourselves.
And I think we do that by, again, looking at our students as goldmines in our our real challenge is how do we. How do we find that goal? What can we say to spark the conversation and creativity? Because it's there, but it's our job to try to make it shine, to bring it out and to show them how to move in the world, because particularly as a scholar, color a big part of what I do.
Simply telling my story, you know, so that you can notice this. You know, we in many ways we demystify the academy. You know, I'm first gen. I know what it's like to be counted out. I know that when I told my colleague, my, um, my advisor in high school that I wanted to go to St. John's University, he was like, oh, you'll never get in.
She didn't believe in me. So, part of my job was to make sure that I got in and came back to tell her, oh, guess where I'm going. You know, in the fall, because I knew that, you know, she didn't think that I could do it. So, I think a big part of what we do, is that that we are dream keepers.
You know, we have to harvest and keep young people dreaming. We have to dream with them, believe in their dreams. So, when I tell you what they will be, you buy into that. You don't agree with them. Tell them, yes, you can, and then show them how they can do so.
Tell your story and help them find their own story. But our job is to nurture, to care and to dream, you know, and I think that's missing in many communities of color.
We stop dreaming with young people. We stop believing in young people. We don't see that they are gold mines literally in our presence. We think that they are broken, and we need to fix them. Young people are not broken. We have to fix our mindsets and move away from these deficit ideologies that we've been taught in the academy that these are broken or disease people.
No, not at all. We are rich and resilient people. And I think well, maybe. Sorry. I think maybe that comes from also how we're always having to frame a problem, right. So, with that search, we also we always need to see what the problem is and how we can generate evidence which helps provide solutions to these problems. So, I like how you're challenging us to think about this. You know, it's interesting you should say that because the Spencer, they just released the funding opportunity and the funding opportunity.
It's a racial equity special. Right? A racial equity special research grant initiative. So, they're looking for ways to do that. They're looking for ways to fund promising directions for engaging and supporting children, families and communities. And I think the best way to do that, like in solving any problem, we have to go to the people who are most impacted by the problem because they are working on solutions and real meaningful ways because, you know, their lives depend on it. And I think that's why we have to go back to the community, go back to the people and see what they are doing.
You know, in real time. And that's what the solution is. Too often we come at problems with this top-down perspective, because if you don't live in these communities and how can really understand or even frame the problem, to say that it's a problem because what you think is a problem may not be for that particular community, could be something totally different.
And what you're seeing is an outcome of the problem, but not the problem in and of itself.
So even defining the problem, I think we have to go to the community and ask them what do they feel the problem is and how have they thought about addressing it?
And then how can we lend our intellectual talent to marry what they are already doing?
Like, we have to go to the community, like they already have the answer, because, again, they are closest to the problem because their lives depend on it. So, they have a vested interest in solving the problem.
And for I think we search as many of us, we don't live in the communities that we study are a part of it, know we are outsiders. And that's bad in so many ways because then becomes you know, we come in at a handicap, like we're doing this community a favor or, you know, they are a problem, and we are here to fix them without realizing that you don't think they care like you think it doesn't matter to. Of course, it matters to them. Of course, they've tried addressing it and I'm delighted to see what they have done.
And then what can we do together that may improve it? Like, how can we add to an already rich resource and it's just how we frame it. You know, we have to you know, too often we think that we are the light and we're not. And many times, you know, I think we don't celebrate the community enough. But this is a really, I call this is really a call for more community based and participatory research methods.
Exactly. Too often we are outsiders studying the problem at a very esoteric level. We have people who are living with their day in and day out and trying any and everything.
And that's where we really need to lend our intellectual talents to work on them. I want to tie this back to something you said earlier when you were talking about community involvement and service and how as universities, we need to make our institutions relevant. Can you talk a little bit about how maybe some of this community and service work can help make our universities more relevant to the communities that we're trying to serve? I think that for many of us, we have to reframe.
You know, unfortunately, in the academy, you know, we are very ego driven. We don't want to be you know, we want to be the biggest and the best and the smartest. But you know what we learned in leadership, and I think you said this, but leadership must be embedded in service.
And if service is beneath you, then leadership is beyond you. So, if we are to be forerunners, then we have to ground ourselves in service. And that means not working for the community or speaking to the community, but as working with the community and speaking with the community and more importantly, becoming part of the community.
Like we have to truly invest in those, you know, we claim to want to serve because what we do, particularly if we are to change, you know, change lives, you know, its service. But in changing lives, there's reciprocity in it because we become better, our scholarship becomes more informed. But we have to, again, go back to the community because that's what's going to make us better.
And part of that is being humble, saying what we don't know and understanding the community and the challenges they face. Looking for ways collectively and collaboratively to address those problems. But too often, as researchers, we come in with the answer. You know, we have the funding and we're going to throw money at it. But that's not really addressing deeply rooted problems.
And we can only do that by being in community and understanding kind of, you know, what's exacerbating the situation. And then, you know, how can we, you know, think with them to address it? Like we don't have the answers that that's not that's not the right framing of the problem.
You know, here's the situation and then we have to look at the participants in and see how we want to change the outcome and the reality. And that has to be a conversation that has to be about trial and error. It's not a one and done. You're not going to come in with, quote unquote the answer and then, you know, magically, you know, the situation is right and that's not going to happen.
I think you're right that as researchers, we do kind of have these big egos. And I think even if you're a person that's not necessarily has a tendency to have a big ego going into it, the way that success is measured and the way that you kind of go through the system, it makes you kind of be that person that pays attention to, you know, these measures of success. So, thinking about how we measure success as academics, you know, it's really about publications and grant.
Yeah. So, what did you as an individual? How much money are you ringing in and how many publications did you have this year? So, thinking about the criteria in which we judge academics. Do you have any thoughts about how we can move the dial on these criteria to maybe make it more engaging or recognizing some of the very important and time-consuming work that scholars are doing?
Younger scholars, scholars of color? How can we recognize those efforts to make them successful in the system? I think we have to revise the standards for tenure and promotion. You know, too often is about quantity. It's like how much money, you know, how many publications. Instead of looking at the qualitative aspect of it, like where is the work, you know, seated? Who are you working with? And how are the outcomes applicable to real, real-world problems? You know, oftentimes, you know, we're so theoretical. Our work is sometimes so absent of practice, not across the board.
But what I found by and large is that, you know, we all have these grand, grandiose ideas that we speak about and create this utopia without looking outside our windows. And in many of these institutions are, you know, so removed from, you know, everyday people, particularly those who could really use our scholarship.
So, I think what would makes it I guess what makes the academy or doing this kind of qualitative, meaningful service, deeply rooted in service work in studies, is that, you know, you won't get the big bang, you won't get the you know, the publication in a you know, a tier one journal or you won't be at an hour one.
I think we have to look at not what we do, but why we do it and ask ourselves how does this leave not only the people that we hope our research will impact, but how does we must better make are we more thoughtful? Is our scholarship, you know, does it really matter like this? It's like I'm pretty sure that you're someone is going to be fine. And I know my daughter just graduated from Tufts University, so that's cool. But I'm not really trying to talk to you. I'm trying to talk to the people in those mom and pop stores who live in food deserts who are first gen.
Like, that's where the real change is going to happen. So oftentimes, you know, the academic journals that we publish in and the conferences that we go to talk about our work.
They don't affect the people that we care most about. So I think if we're really to to change the focus of the work we do, then, you know, unfortunately, we can have to change the guidelines for tenure and promotion. We have to see. No. Why do we give you know, like we talk about service, you know, service.
Where is it? A university committee or service in the community? You know, like how is how do we define service and what does it look like in a publications should be published in a tier one journal or should it be a union newspaper or for public consumption?
You know that we really talk to people who don't have PTSD, who aren't, you know, whose university does not subscribe to this particular journal, you know? Is it a grass roots community based Forward-Looking publication or is it, you know, written with academic standards that, you know, the common person just won't get?
And I know from myself one of the things that I promised myself, that if my mom with a with that with the high school graduate high school degree, like if my mom can't read it, then I should write it. I want people I care about to be able to understand, you know, the ideas and thoughts and methodologies that I'm using and writing about and spending so much time on. So, people I care about can't read it and I don't want to write it, that I have to find ways to make my language accessible and more importantly, that the work I do matters for those I care most about. So, we have to kind of reframe even, you know, tenure and promotion and what's quote unquote research.
Tia Palermo: Absolutely, wow, you've. You've given us so much to think about today.
So, what I want to do is I want to give you an opportunity to just maybe follow up or or, you know, is there anything that you want to say that you haven't been able to say?
And I just again, I just want to thank you for being with us today. It's always a pleasure to talk with you.
The first time you and I met, you were giving a talk to a group of faculty, and it was VSL in a breakout session. And I was having a rough week and it was a Friday afternoon.
And you just gave such a fiery and inspiring talk. And it was similar about, you know, doing work that's meaningful and being true to yourself and making a change in your community.
And it was really just what I needed to hear at the right time. And so, it's been such a pleasure to talk to you again. You've given us so much to think about and unpack and ways that we can be critical in our own lives and our work with students and how we can really make small changes that can make big differences. So, I really do thank you for everything you've said today. I just want to give you an opportunity, you know, if there's anything else that you want to tell us before we have to go today with those kind words.
Terri Watson: And I just remember that conversation and, you know, I guess I practice what I preach, you know, what matters, matters in everything, matters like something always matters to someone. And I never I never disregard that. So, I tell people, you know, do what matters for you. You know, speak like speak truth and make sure they all reflect and resonate within you, because then it will always matter, and our work will never be in vain. We spend a lot of time doing this work.
A very big portion of our lives is scholarship, is the reading, is the writing, is the, you know, unpacking what we've learned. And if we're not, it doesn't matter. Then why are we doing it? You know, like who does it change in? And if it's not changing and changing.
If it's not improving, then the realities in life outcomes of people and communities that we care most about, then it's all for not in my perspective.
So, for me, I always ask myself, you know, is it important? Is it important to me? Doesn't matter. And nine times out of ten, nine times out of ten it does. And so, I put my heart in it. And I think we have to go back to that. I think we have to put our heart in this world, you know, like I I love people, you know, and I love black people in particular.
So, I'm going to do my best not to show up and to speak life. I'm going to speak love and win.
And even if it doesn't work, know that I cared. I tried. And this is my best. And I feel good about it, you know, and every grant that goes unfunded, every project that goes left know that I came in with an open heart and my job was always to be of service.
And I tell people that, like, that's what I'm looking for. Well, I'm looking for the asset.
I'm looking to celebrate the good work you already do. So, it's never a aha moment.
You know, I don't I don't. Do we call it deficit data? I'm not here to tell particularly black, black and brown people that they are broken. That's not my job. That's not what I do.
I'm here to tell you that you're awesome, that we are awesome in this research will simply highlight the good work you already do. If my people can't read the work that I do, the why am I doing it? Because, you know, I am my people, you know. And that's important. We have to remember the communities that we come from, particularly ourselves, sellers of color.
You know, we didn't get here by ourselves. I come from a long line of beautiful black people, and my work will always reflect and celebrate that. And that's important. And I hope that others find a similar, you know, important. It's an agency in their own work. You know, find the beauty, find a true speak like, you know, speak life for people who care about.
Tia Palermo: Love you through this because that's how we got here. Dr. Watson, and it's been so fabulous talking to you today. You've given us so much to think about. And as always. Just very inspiring. So, I really thank you for your time today and for our listeners.
Dr. Terry Watson is associate professor of educational leadership and the Department of Leadership and Human Development at the City College of New York. You can look up her work there. And this year, she is also a Center for Diversity Innovation, distinguished visiting scholar at the University at Buffalo.
So, again, Terri, thank you so much for being with us today. Thank you.
PhD Candidate Schuyler Lawson interviews Stan Martin of Cicatelli Associates, Inc., and Ebony White with the African-American Health Equity Task Force about health inequities in Buffalo's Black/African American communities in the COVID-19 era.
Hello and welcome to Buffalo HealthCast a podcast by students, faculty, and staff of the University at Buffalo School of Public Health and Health Professions. We are your co-hosts, Tia Palermo, Jessica Kruger, Schuyler Lawson. In this podcast, we cover topics related to health equity here in Buffalo, around the US and globally. In this first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the US as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health equity and inclusion.
Schuyler Lawson 0:47
Alright, so hello everyone, and welcome to another episode of Buffalo HealthCast. I'm your host, Schuyler Lawson, first year PhD candidate in Community Health and Health Behavior. With us today is Stan Martin with Cicatelli Associates Incorporated, and Ebony White with the African American Health Equity Task Force. Thank you both for taking the time to be interviewed today. It's great to have you. So first off, can you tell us a little about yourselves?
Stan Martin 1:19
Sure. Why don't I go ahead and start us off?
Schuyler Lawson 1:24
Stan Martin 1:25
Thank you, Schuyler, for the opportunity to be a part of the podcast and to share our program. Once again, my name is Stan Martin. I am a Project Director at Cicatelli Associates. I'm a native son of Buffalo, I like to say, so I've been away for a few years and recently moved back home, back to Buffalo, a place that I love and that's near and dear to my heart. So, I'm looking forward to having our conversation today and share some of the work that we're doing here personally, as well as professionally. So, thank you.
Schuyler Lawson 1:56
Great, great. And how about you, Ebony?
Ebony White 1:58
I'm Ebony White and I work with African American Health Task or Health Equity Task Force. So, a lot of acronyms out here, and I have been working in the community for over 10 years. Most recently, I do a lot of work with the barber and beauty salons. That's where people first were introduced to me doing my work and spreading all the education and knowledge to build health knowledge in building the capacity in our very own community. And I am a native of Buffalo, New York. So, thank you this morning for having me.
Schuyler Lawson 2:34
You're very welcome. I was going to ask you about being a Buffalo native, but you already answered that. I'm pretty fond of Buffalo too. I'm not a native, I'm actually an Alabama native. Birmingham, Alabama.
Stan Martin 2:50
Yeah, we won't hold it against you.
Schuyler Lawson 3:03
So now, I have another question. This one's more for Stan. So what is the mission of your organization, CAI?
Stan Martin 3:16
Yes, it actually is not my organization. I wish it was, but CAI was founded by Barbara Cicatelli over 40 years ago. Our headquarters’ in New York City, we obviously have an office here in Buffalo, New York. Albany, New York. Atlanta. Denver, Colorado, as well as LA (Los Angeles), and we also have several satellite offices in Latin America, the DR (Dominican Republic) and El Salvador. So, a lot of our work that we do is global, not just domestic. And our mission is really to utilize the transformative power of research and education to foster a more aware, healthy, compassionate, and equitable world. So, it's a pretty lofty goal. And yet, it still is something that we thrive in terms of working towards. I look forward to doing it on a day-to-day basis. So, I'm very proud to work at the organization. I've been with them for, actually, going on 10 years now. So, it's very rewarding and gratifying. So, thank you.
Schuyler Lawson 4:25
Those are impressive goals. And that's also a very impressive tenure, about 10 years. Very nice.
Stan Martin 4:31
Yes, especially when we talk about reaching out, I should emphasize that our focus is on marginalized communities in particular, who have some of the greatest needs and the least amount of resources. So, given all that's happening in the world today, it's very gratifying.
Schuyler Lawson 4:53
That's definitely an important group to focus on. Shows there's still a lot of work that needs to be done. Actually, that's a good segue to my next question. So, CAI recently received a $2 million grant from the US Department of Health and Human Services Office of Adolescent Health, to focus on improving the lives and opportunities for adolescents by facilitating and resourcing a community driven response to reduce teen pregnancy in select zip codes in Erie County. Can you tell us more about how these zip codes of communities were chosen? And also, what barriers those adolescents face to getting accessible sexual and reproductive health care services?
Stan Martin 5:38
Thank you for the question. I think I should probably, as we say, utilize the sankofa principle; let's go back to go forward. So actually, the grant itself that you're referencing, our teen pregnancy prevention grant, through the Office of Population Affairs now, actually started five years ago. And it was really focusing on nine zip codes that had high rates of disparities of teen pregnancies, as well as STIs. And I want to preface it by saying, not that there was something going on in these nine zip codes, that weren't going on outside of these nine zip codes in terms of adolescent health and reproductive services. The important element, in my opinion, was that, having access or access to information, having access to resources, and dealing with the root causes of teen pregnancy, and also STIs, as well. So, when we look at the root causes, then that allows us to not only look at why someone is getting pregnant or getting an STI, but what is it that have precipitated that experiment. So, looking at education, looking at access to housing, looking at, believe it or not, like I said, housing, looking at employment opportunities, looking at the social determinants of health, as the root causes of some of these issues that we're facing, as opposed to looking at from the opposite lens, as being a teen parent, or a teen father, and then resulting into some of these other social determinants. So, having said that, when we started the initiative, we really went to the community and wanted to ask the community, how could we implement this program in a real authentic, participatory way? And after doing several listening sessions, conversations in the community, one of the things that resonated with the community, that came out of those discussion was HOPE. And Buffalo was, at that time, within the middle of this renaissance, but people were feeling like they weren't a part of this renaissance. So, HOPE actually stands for Health; making sure that our adolescents and adults have access to quality health care services. Opportunity: the opportunity to receive a quality education, opportunity for job employment, for placement. Prevention: if we can look at the root causes of some of these factors, and we can prevent it and promote a healthier lifestyle, why wouldn't we? Last but not least, E for Equitable; it's not all about being equal. It's all about addressing the health disparity through a lens of equity, so to speak. So that came from the community and utilizing those concepts and those principles actually provided us opportunity to create a brand, in terms of HOPE Buffalo, for adolescents, for adults to wrap their arms, provide wraparound services to adolescents, and build a stronger, healthier, thriving community. Which led us to get refunded, just this past July, for a second round of really looking at how do we look at system change, policy changes that reinforces the environment that I just described to you, where every child has an opportunity to succeed, and access to quality health care services.
Schuyler Lawson 9:20
Given that you've been refunded, I assume that there's been some progress made in addressing this particular issue.
Stan Martin 9:30
Yes, when you look at what, for my five year program, my first initial cohort, we're crunching the numbers right now to look at where we are in terms of our nine zip codes. We know that, overall, that our teen pregnancy rates are the lowest that they've been in 30 years, which is saying a lot. And we also know that, as you mentioned earlier Schuyler, that there's still a lot of work to be done. We're proud of our successes in terms of being able to refer and make use of services to partner with other community organizations, including the Buffalo Public Schools. When you look at the enrollment of the Buffalo Public Schools, over 50%, I think close to 70% of the students, live in poverty or at the poverty level. So, it's very important that we are engaged in the conversation. In addition to working with health care providers, making sure that they're meeting with leaders, students, adolescents, where they're at, and that is sometimes a challenge. And yet, it's still, it's the goal they'll understand that, as adults, our children have rights, especially here in New York State, when it comes to reproductive health and the amount of services and privacy and confidentiality. So, we still have a lot of work to do. And I look forward to coming back on other shows, and pointing and sharing some of those numbers with you.
Schuyler Lawson 10:56
Absolutely, I look forward to that too. There are so many projects that this organization is doing, so it would definitely probably constitute multiple episodes to just adequately cover them all. Okay, so now, I did have a question about - you mentioned social determinants of health, and that's a great topic. That's talked about a lot at the UB School of Public Health. So regard to this particular project, what have you found are some of the social determinants of health that are sort of easier to address, like, for example, housing may be a heavier lift, as far as maybe addressing that, but are there some others that are kind of some of the ones that you focus on more readily, because they're, maybe, so to speak, lower hanging fruit that can be modified?
Stan Martin 11:46
Well, this work is very complex, so I don't know, necessarily, if I will use the term "easier". What I would say, what's really important is that the youth and the community are involved in everything that we do, and every decision that we make. From branding to the delivery of interventions, to know how things are marketed. So, I think that is a critical point and critical piece that I would like to really shine a light on. Because when you look at COVID-19, when you look at where we are today, and how that has shined a light on the disparities that are impacting our community in terms of health, and chronic disease, etc. Essential workers- it's very important to have those, as we say, those contacts, those with those real-life experience at the table, and that they are involved in the solution, and not always seen as a part of that problem. So, that has been, I would say, very important in order to address the social determinants of health, and then to eliminate some of these disparities that we've talked about thus far.
Schuyler Lawson 13:03
Thank you. So, my next question is, what is the Tobacco Free Coalition? And what role does CAI play in it?
Stan Martin 13:15
Well, you know what. Can I sit with that question for a moment?
Schuyler Lawson 13:18
Stan Martin 13:19
Because I really want to - I would like to invite Ebony into the conversation.
Schuyler Lawson 13:25
Stan Martin 13:25
She could speak for herself and has a lot of experience at the individual, at the community level, as well as the policy level as well. So, if you want to chime in or share a few words, in terms of working with adolescents in this area, or in our community, your experience, kind of addressing the social determinants of health, please, feel free.
Schuyler Lawson 13:48
Ebony White 13:49
So what I will say, in reference to addressing social determinants of health, generally, we have focused on education, transportation, access to adequate health care. And primarily, I've worked between adolescents and adults, all the way to geriatrics. So, trying to make sure we're working through community health workers have been pivotal in actually being boots on the ground and coming back, and helping us develop strategies that really assist to minimize those barriers. A lot of barriers are, of course, our education around it, and trust issues with our healthcare system. So, I think I spend a lot of time getting word of mouth right from them. And I'll show back up at a meeting table and say, hey, listen, that didn't work. That strategy didn't work. It missed the group that we were attempting to support. So that's why I think it's very important to have those listening sessions, those focus groups, and come back to make sure that everything that we're doing is being helpful. I want to be going in the right direction. People improving their health, as it pertains to chronic diseases. So, as I mentioned, in my introduction, I spent a lot of time in hypertension, assisting with hypertension in a barber shops. We just started the conversation in those barber shops and salons and that conversation kept buzzing around, and just how important that is. And it's the same way, currently, we're doing with starting those conversations about our initiative. And I think we're going to segue right on to start talking about the REACH initiative, and all of those other things. So that's most of it. I get right to the people to make sure we we're getting the appropriate questions, we're addressing those barriers, and those misunderstandings, if you will.
Schuyler Lawson 15:38
I like that you mentioned the barber shop. That's an interesting - that's a good social location to reach African American men, and I think that's a really novel approach at trying to do outreach, as opposed to maybe some of the more traditional approaches. Have you found that to be more successful?
Ebony White 15:57
I've found it to be very successful. So, we were able to do it in Erie County as well in Niagara County. What we found is those barbershops held those very intimate conversations, but we wanted to make sure that they had the right information. And we were able to work with another federally qualified entity to navigate individuals there. Because sometimes the health care provider wouldn't know some of the issues that men and women were having, but their barber would know, so it was intriguing. So my job was to make sure we gave them all the right information, gave them all the right tools to navigate to healthcare to get their needs met.
Schuyler Lawson 16:40
Yeah, and that is a great segue into our next question. So, CAI and the African American Health Disparities Task Force both received annual grant funding, through 2023, from the CDC to address health disparities and rates of chronic disease. And this project was known as Racial and Ethnic Approaches to Community Health, REACH for short. Can you both tell us more about this ambitious project?
Stan Martin 17:11
Sure. I think you hit the nail on the head earlier in your introduction. REACH is funded by the CDC, and when you look at health disparities here in Buffalo, in particular, we're one of 40 recipients from across the country that's working on reducing chronic disease amongst African Americans, as well as, I would say, communities of color specifically. So, we look at them, think about cancer, diabetes, asthma, hypertension. Who are those individuals, those communities that are most affected by it? So here in Buffalo, our selected area, or, as we like to say, our area of focus, not just in terms of ethnicity, looking at geographically, it's across five zip codes here: The 14208, 14209, 14211, 14213, 14215 communities, and those community in particular, in chronic disease, startlingly, are 300 times more likely to have or, to be impacted by one of those kinds of disease, if not more, as opposed to those who live outside of the community in particular, white people. So, therefore, in order to address that health disparity, we've partnered with the African American Health Equity Task Force to look at not just how we can address those health disparities, but as I mentioned earlier, how can we eliminate those health disparities by focusing on the root causes of them? Now, I like to use analogy that some people may have heard before, where you have this community that's impacted, you by these health issues. And when do we finally say, for example, what's in the water? What is it that they're drinking? What is it that they're consuming before we finally actually go to the well and look in the well, what is the root causes? Utilizing that analogy, they say that we have to start going to the well, and saying what are the root causes, addressing them to eliminate them ultimately for communities that are disproportionately affected by them. So, Ebony probably would like to share some of her thoughts as well. So, I will go on mute and turn it over to you, pass the time to you, Ebony.
Ebony White 19:44
I totally agree with everything that Stan has shared - definitely getting to the well. Our listening sessions are opportunities for us to get to the well and figure out what's happening within our own culture, within our own behaviors, in those particular zip codes, and trying to shift. Trying to change many of our behavior patterns as it pertains to cardiovascular health, diabetes, cancer, all of those things that plague our communities year after year, and there is more and more data that says - I'll give you this. I was sitting in a meeting, and they were showing some data about, if you are this age, you won't live to this age, because you'll more than likely be impacted by this, this and this. And I'm thinking, wow, they can literally project that I'm going to be a goner? Because I live a particular way, and I live in a particular zip code. Wow. I just didn't feel comfortable. And that was my push to educate my community more. Someone is sitting in a room, and they can, based upon your behavior, you're going in the direction that you will be gone before you're 62 versus your counterparts that live in different zip codes. That was my "aha" moment. That someone had that ability, that power, because of my behavior, or in people just where I live, that that would be the outcome for me. Then I said, not so, not so. So, I do everything I can to educate, whether it's in our faith community, our medical community, our small groups, our pockets, our barbershops, our salons, our businesses, to make sure that is not the narrative for my community. So, REACH is an acronym, but it's a beautiful word. So I'm reaching over, I'm reaching in, I'm going deep, I'm going under, I'm going high to doing everything I possibly can, through our strategies and innovative ways to get that communicated to our community members, our concern for them overall.
Stan Martin 22:01
And if I can just ask - thank you Ebony. Some of those strategies that we're doing implementing, thinking about increasing access to food and nutrition, addressing the issues of food deserts that are in our community, and how do we work with those businesses, those retailers, those barber shops that are in our community, to ensure that they are all capable, have the ability to provide access to fresh fruits, and vegetables? So, food and nutrition, as one of our strategies, our area of focus, and another component of that, that we don't oftentimes think about, that has huge implications on one's development, is breastfeeding. Something that really early on from onset, from the cradle, through maturation, can have significant health benefits. So, educating the community on the benefits of breastfeeding and providing access to those peer groups, so that women, as well as fathers, who can be a part of the conversation to encourage a healthier lifestyle. Also, we're working closely with health care providers to improve our community and clinical linkages, or relationships. There's a lot of historical traumas when you look at Black and brown communities. That really presents a barrier for us to have bidirectional, two-way conversation. So how do we create an environment where there's trust, where there's rapport, where it's authentic, that we can have these open conversations, and that doctors, our physicians, health care providers are meeting their patients where they're at, and not closing and keeping at least the lines of communications open for that behavior change that avenue to describe? In addition, there's no secret from my lens that there's disparities in terms of tobacco use. Those who live a certain lifestyle, in terms of income, and education, are disproportionately affected by tobacco now, and tobacco is also heavily marketed or advertised in communities of color, more so than in other communities. So how do we not only reduce the prevalence of tobacco use, but also increased access for those who want to quit, to quit in terms of tobacco cessation? So, we're trying to create change at the individual level. Also, we have to also address the built environment. The environment has to change, that supports the behavior change, and something that Ebony always oftentimes talks about, how do we provide opportunities to maintain and to sustain that over a longer period of time of lifespan? So those are just some of the strategies or areas that we're focused on. To improve health and wellness for residents who reside pretty much and along the Ferry Street corridor, from Bailey and Ferry, to the foot of Ferry or as some say today, Broderick Park, and I would say 4.4 miles along the Ferry Corridor, and East, North and South of Ferry as well. So it's roughly like a 4-mile radius.
Schuyler Lawson 25:26
Thank you both for providing detailed descriptions of the REACH program and the extent of its reach, which is now quite remarkable. I have another question about the REACH project. Do you have any notable milestones that you'd like to report, as far as the progress of the REACH project?
Stan Martin 25:52
In terms of milestones, I would like to say, due to our partnership with the African American Health Equity Task Force, we've been able to be recognized by the CDC for our work as a model within a short period of time. We're actually in year three of a five-year grant. And because of this partnership that we have with the Task Force and the community, we had an opportunity to apply for some supplemental funding to address the disparities surrounding flu vaccinations. So, if you don't mind, Schuyler, once again, I like to pause and just ask Ebony to talk a little bit more about that from her perspective. And to me, I think that's a project that we both are very excited about. And then we have some things that we're working towards that we want to share with folks.
Schuyler Lawson 26:50
Yeah, and it's very pertinent too, especially in this time of year for flu season. Absolutely.
Ebony White 26:55
Correct. So, that supplemental funding, as it pertains to flu vaccination has given us the opportunity to partner with Dr. Vasquez in Urban Family Practice, different pharmacies, faith communities, and one of the large business entities that has kind of showed up in the city of Buffalo, is giving us the opportunity to work with their mobile unit to actually get access for flu vaccinations and give education around flu vaccinations. We are at a pivotal time; we've never been in a pandemic. So, we have COVID-19. And then we have the flu. So, what we're trying to do is educate our community about the importance of making the choice. So, I want to give you the education, but it's always your choice. But when you do it, and you make that choice, you're doing it with you in mind, your family in mind and your community in mind. And I think that is a conversation that generally has not happened around flu vaccines. People are asking more questions and questions are good. Why do I have to have it every year? I feel like I see more signage about it. Why? Because it's important, because we're in this different time, this pandemic time. And we want to keep you safe. We already have adopted a lot of safety measures - hand washing, masks. We've been giving out food and nutrition actually, during those mobile unit events. We've been to some of the faith communities all the way in Lackawanna, and a couple of more in the city of Buffalo, distributing flu vaccine, shingles shots. If people are asking questions and trying to get back on track with their medical care. So, what we look forward to doing is making sure that, if that is the intersection that we meet in our mobile units, we want to make sure that we give you the education to move forward in maintaining, and the maintenance of your health care going forward. So, in the upcoming months, we are in we're actually we're embarking on the peak of flu season, which will start December the 6th. So, we are encouraging people - I know this is a really hard time. You're telling people to socially distance, avoid, but nobody wants the flu, not alone. We don't want COVID. COVID has impacted pretty, much touched everybody's home one way or another. You know somebody, it may be you that has been impacted by COVID. So, we were trying to get the word out as much as we can, just for our community. We don't want - we know what COVID did to our community. It impacted our Black and brown communities at a much higher rate than it did our counterparts. So, we want to bring that down. We want to bring that down. We want to change the manner the direction that the data is showing, if we don't. So, we want to make sure it's about education, it's about your choice. It's about your family, and it's about your community. So, Stan, you want to jump in?
Stan Martin 30:11
I think you hit the nail on the head. Like you said, we do our listening sessions, having conversations, Ebony has met with the community. They said that they felt as though it's important that the community have this information, that people recognize that they do have a choice. And what we've heard, as Ebony eloquently shared, was that people aren't only concerned about themselves. They were concerned about others. And that message of having love for your family and for others, your community, is something that they thought that they could champion and rally behind.
And just some of my, as I like to say, my one show surveys and talking to pharmacies and providers, that they are seeing more people getting vaccinated. So, we're looking to continue to march our campaign on our conference meeting campaign through platforms such as this, radio, TV, as well as in print, and then in the weeks ahead and even into the New Year as well. So, stay tuned.
Schuyler Lawson 31:17
All this is very encouraging, and I really do hope that it leads to higher vaccination rates in those marginalized groups.
Stan Martin 31:25
Well, you know, Schuyler, as we mentioned earlier, we really have to address the trauma. You know, when people say that "I had a reaction towards getting shot." People aren't aware that also there's a nasal spray that's available or, is this someone 65 and older? There is a different vaccination that they receive as opposed to someone younger. And it's one of the things that prevalent and I hate to pick on Ebony - she always reminds us of if Mama said it or Grandma said that, their opinion matters. You can't go against Grandma, you can't go against Mama because that shuts down the conversation. How do you have that conversation in a respectful way that really says, okay, I'm not throwing Grandma or your mom under the bus, and I want to recognize that providing information that dispels some of those myths. That's critical in terms of people making that change, and it may not happen right then and there. And I think what we're say saying, different points of intersect is occurring that we're encouraged by. Knowing that and having those trusted - having an Ebony, having a Dr. Vasquez, to meet someone in a barber shop or a salon or a place of worship. Not on their Sunday though, but to meet them in their comfort zone and share information in a nonjudgmental way is important.
Schuyler Lawson 33:15
It appears that a thread that I'm seeing for all of these projects is the importance of meeting people where they are and having sort of a community participatory approach addressing these very unique issues. Would you both agree?
Stan Martin 33:31
Ebony White 33:33
Stan Martin 33:35
And you know, I know you're very versatile, I believe you're very versed, Schuyler, and a community participant in practices and approaches. And we also utilize collective impact as a part of that. Collect, for those who may not be familiar, having a shared agenda, bidirectional communication, a combination of coordinated strategies, having a backbone organization. CAI and the Task Force, the African American Health Equity Task Force, working collaboratively together and being able to provide resources and utilize science and data in a manner that we aren't weaponizing or victimizing and traumatizing those we're trying to reach. Those are critical elements, moving from implementation to creating a movement. Any movement that's successful, in my opinion, including the Black Panthers, you have to start at the grassroots level, and you have to have the community's trust in reporting that. And those are just some principles and frameworks that we embed in all of our work across the board here in Buffalo.
Schuyler Lawson 34:50
Thank you both for sharing more information about this very important project. Did you have anything else you wanted to speak to us about, particularly about the vaccination initiative
Stan Martin 35:04
I want to say, get your shot. If you haven't already, get vaccinated, get the shot to protect yourself, your families, your loved ones, and your community.
Schuyler Lawson 35:15
Yes, to all our listeners, please get your shots. It's not just about you. It's also about everyone else as well. Please get vaccinated. So, I want to move on to the next question now for both of you. So, in your opinions, what are what are the biggest drivers of health disparities, and what would it take to eliminate these drivers? This is a very complex question. There's no simple answer, but I'd love your viewpoints.
Ebony White 35:50
What I would say is, education. Education around, these are the impacts of these chronic diseases, the impacts that they have on our community widespread, and how they are connected to our behavior. So, when I think about what is - Stan was talking about previously, they advertise more cigarettes, they advertise more alcohol in our community. What are we messaging? If you're the consumer, we have to understand, if you're the consumer and someone wants to sell something to you, you have to change what your desires are, what you want. So, we have to really get into our thoughts, process how we value our sales and what our desires are for our lives that we can change what is happening on the outside, what is being offered to us. If I say I don't want chicken, I don't want a bunch of cigarettes, the person that wants to come in, they have to dig a little bit deeper and find out what is in fact that they're trying to sell me, and what I want. So really, I think that education widespread, spending that that time, building that trust in our community, apologizing for stuff that you may not have done. You may have apologized for some things, but still standing, not running away from the pressure of the complexity of everything. People always have a lot of complaints, but we really strive to be solution focused. I hear you. I heard you acknowledge it. And how can we change this? So really, for me is education and more education. And it's going to take time. It's going to take a little time to change overall everything and finally eliminate it. So we have to change the minds of our community.
Stan Martin 37:52
Thank you, Ebony, I agree with you. And I would add the elimination of poverty. That's lofty. That's my vision though. I think that's the vision of a shared vision of others as well. To eliminate poverty, if we eliminate poverty, then really the essence of when we talk about where you live, where you work, where you play. And even pray and learn, then every child, every adult, every person has the opportunity to reach their fullest potential, their fullest ability, whatever that means to that person. In addition to that, I think that we have to address using the same cultural principles. We have to address racism in this country, the racial justice or injustices that have happened. We have to move from addressing that to really a point of being anti-racist. We have to dismantle systemic institutional racism. That really appears in every aspect of the work that we do, and until we do those things, I think that we will continuously revisit those things in one shape, form, fashion or another. And I think that really also we're in a climate of social justice and unrest. And a lot of that is due to not focusing on being equal, but we need to focus on equity. Equity is the denominator or the lens that we should look at promoting health and wellness from. To address it at every level, when you look at those social, ecological, at the philosophical, but at the individual level, the community level, at systems and policy changes and not have policies just exists on paper. What is having to come to reality to actually change to being a social norm? Like I say, it becomes our way of life in a healthy way. Thank you for the question.
Schuyler Lawson 40:15
Thank you both for your thoughtful responses. Very much appreciate it. So now we're nearing the end of the podcast. So, my last question is, is there anything else you'd like our listeners to know?
Ebony White 40:30
Get your flu vaccination. Again, I'm going to repeat it, do it for yourself, do it for your family and do it for your community, and continue to wear your mask. Practice social distancing. I know you miss all your friends, but please, let's not do that. Let's take care of each other, just for this period of time. And I'm hopeful that we'll get through this, but we want to make sure we're doing everything that we possibly can. Good handwashing, social distancing, wear your mask. If you don't have your flu vaccination, they are available. Stan will provide you with the website to get a flu shot. They're in your local pharmacies. If you have a primary care doctor. If you don't have a primary care doctor, please get one. Go have your flu shot this year and take care of each other.
Stan Martin 41:20
Yes, definitely. I echo Ebony's sentiments. Get a flu shot. If you don't know where to go, you can, if you have access to the Internet, you can go to GetMyFluShot.org, and then you put in your zip code and they'll give you information on where you can go locally, at your supermarket, at your pharmacies, or at different clinics in your area to obtain the vaccination. Thank you, Schuyler, for the opportunity to share this information with you and your audience.
Schuyler Lawson 41:57
You're very welcome. Again, thank you both for coming on onboard and be willing to be interviewed. I hope this reaches a wide array of our listeners. Thanks again to you both for taking the time to be on our podcast. We hope to have you on again to discuss future projects or ongoing projects to see how things are going. And listeners...
Stan Martin 42:25
I’m sorry. GetMyFluShot.org, not dot com. I stand corrected.
Schuyler Lawson 42:34
GetMyFluShot.org. Thank you for the correction. And listeners, if you're interested in learning more about CAI and the great work that they do, visit CAIGlobal.org. Ebony, is there a website that the listeners could visit to learn more about the African-American Health Equity Task Force?
Ebony White 42:54
I would just direct them directly to CAI. Thank you.
Schuyler Lawson 42:57
You're welcome. I'm Schuyler Lawson, and thanks for listening to another episode of Buffalo HealthCast. Take care and be well.
This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity here in Buffalo, the US, and around the globe.
All content © 2022 Buffalo HealthCast.
Adia Harvey Wingfield is the Mary Tileston Hemenway Professor of Arts and Sciences, and Associate Dean for Faculty Development at Washington University in St. Louis. Her research examines how and why racial and gender inequality persists in professional occupations.
Intro: Hello and welcome to Buffalo HealthCast, a podcast by students, faculty and staff of the University at Buffalo School of Public Health and Health Professions. We are your co-hosts, Tia Palermo, Jessica Kruger, and Schuyler Lawson. In this podcast, we cover topics related to health equity here in Buffalo, around the U.S. and globally. In this first semester of the podcast, we're taking a deeper look at racism and health. We'll be talking to experts around the U.S. as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and well-being. You'll hear from practitioners, researchers, students and faculty from other universities who have made positive changes to improve health, equity and inclusion.
Tia Palermo: Okay, hello and welcome to our SPHHP podcast. I'm here with Adia Harvey Wingfield, Associate Dean for Faculty Development and Professor of Sociology at Washington University in St. Louis. Adia, I'm delighted to be speaking with you today
Adia Harvey Wingfield: Thank you for having me. I'm happy to be here.
Tia Palermo: This year we've launched a new podcast for the University at Buffalo School of Public Health and Health Professions, or SPHHP. In the first year of the podcast, we are broadly focusing on the topic of racism and health. And today I want to talk to you about one aspect of racism in academia: the hiring of faculty.
You were recently involved in hiring several faculty members for a new Department of Sociology at Washington University in St. Louis, an effort that you detailed in your article in the Harvard Business Review, which was entitled ‘We Built a Diverse Academic Department in 5 Years. Here’s How.’ Can you tell me a little about these efforts?
Adia Harvey Wingfield: Sure. So, I should say that when I came to Washington University in 2015, I was actually hired as part of a small cohort that was tasked with building the sociology department from the ground up. The university did not have a department prior to my arrival with my two senior colleagues, and our job primarily was to change that pretty much, and to do the work of making sure that the department grew into a top sociology department.
And one of our shared goals early on in those stages was that we really wanted to be indicative of the fact that departments can be really strong academically. They can do a great job focusing on research and teaching, but they also can do so in a way that prioritizes both excellence and racial diversity, and that contrary to what some might think, it's not impossible at all to meet both of those goals and to set those standards.
So, our focus was on making sure that we certainly built an outstanding department, but that we did so with an eye towards what it would mean to be a racially diverse department in the university and in the discipline. And that's driven a lot of our focal points on hiring and outreach and building over the last five years.
Tia Palermo: That's great. Thank you. So how did your own research background - examining how and why racial and gender inequality persist in professional occupations - inform these efforts in building this department of sociology?
Adia Harvey Wingfield: That's a great question. I would certainly say that my own research gave me some insights into the types of pitfalls and challenges that many workers of color encounter when they are in spaces where they're in the racial and/or gender minority. I know a lot about that experience from the work that I've done in identifying what those challenges look like and some of the processes that workplaces and organizations engage in that can be unwelcoming or hostile to communities of color.
But I have to say that it wasn't really so much an issue of building from my own research as much as it was working collaboratively with my departmental colleagues and university administration, all of whom were very supportive and enthusiastic and shared this goal of wanting to make sure that we did have a racially diverse department. It was very much a team effort at a variety of levels, which is really critical and important for being able to achieve these goals.
Tia Palermo: When you and colleagues decided that you wanted the new hires to be racially diverse, did you face any pushback? So, you talked about how you had support at multiple levels, but was there pushback from any corners and how did you overcome this?
Adia Harvey Wingfield: Again, luckily we all were of the same mindset and the fact that we believe that racial diversity and really working to achieve it was important. So, there were not issues internally around why this mattered or if we could do it or if it was something that we really wanted to focus on, or, again, this false dichotomy between diversity and quality. None of that was an issue at a department level, and certainly it was not an issue at the administrative level either. We're really very fortunate that we were very clearly supported in this goal by the administration and the workers that we dealt with that level, the dean, the provost, the chancellor at the time, were all very much on board with this being an important factor for us, which is part of why I write in the article that for these types of initiatives to succeed, I believe it's really critical to have support from multiple levels of leadership.
I think it would have been a lot more difficult for us to achieve the diversity that we did, if I were a lone voice with making this argument in a department with colleagues who did not share this principle. Similarly, I think it would have been very difficult for us to achieve the outcomes that we did if, as a department, we had to face a lot of headwind from the administration, if we were working with leaders who did not share our commitment to these values and see this as important. I think that my experience shows that the synergy along those lines indicates that change certainly is enabled when it comes from the top, but that that change also has to have buy-in at, what you might think of as middle management levels as well. But when you do have those synergies lining up, it really opens up a lot of potential doors and opportunities for what you're able to build and accomplish.
Tia Palermo: Thank you. When you were going through the hiring process, what efforts did you make for the candidates when they were visiting? Both so that they would feel that Washington University in St. Louis was a welcoming environment for them, and then once you hired candidates, how did you make them feel welcomed and supported once they arrived on campus as new hires?
Adia Harvey Wingfield: Yeah, that's a great question. So, when going through the interview process, I think it's really critical to make sure that people get a feel for what their experience on that campus will be like, should they decide to join the department. So, you have to make sure that people see that there are opportunities for them that relate to the things that they want to pursue.
If you have a candidate who might, for instance, be interested in studying issues related to immigration, it's important to let that candidate know that not only rebuilding that in our department, but there are other people on campus that you might want to connect with who are doing this kind of work. We're talking about attracting faculty of color. It's critical for faculty of color to see that they won't be alone, isolated or excluded in everyday campus interactions and deliberations.
So I think it's really key to make sure that when you are trying to recruit underrepresented minority faculty, it's important to make sure that they see other people on the faculty and that they have a chance to talk openly and candidly and privately with them about what their experience has been like, rather than having simply people tell them, "This is a great place for scholars of color," and "People are really happy." That doesn't carry as much weight unless you hear it from the scholars of color in question who can tell you again in a private setting where they can speak honestly whether or not that's actually true. So when we were recruiting candidates, we made sure to try to show them that there were links between their personal and professional identities, that the university recognized, respected and wanted to support so that if they accept an offer and they joined us in the university community, they would have a view from their interview with what that experience would look like for them up front.
When it comes to people actually being here, I think if you want to build on the groundwork that you've laid through the interview process to make sure that once people have accepted the offer, you can't then pull a bait and switch and have them in an environment where they and their work are not supportive and are not respected or treated equitably and fairly. So, we a pretty robust mentoring program in our department to make sure that everyone has access to mentors and support and people who can guide their careers, particularly for assistant professors who are going through the tenure process. But we also make sure that assistant professors, particularly underrepresented minority faculty, continue to remain aware of and feel connected to the life of the university, whether, again, those are through initiatives and groups that speak to their personal identification and/or things that speak to their professional research interests.
Tia Palermo: So, it sounds like you had a lot of support systems built in, in this department from the beginning. Do you have any examples of cross campus initiatives that help support those incoming candidates?
Adia Harvey Wingfield: Sure. Well, so our vice president provost for diversity and equity and inclusion actually runs a number of initiatives that are designed to reach out to all areas of the university and provide those kinds of supports. There are informal activities. There are more formal activities. There are monthly lunches for women faculty of the university to make sure there's a sense of camaraderie in cohort building. There are also leadership development seminars for faculty of color who may be interested in pursuing those types of initiatives there, and that's just in one office. So, there are a number of programs on campus that are in place to draw attention to the fact that if Wash U is going to be a place that does want to take seriously these imperatives of diversity and equity and inclusion, it's not enough simply to say that. That has to be matched with clear, robust directives that speak to acknowledging those issues, tackling them head on and making sure that the university is working to do all it can to support faculty who are underrepresented.
Tia Palermo: Thank you for that insight. Have you seen the success that your own department effort has had, influence other departments or initiatives university wide in their hiring practices?
Adia Harvey Wingfield: It's a little hard to measure just because there's so much variance across arts and sciences and there's so many different disciplines within that one college alone that there's a lot of range among them. But I will say that I think that the fact that we have been so successful and done so well in building a racially diverse, academically strong department in a short period of time has certainly been recognized in the university community. And I think serves as a clear message and indicator to other departments that, again, this is something that's possible to do with the right programing, plans, commitment, and initiatives in place. I will say that I do think that the work that we have done that functions to show that this is a step that that departments can take, to follow this lead.
Tia Palermo: That's great. And it really is an impressive group of scholars that you have in your department.
Adia Harvey Wingfield: Thank you.
Tia Palermo: You have a recent paper entitled ‘Getting In, Getting Hired, Getting Sideways Looks, Organizational Hierarchy and Perceptions of Racial Discrimination.’ The participants in that study were from the health care industry, not academia. But in this work, you demonstrated that position in the organizational hierarchy is linked to perceptions of racial discrimination, whereby individuals at the top of the hierarchy, some examples in that study where doctors, reported fewer individual incidents of racism but identified more structural and organizational discrimination as compared to individuals lower in the hierarchy. Examples of structural discrimination included the education pipeline, hiring decisions, and developing a mentoring relationship, something you spoke about earlier. What parallels can you draw between that study and implications in academia, given that academia is also vertically ranked in terms of students, professors and hierarchy among professors?
Adia Harvey Wingfield: So that's another great question. And I first want to offer the caveat that the study, as you mentioned, is focused exclusively on health care workers. So, I think that there likely are some parallels, but I don't want to give the impression that I'm speaking from data when I answered a question. I did not interview primarily academics. So, I cannot say with certainty that the patterns that I described among health care workers would necessarily be present among people in academia. But that said, I do think that it's at least likely to, I think it's safe to hypothesize that there may be some comparable outcomes and there might be some parallels, right? So by way of example, when we think about how academia is hierarchically organized and how it's very hierarchically structured and ordered in a lot of ways around similar ideas of status and prestige, I think that it may certainly be the case that for faculty, the experiences that they cite with how race has an impact on their work may certainly be more likely to include more structural processes as well as the more interpersonal ones, which was what I found with actors in my study.
They cited that there were some cases when they had interpersonal experiences with racial discrimination. But as you mentioned, by and large, what stood out for them were the structural barriers that made it difficult to advance into and thrive in medicine and in physician work in particular. I think it's not difficult to speculate that similar processes might be true for Black faculty and certainly for Black administrators in ways that I think might reflect different outcomes. If we're talking about black employees of a university who are in staff positions, particularly if they maybe a lower level staff positions that don't offer the same autonomy or status or ability to shape one's work environment.
That, I think, is certainly true for professors. So, I think that there are likely some comparable outcomes that we would see between academia and the health care industry. Even though the study didn't focus on those fields, I think it's safe to guess at least, and hypothesize that the higher one is positioned in the organizational hierarchy, the more impact that may have on perceptions of racial discrimination in academia as well. But that's a question for maybe a future graduate student to just study a little bit further and to see if my hypothesis is correct.
Tia Palermo: That's great. We're exploring ideas for future research here. Thank you. Can you say anything about the resistance to hiring more than one underrepresented minority in a department or what's sometimes termed as the ‘only one’ syndrome? Have you seen this played out?
Adia Harvey Wingfield: Fortunately, in my current department, that's not an issue that we have. Like I said, we've worked hard to make sure that we do have a racially diverse department, both among our top ranks of faculty who are full professors, and that that continues throughout the department as well at the untenured ranks as well. But I will say that this experience of being the only one or organizations that seem to feel as though hiring one person at a high level ranking is sufficient and gets the job done, is not only something that exists, but something that is inaccurate in terms of the ability to really diversify an organization or a level of an organization.
Research indicates pretty clearly and conclusively that when workers are white women or people of color, and they are underrepresented in positions to the point where they are the only or one of very few at that organizational level, they are a lot more likely to be mistrustful of the organization's commitment to equity and equal opportunity. They are, if they are women, more likely to experience sexual harassment, they are more likely to consider leaving and they are less likely to be satisfied with their employment in that company.
So, organizations in many cases may see this idea of this only hiring phenomena as progress. right? That we've got one person in our C suite, and we've done a great job because we've got one person at this executive level, so we can brush up our hands and say we've solved that diversity problem. But again, that's short sighted and it's not correct. And it comes with creating an environment where in the short term, you may be able to say that you have this one person filling this role, but that one person's experiences are likely more challenging than they would be if they had a cohort experience of more robust representation. And if ultimately what that leads to is that person not producing as well as expected, or that person looking for other opportunities, or that person being disengaged from the organization. The organization is not really winning if they're not maximizing and making full use of that person's talents and opportunities.
Tia Palermo: That's a really great summary of how the challenges that the individuals can face, but also how those challenges can play out in adverse ways for the organization as well. What would your response be to people or departments who say we've tried to diversify our hiring, but qualified scholars of color either aren't accepting our offers or they have too many offers to choose from. They don't want to come here.
Adia Harvey Wingfield: One wants to know what exactly trying to diversify your hiring looks like. Does that mean making an offer to one person? And then if and when that one person declines, not trying again? Does it mean trying to hire someone that you know is already in demand from other places who has multiple other options, and then saying, well, we made an effort, but this person just doesn't want to be here. These people don't want to be here. There not much more that we can do. Does it look like that?
If that's the case, I would not really find that to be such a compelling argument. I'll put it that way, right? I mean, we know if we look at data that there, in most cases, research indicates, are more candidates of color available for positions than there are actually positions. So given that mismatch, it's not that we see the glut on the supply side, right. The issue is not that we see the narrowing on the supply side, more so on the demand side. And if that is the mismatch, then it strikes me that most departments, if they really have the will, if they really have the interest, if they really want to put the work into finding really strong candidates of color, this this is achievable. And I think that my department and the success that we've had indicates that this is achievable, right?
But it may mean not simply going back to your networks of people that you already know and looking for candidates through them. It might mean looking for candidates through other networks that are specifically inclusive of and designed to include candidates of color. It may mean reaching out to people and explicitly saying that you really want to have a racially diverse applicant pool and asking your connections and your networks to make sure that they mentioned that you have an available job and encouraging candidates of color that they may be advising to apply for this position on top of the accessing listservs and professional organizations and things like that, that are more racially diverse.
Those might be critical steps that organizations have to take when it comes to hiring. But I believe that doing so really has implications for what the applicant pool looks like. I'll also say that taking those first steps should not be the sum total of what those efforts to racially diversify looks like, because if organizations take those early steps and build an early pool of candidates that are racially diverse, but then as we go through the whittling process, somehow it just happens that you happen to whittle out all the candidates of color. You want to be a little bit more reflexive at that middle stage about what you're a long, short list is looking like, or what your fly out list is looking like, or whatever you want to term it. So, I would say that I don't really think in this day and age when organizations or departments say that they've tried, but they are simply unable to hire candidates of color. That makes me wonder what processes they are using to engage in hiring, because it makes me suspect that perhaps it's those processes that are returning a dearth of strong candidates of color, more so than a lack of strong candidates of color really being out there.
Tia Palermo: There's some really great recommendations in there about directly reaching out and exploring new networks, and making sure that the early steps in the process are not just where it ends. So those are really great suggestions. Thank you. What advice do you have for departments? Probably some similar advice along those lines, but advice for departments who are aiming to diversify but perhaps can't do so as rapidly on the scale that your department did?
Adia Harvey Wingfield: So that's a great question. And one thing to acknowledge about our department is, like I said, when I started, we were brand new, we knew that we had to build. We had support for from our administration for doing a lot of hiring in a short period of time because we had to. And I obviously recognize that every department is not going to be in a position where they are granted 10 hires in the state of three years. I think most departments are not going to be in that position. Again, that said, that does not necessarily mean that it's impossible to achieve these goals. And the fact that our department had these hires didn't necessarily automatically translate into making sure that our hiring process would turn out to be racially diverse. That didn't happen just because we had hires. That happened because as a department, we made an explicit, intentional commitment to making sure that that was the outcome and that that commitment was supported by administration. Had we not had that commitment and had administration not been supportive of it, we could have very easily not had a racially diverse department. I could have not written that article at all because there wouldn't have been anything to talk about. So, I say that to make the point that most departments are not going to be in a position where they're doing that much hiring that quickly.
However, I recognize that we're in a pretty difficult situation now for many universities where budgets are lean and positions may be cut, but knock on wood, eventually we've got to get to another side where universities and departments do begin hiring again. When we do get to that point, I think that any department is in a position where they can follow these steps. Think about how you are initially seeking candidates for open positions in your departments. Are you simply posting an ad on a list serv and waiting for people to come to you? Or are you actively trying to cast a wide net so that you can attract candidates of color to want to apply to your department? Once you are going through the applications that you have, are you doing so with an eye towards making sure that you are not somehow systematically weeding out candidates of color from those who make the initial applicant list to those who make the long shortlist? Are you doing the same thing when it comes to your fly out list? When you do bring in candidates, if you do bring in candidates of color, are you making sure that on the campus visit you are not creating an experience that is alienating? Are you making sure that they have access to or have a window into what their experience of campus life would look like, were they to be hired? And if you ask yourself that question and the answer is that the window of what campus life would look like for a candidate of color is campus life would be pretty bleak, that's a point to some bigger issues that could be useful to reconcile. What would it take to make your university campus one that is approachable and welcoming and inclusive of a variety of candidates of color? If that's something that is a sticking point at that point, it's useful, I think, to have a bigger conversation to raise these bigger questions of how the university at large may want to change, to be a place that is more attuned to the importance and need for more racial diversity on campus.
Tia Palermo: Thank you for that. So, we've been talking a lot about the hiring side. But let's flip it. And do you have any advice that mentors and advisors should give their underrepresented minority PhD students, when they're going on the job market in terms of finding an environment that's a good fit?
Adia Harvey Wingfield: That's a great question. Again, I think that it's useful to look at the experiences that faculty in a place already have a place. Right. So, if you are a mentor or an adviser to a person of color who's going on the job market, I think it's useful to encourage them, and they may already be thinking this, but I think it's useful to encourage them to get a sense of what life in that department and in that university would be like. If they are applying to departments where the department in question hasn't tenured any faculty of color. Are they applying to a department where the department in question hasn't ever hired any faculty of color? Those are things that are going to matter, and those are things that the faculty of color have to navigate when making employment decisions and weighing particular options.
So, I would encourage mentors and advisors to make sure that they are assisting their advisees in doing the legwork of finding out what the general climate and experience for them is going to be like. You don't want, in my view, simply to say that you want to send someone to a top rate program in whatever field if being in that environment is going to be miserable for that person. In my view, that is simply not worth it. Other people may think differently and probably do think differently. But I think that that's not a fair trade off to ask junior faculty of color to make when they are looking for employment.
So I think it's important for advisers to make sure that they take into consideration that advisers of color have a relatively unique experience and that they consider what the entirety of department and university life will be like for them as people of color in these settings, and to make sure that that is a factor that they weigh in determining whether to apply for positions and ultimately whether to accept.
Tia Palermo: Some really great advice for advisors and PhD students on the market.
This has been really insightful. Is there anything else that you'd like to share with our listeners about the topics or related topics that we've been talking about?
Adia Harvey Wingfield: I believe I would just add that I think this is really a critical moment for universities right now for a lot of reasons. We are seeing the ongoing protests for more racial equity and an end to systemic racism in society right now. We are at a point where the nation is becoming increasingly multiracial. Students of color are growing numbers of those who are attending universities. The numbers of faculty of color have not necessarily shifted in commensurate ways.
And this presents a real problem that I think universities need to devote some time and energy and effort into tackling. That kind of mismatch, in my view, does not bode well for outcomes for students. But not only that, it doesn't necessarily bode well for universities as we continue to move into the 21st century and becoming a more racially, more multiracial society. I believe that universities will be largely better equipped to come to terms with those demographic changes if they actually reflect those demographic changes. So, I think it's really critical to grapple with these questions of how best to do that in ways that make sure that both students and faculty are adequately represented and completely included in environments that have a long history of being very exclusive and unwelcoming and alienating and hostile.
Tia Palermo: Adia, this has been so insightful and really a pleasure to speak with you. I really just want to thank you for sharing your insights with me and with our listeners here at SPHHP. It's been really great to talk to you. Thank you.
Adia Harvey Wingfield: Thank you for having me. I'm happy to do it.
Outro: This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.
Temara Cross was born and raised on the east side of Buffalo, New York. She is currently a senior/first-year graduate student at the University at Buffalo, majoring in African-American Studies and pursuing a BS/MPH in Public Health, concentrating in Community Health and Health Behavior.
Intro: Hello, and welcome to Buffalo HealthCast, a podcast by students, faculty, and staff of the University at Buffalo's School of Public Health and Health Professions. We are your cohosts Tia Palermo, Jessica Kruger, and Schuyler Lawson. In this podcast, we cover topics related to health equity here in Buffalo, around the US, and globally. In this first semester of the podcast, we’re taking a deeper look at racism and health. We’ll be talking to experts around the US, as well as individuals here on campus, and in the Buffalo community who are working to remove inequities and improve population health and well-being. You’ll hear from practitioners, researchers, students, and faculty from other universities, who have made positive changes to improve health equity and inclusion.
Jessica Kruger: Welcome to the Buffalo HealthCast. I'm your host today, Jessica Kruger, and I'm joined by one of our amazing three plus two students in the Department of Community Health and Health Behavior, Temara Cross. Temara, will you tell us about yourself?
Temara Cross: Sure. So hi, everyone. My name is Temara as she said, I'm currently in my first year of the CHHB program. I'm also pursuing a Bachelor's in African American Studies. I was born and raised in Buffalo, involved in several social action organizations in Buffalo, and in my "free time", I say with air quotes, I enjoy giving back to my community singing with the gospel choir at UB, going to church, and also playing basketball. So that's a little about me.
Jessica Kruger: Fantastic. Well, thanks so much for joining us. I'm really interested in learning more about your internship that you're currently in with REACH Buffalo. Could you tell us about your role in that internship and a little bit more about REACH?
Temara Cross: Sure, yeah. So, REACH Buffalo stands for Racial and Ethnic Approaches to Community Health, and this initiative is funded by the CDC. We're in year three now, and the primary goal is to reduce chronic disease in our target population, our priority population, which is our residents along of Ferry Street, which is East Ferry and West Ferry, and also, we try to focus on five zip codes which is 14208, 14209, 14211, 14213 and, 14215. So that's our primary goal and we make sure that whatever programs that we implement, we make sure that we have community voice. So, we have community wellness champions, and then just several people on the team just working together, but my specific role is a REACH program Intern/Assistant. So, I'm helping out on various projects, not just one focus area. We have different focus areas, by the way. One is Community Clinical Linkages, another one is Nutrition, and another one's Tobacco. So, we focus on all of them. And we also received a supplemental grant this year because of COVID, of course, but our main goal is to promote and educate the community about the flu vaccine and just making sure the community knows that they had the opportunity to take it, and yeah so, that's what I'm doing.
Jessica Kruger: Sounds like a really exciting project and group to be part of. Could you give us an example of maybe something specifically that you've worked on with the program?
Temara Cross: Sure, I'll talk about how I hit the ground running. So, I started in August of this year, and soon as I got my laptop, they were like, alright so Black Breastfeeding Week is coming up in two weeks. So, we want to start some programming, but obviously we had restrictions because of COVID, so we did stuff virtually. We broadcasted Chocolate Milk, which is a documentary about black women who breastfeed. We did that, we had a discussion/forum about partners, how they feel when they're supporting mothers who breastfeed. We just had discussions about black mothers who breastfeed and how they felt about that. All virtual.
Jessica Kruger: Wow, sounds like a huge undertaking that you definitely rose to the challenge for. In your internship, what are the most valuable things that you feel like you've learned so far?
Temara Cross: That's a great question. I would say the most valuable thing I've learned in practice, I would say, is really actually appreciating community voice, because we might have X amount of years in a community, we might live there, we might know someone who lives there. We might have been in the field for so long, but if you aren't living and going through certain things, you really don't know how other people perceive what you might think is the best for them, so I've just really learned to appreciate community voice and really use that as community assessment. Really taking that - not just checking off a box like, okay, we listened to the community, but we're still going to do XYZ. No, really taking that into consideration. That was something that I found really valuable and really helpful because again, they don't even have to be taking their time out to help us mitigate chronic diseases in that area, but they're still contributing, and we appreciate them for it.
Jessica Kruger: That's a really important part of public health that sometimes often, like you said, as a checkmark, right? But we really, really need to think about who we're serving and how we serve them. I heard a quote; “Not about us without us.” Right? And that has really stuck with me and how you work with the community, and work with the community, not just for a community.
Temara Cross: Exactly.
Jessica Kruger: So, thanks so much for telling us about your internship. But I want to know more about you. In particular, you have a really interesting background in some of the areas that you have studied. So, you're a major in African American Studies, and you minor in Anthropology. Can you tell us a little bit about why you have chosen those, and how they flow into your work in public health?
Temara Cross: Of course. I'll start right back to 16-year-old me, junior year of high school. I knew I was going to be a teacher of some sort. Didn't know what, but I was just going along at Hutch Tech. That's where I went to high school, here in Buffalo. We had majors in high school, like certain concentrations. I was in biochemistry, and I was like, I don't know what I'm going to do, but I'm going to do something and it's going to be teaching, and November comes around and I find out my grandmother's really, really sick. She had kidney failure, and congestive heart failure. So, I'm like, what is going on? Before she was able to speak with us anymore, I was asking her, "Why didn't you take action sooner Grandma? Why weren't you talking with the doctors, really doing what you had to do?" She was, obviously, but she really stressed the fact that she was tired of seeing other doctors, all different doctors, all the time, because she had different organ systems, which require different doctors. So, she was tired of seeing different doctors, and then she had to keep explaining her story to different doctors. So, there's that. And then not seeing doctors who looked like her. And that was really the big thing that stuck with me. The distrust that we see in the medical industry, that was just really my firsthand, wow, this really exists. So, after she passed away, I was like, is this really recurrent like in my community? Is it just her? So, as I'm observing, asking my community members, asking my neighbors, asking my family, my immediate family; how do you guys feel about going to the doctor? And they're like, we don't go there unless we absolutely have to. We don't go, we're not we're not speaking to "these people", but again, that's when I realized the best way I could serve my community, because I'm always very community oriented. But the best way I could, was to serve in the health industry, in the medical field. So, I decided that I would pursue medicine eventually, and then launch a health facility on the east side of Buffalo.
So with that, to kind of reel it all in, I'm majoring an African American Studies, just to gain more a historical and better understanding of why, because we're not learning that, and that's another thing - we're not learning that in our general education courses. We know it's briefly talked about, but we're not learning about Tuskegee as much as we should be, we're not learning about Samuel Cartwright - all these people who have used Black bodies for the advancement of medicine. We're not talking about that as much as we should be. So that's why I decided to major in African American Studies, and then with Anthropology, I just wanted to pick something up to learn more about why people do what they do, as far as culture. I've had the opportunity to go to a more diverse high school, so I was exposed to different cultures, but not really understanding why people do what they do - how cultures are formed and things like that. So that's why I decided to just minor in Anthropology, get the best of my money's worth.
Jessica Kruger: That's such a moving story that how you took a very traumatic event in your life and turning it into something positive. I'm right there with you. I also have a minor in anthropology for my undergrad and I think it's pivotal to begin to understand the perspectives of others and how that's created, and you bring up a really good point about the culture, the historical relevance of events that we really need to integrate into our curriculum. And think about, we can't move forward, if we don't understand the injustices that have occurred in the past. Do you have any advice of how we can begin to make some of those changes?
Temara Cross: I'm not going to speak too much, can't spill all the tea, but I'll say Black Council is in the works of really redeveloping and redesigning the undergraduate curriculum, just to kind of expose people - to have a course where not only, of course, but also make sure this is a design where it's throughout all courses, but really understanding how to be antiracist because I know from personal experience, a lot of my friends from Williamsville, Orchard Park, they have never had to have those experiences and they have never had to have those conversations. So, coming to UB, we as Black Council and also personally, we believe that UB should be held accountable to provide courses like that and be able to put that into correct themselves required for students. Not, "Oh, I'm going to check this box for diversity because I took a class in diversity." And it's not like that. You don't have to experience it, but you have to have training of some sort, and you really need to be exposed to how to be antiracist because being complacent is just as bad as being racist.
Jessica Kruger: Wow, that's, that's a really important point that you're making. It's not just one class that changes you - it's being open to continually learning, being open to hearing diverse voices and viewpoints, and being uncomfortable. Some of this can be very uncomfortable to learn about, especially, we know that in the history books that you're taught through school, it's from a very white lens. And so how can we begin to change that? And I think you've come up with some really great ideas. So, tell us more about the Black Student Council.
Temara Cross: Right, I actually saw that you looked for it on UBLinked, and we're not on UBLinked yet. I don't know what we're doing, but the UB Black Council is a coalition, I would say, not a coalition, but it's comprised of all the black organizations at UB, so we have Black Student Union, Caribbean Student Association, African Student Association, UB Gospel Choir representative of that organization. So many of us, but we came together. It all started back in 2019 February, where there was a town hall meeting, we were really upset about the budget cuts to organizations that really aim to ensure Black student success. So Educational Opportunity Program, C-Step, and there was a town hall, and we had a rally, and we were like, you know what, since all of us think alike, why don't we just come together? Because we have all these different black organizations, but we all feel the same way. So, we came together and wrote a couple proposals, wrote a couple demands, and we just hit the ground running from there. And as people graduate, as people and move on and start adulting, we have to pass the torch and stuff. So, our main goal right now is sustainability of the Council, and making sure that we continue to increase the momentum and push the administration at UB - just making sure that we keep that going. Despite having online classes in these unprecedented times, it's really hard for us to come together, but when we do, we're trying to make sure we really hit the ground running and hold UB accountable for ensuring black student success. A few of the things I'll just mention.
So, one of the things we are really looking forward to making sure UB addresses is increasing the minority admission or acceptance rate. And one thing that resonated with me when I read that demand was how - so I serve on the Say Yes council/committee at UB. We just ensure the students at UB who received a Say Yes scholarship or are a Say Yes student, so they don't have to get the scholarship, but they graduated from a Buffalo Charter or public school. So, our goal is just to make sure that they have the resources they need at UB, and one thing I learned was that the admissions at UB goes to certain high schools. They don't go to all the high schools in Buffalo. And looking back, this is why sometimes, I just wish I knew all these things when I was in high school, but you learn as you grow, and as you get older. But they only go to Hutch Tech - the high-performing high schools - City Honors, Da Vinci... And it just goes to show you, the students in the other high schools aren't even given the opportunity of exploring what's out there, of not just the other local colleges. This is university and for them not to do that alone, is really systematic. It's a systematic and it's really something we wanted to address because the population of black students at UB is so small, the proportion is so small. So, we want to just hold UB accountable, such that they really strategically seek out other students of color to have the opportunity to obtain a degree there.
We're also looking at increasing Black faculty. We know that while Black faculty are recruited and they come along, a lot of times they leave because of the climate of the institution. So that's one thing that we feel like they should address. Again, another thing I'll mention is the curriculum development; really making sure that it's not just one class that addresses racism and discrimination, but it’s implemented throughout all fields, especially STEM fields. One of our members, she shared a really touching story about how she came in and her advisors really were discouraging her from taking African American Studies courses because you don't have space for that, and I'll attest to that because I came in as biomedical sciences, and it was a really rigid curriculum. I couldn't take what I wanted to take, so those are just a few of the things that we want to address. We're finding out as we go along that a lot of people think the same way we do, so there's power in numbers, as we know, democracy. So, we're just working together, working, finding the connections where we can, but we always need support. So if there's any students up there, any organizations that want to get involved, Black students - you can hit us up on Instagram, Twitter, @UB Black Council. I'm just promoting here. UBBlackCouncil@gmail.com you can hit us up and find out ways you can get involved. We're just trying to really hold UB accountable especially given the climate now. And I always say this, and I'll continue to say it; it's unfortunate that it took the death of a man for the country to realize how oppressed black people have been for over 400 years, but it's time. With that, I'll stop, I'll get off my soapbox but that's what we're doing.
Jessica Kruger: Well, it sounds like you're using a lot of your public health skills to organize and break down some of these systems. It's really powerful to hear how much you're doing as a student. You want to kind of tell us a little bit about how your work with the Black Student Council relates to your overall public health lens or how you kind of view things?
Temara Cross: Oh yes, I'll just say, every week going through, even in undergrad, every week I'm just finding how public health is my life. I won't speak for anyone else but like how public health is every day is something. I think it was last week, we learned about negotiation in one of our leadership courses in the in the CHHP (Community Health and Health Behavior) program and I was like, this is really applicable to my life, it’s not just public health. And they gave us examples of how negotiation is used in public health - negotiating with a state about funding for vaccines, stuff like that. And I'm like, well, you know, we have to negotiate on a daily basis. So, it's not just from a public health lens, and I'll say my internship with REACH, I'm literally taking what I learned in the class. I know this is the purpose, but it's like I'm scooping what I learned in the class and putting it right in the internship and it's vice versa. I'm taking what I learned the internship and really applying it with the coursework and I'm so grateful. I'll shout out to Heather Orom; she was the one that emailed me and was like, this is for you. So, I thank her for that.
But yeah, it's really just so applicable and I'll just go back to the Black Council on the negotiation. That's just one primary example, really negotiating such that administration - I'm grateful for what UB administration has done thus far, for some things I'll say. That's a long way to go. But again, it has to be negotiation, it has to be communication, consistent discussions and yes, so that's just one thing that I've learned primarily in my program that I was able to like directly apply, but there's so, so much, so much.
Jessica Kruger: It's so great to hear, it sounds like you're really taking what you learned and applying it exactly as you know an internship is planned and I love how you can really translate this into multiple areas of your life, not just your internship or your professional career, but also how you're taking some problems that are very apparent of the university and using those skills and knowledge to make some of that change. So, bravo to you!
Temara Cross: Thank you.
Jessica Kruger: Tell me what's next.
Temara Cross: Oh, man. You know what's crazy is I have all these post-it notes on my wall. And I said, I am never put any post-it notes, that's so disorganized, but every idea that pops in my head, I just put it on my wall, and eventually I want to go to med school. And I was like, do I take a gap year? What do I do? Because this semester alone was really, how can I study for the MCAT, with all this going on?
But I was thinking, okay, maybe I'll take my break, considering we have an extended break, take my break to study for the MCAT. So, I guess, next, aside from actually finishing my master's program, I'll be starting to look at med schools. And I don't want to leave Buffalo, but I'm a homebody but exploring other options, I'll say. So that's what I'll be doing. I'm just chugging along with my social action organizations - Open Buffalo, Buffalo Transit Riders United, and obviously being a student too. But yeah, really, just chugging along but also taking days to myself. Like I said, I'll be eating a lot tomorrow with Thanksgiving. I'll be eating so much, but yeah, making sure my cup is full. I'll say that. That's my primary next step is making sure that my cup is full. So, I can do what I want to do and give back to others.
Jessica Kruger: And self-care is so important in our field. Well, I can't wait to see all that you accomplish in your program. So, thank you so much for being a guest on Buffalo HealthCast today. I'm sure all of our listeners have learned so much about REACH, but also some opportunities in which we can make change and support students and making change.
Temara Cross: Of course, of course. And if you guys have any questions, feel free to email me firstname.lastname@example.org, find me on Facebook, I post memes mainly, keeps me sane.
Jessica Kruger: We'll put the contact information in our show notes. Thanks so much for tuning in.
Temara Cross: Of course.
Outro: This has been another episode of Buffalo HealthCast, tune in next time to hear more about health equity in Buffalo, the US, and around the globe.
Reverend George Nicholas is the pastor of Lincoln Memorial United Methodist Church in Buffalo, an active member of the Concerned Clergy Coalition of WNY, and co-convener of the African-American Health Equity Task Force. Listen and learn about public health community engagement from both of these organizations, as well as how public health and COVID-19 have interacted with our Buffalo community.
Intro: Hello, and welcome to Buffalo HealthCast, a podcast by students, faculty, and staff of the University at Buffalo School of Public Health and Health Professions. We are your cohosts Tia Palermo, Jessica Kruger, and Schuyler Lawson. In this podcast we cover topics related to health equity here in Buffalo, around the US and globally. In this first semester of the podcast we’re taking a deeper look at racism and health. We’ll be talking to experts around the US, as well as individuals here on campus, and in the Buffalo community who are working to remove inequities and improve population health and well-being. You’ll hear from practitioners, researchers, students and faculty from other universities, who have made positive changes to improve health equity and inclusion.
Schuyler Lawson: Hello everyone, and welcome to another episode of Buffalo HealthCast, the University of Buffalo Premier Public Health podcast. I am your host, Schuyler Lawson, a first-year PhD candidate in Community Health and Health Behavior. With us today is Reverend George Nicholas, co convener of the African-American Health Equity Task Force and a member of the Concerned Clergy Coalition of Western New York. Thank you for taking the time to be interviewed with us today.
Reverend George Nicholas: Well, it's certainly an honor and a great opportunity to be with you today.
Schuyler Lawson: All right, great. So first off, for our listeners, can you tell us a little bit about yourself?
Reverend George Nicholas: Yeah, I'm from Buffalo. This is my home - grew up here and then went to Ohio State University for undergraduate, and then came back to the area, have a graduate degree from the University of Buffalo and had been working, doing various jobs, doing things. I’ve owned companies, I was CEO of Geneva B. Scruggs Community Health Care Center at the time, and then I decided to answer the call that the Lord put on my life many years ago, to go into ministry full time. And I did that. And it was pastoring Rochester for about 12 years. And then, the Lord called me back to Buffalo. I've been here since 2012.
Schuyler Lawson: A lot of history in Buffalo.
Reverend George Nicholas: Yeah. It's home, and I've seen the ups and the downs, and I think we have an opportunity to really do something transformative right now. And it's necessary because I've seen how Black Buffalo really hasn't progressed. Some of the things that in terms of - we have less businesses now, we have less community-based organizations. We're so vulnerable. We used to have the Geneva Scruggs Community Health Center, which was a community health center that served this community, we had the St. Augustine Center, which is a tremendous community-based organization on Fillmore Avenue. They're no longer there. The Langston Hughes Cultural Center, which was at 50 High Street was a tremendous cultural center. The Friends of the Elderly, and there were a number of programs and that were run by Black people and that address the needs of Black people. And over time, these things have not been supported by the existing political establishment. And they've gone away. You certainly, on the business side, we had tons of cleaners and restaurants and all kinds of things - Jefferson Avenue, Fillmore Avenue, parts of Genesee - they were bustling with Black-owned and operated companies. Then finally and I know, when you get to these questions, but I think it's important to put things in a context. I'm 57 and when we were coming up in their area, the notion of Black kids not graduating from high school wasn't even a conversation. You graduate from high school. But now, we have folks struggling just to graduate from high school. And then even as they matriculate on to the campuses at the University of Buffalo, it is probably less black students from Buffalo there now than there was fifteen, twenty years ago. And so we have to we got to turn this thing around, Schuyler. We're not going in the right direction. And so, we'll talk about that a little bit later, too, if you want to.
Schuyler Lawson: I agree with you. I agree with you. And like you said, even though the current situation appears to be bleak, you did say that there is an opportunity for transformation and hopefully lasting changes, which is a great segue into the African-American Health Equity Task Force, which appears to be a force for good with respect to the issues that you mentioned.
Reverend George Nicholas: Yeah, so we've been working really hard since it started off with a conversation with just a few of us. This woman, Mary Walls, was at the time, working for the Heart Association or the Red Cross, one of those places, and she wanted to engage some Black clergy in conversation about colorectal cancer. There's a disproportionate amount of black people who suffer from that. And so, I challenge the group to think bigger and to look at the overall health of Black Buffalo. The factors that were driving high colorectal cancers are the same factors that are driving diabetes and heart disease and asthma and all kinds of things, hypertension. And it's the social determinants of health. There has to be a shift. Between thinking about and looking at Black health and putting all the blame upon the behavior of people in the Black community, that old adage. You just eat too much fried foods, and all this other stuff. Well, that's part of that. That's part of the equation. But when you look at the reputable organizations that deal with public health; the World Health Organization, the Center for Disease Control, the National Institute of Health, and every reputable organization that focuses on public health will tell you that the driving factor, the most influential factor out there that impacts the health of an individual are the social determinants of health. The lived environment, the economic status, educational attainment, interfacing with the criminal justice system, the air and water quality in the neighborhood, the quality of your housing stock. These are the things that that that drive health outcomes. And if you live in a community where you have access to the things that you need to maintain good health, then your health outcomes will be significantly better. But if you're living in a community where you don't have access to fresh fruits and vegetables because there's no grocery stores that are within a close distance proximity to your community, it makes it difficult for you to purchase the things that you want to put in your refrigerators and on your dinner table that are healthy. And if you're living in a situation where your economic status is such that you have limited income and limited resources, then the food choices that you make for you and your family are going to be influenced by your income, not necessarily about what's always healthy, because healthier food is more expensive in a lot of places. And then we'll say, well, why don't you just change your economic status? If the job opportunities are not available for you and your community or if the jobs are, there's a lot of jobs in Grand Island and places like that. But if there's that transportation and you don't have means for that transportation, then that creates a problem for you. These are the things that drive these, what we call, the social determinants of health. Our work, our mission with the African-American Health Equity Task Force, it started off calling ourselves the African-American Health Disparities Task Force. But we wanted to shift our thinking to a more aspiration. We want to talk about where do we want to be. Right, and where we want to be is health equity. And so, we we're unapologetic, concerned with the health conditions of Black people. This is not a minority thing, and not to take hits or slights. But there are unique set of circumstances that are attached to the enslavement of the African people really in this hemisphere. Starting in 1519. When you look at the slave trade by the Spaniards and the Dutch and others, those in the French, in South and Central America, and then escalating in to around 1619, migrating up north to what they called North America. But it was a land that was inhabited by the indigenous people. This whole notion of the enslavement of African people in this region has from beginning begun the process of the social determinants of health, because the lived environment, economic opportunities, housing rights. From that moment, African people living in America were at a disadvantage. and that continued throughout generations. So, you have slave enslavement from 1619 to1865. But even longer than that, Schuyler, because with the enactment of Black codes and African American men forced to work in steel mills and coal mines in Alabama, Tennessee and other parts of the South after being arrested for vagrancy. Then, the inability to accumulate wealth through to the sharecropping system and just the debt that was begun to just weigh upon freed African people living in America. From generation to generation passed on. Even as we began to migrate into the north and beginning to fill these some of these jobs in during the industrialization, these jobs then became unionized. Into the migration of those from Western Europe, began to come in from Italy and Ireland and other places like that. And Poland, they took those jobs. They displaced folks who were who had migrated from the south and moved up to the north. So, this whole economic disenfranchisement of African people living in America has created such a wealth gap that even today in the year 2020, for every dollar of wealth a Black person has in America, a white person has eighteen dollars. The medium, I believe, you guys are students, so you will look up this data. But it's about African-Americans who have about eighteen thousand dollars of wealth versus over a hundred thousand by whites. And I talk about income. I'm talking about wealth. Why is that? Well, post Second World War, and the beginning of it, when soldiers began to be able to purchase homes as a result of the G.I. Bill, they were they were pushed into communities, segregated communities. Red lines were drawn, and soldiers couldn't even use their G.I. Bill that they had earned on the battlefield, fighting for freedom for other people and forced to live in communities that just create an economic disparity. And then as banks over time, as banks value property, because your biggest asset is your property. One of the factors that they put into in terms of valuation of your property is the demographics of that community. So Black folks living in Black communities, buying homes, investing in homes, but then getting less equity out of their properties than white people in white communities. Then you have what I call "ghetto taxes." If you have your car, insurance is going to be higher if you live in a Black community than if you live in a white community. Life insurance; higher premiums, if you're Black than if you're white. So, all these things, they just suck the well out of Black communities and then finally the interaction with the criminal justice system, where Black people are disproportionately arrested and convicted for crimes. Higher bails, longer sentencing. What happens when a young Black person gets in trouble with the law? Well, it's grandmama and them that have to dip into the savings, the dollars that they began to generate wealth with or that they would want to pass down to their family members. Second mortgages taken on that house that they finally paid up to pay to pay legal fees and things like this. This whole cycle is sucking the wealth out of the community, which creates and feeds into these disparities. This is the level of how we want to attach these issues of health inequities or health disparities as opposed to just doing what the traditional health fairs do, and giving people balloons and coffee mugs and thinking that that's going to change outcomes.
Schuyler Lawson: In light of this, the daunting challenges that you listed, what is the African-American Health Equity Task Force, some factor in alleviating or solving the problems caused by this multigenerational structural damage that's been brought upon the black communities?
Reverend George Nicholas: Well, it starts with truth telling. Right. It's you can’t address problems that you don't recognize are problems, so we want to change the narrative about why these conditions exist and to focus more on systemic changes, and looking more at systemic causes so that our solutions are will impact the systemic causes mean. Let me put it this way. One of the things that, I’m not critical of it, I'm just trying to make an analysis, is that one of the things that happens every year is the beginning of the school year. People who where we speak, and I use this analogy all the time, is there's always this big push to get kids backpacks through and to give kids bread brand-new backpacks. Yet there's no data, that says the reason why Black children are underperforming in an urban school is because they don't have a backpack. So the remedy has nothing to do with the problem, because if the kid, if the child, is still going to a failing school in an at risk neighborhood, and if mother and father still don't have the kind of economic opportunities, the air and water quality in their community, and all these other factors, if that has not been impacted, then the fact that this child has a new backpack, really will have a limited, if any, impact upon their ability to achieve academic excellence. Not talking about passing right, we shifted our thinking and I’m so proud, brother, that you work on your PhD, but the thought process that we're just, you know, think about this man. We're putting a lot of energy in, if necessary, because of what the current reality is to get kids/children just to pass. And what we really should be pushing is scholarship and academic excellence. You have to get a 70 or 65 to pass. If you get a 70, that means that 30 percent of the information that was provided for you, you didn't get. 30 percent. That's a sizable chunk. So, our work is to look at systemic issues, raising concerns, and then bring forth community collaborations to bring community-based solutions. And then engaging partners, institutional partners to invest their resources and to the solutions. Whether it be financial resources, whether it be intellectual capacity, whether it be access to information, whatever these institutions have that could be available to them. We're saying, use those resources and invest this to create a problem solving as it relates to the issues in the African-American community.
Schuyler Lawson: Thank you for your response. It helps our listeners understand the breadth of what the African-American Health Equity Task Force does. I do have a particular question on what have been some of the approaches that the task force has taken with regard to the COVID-19 pandemic?
Reverend George Nicholas: We have a good news story there, Schuyler. And it shows it's actually proof positive to our hypothesis of the importance of community collaboratives. And supporting Black leadership. Let me let me frame this for you. Since we have been doing so, we put out there our report in 2015 about the conditions of the African-American health conditions, which show that you can. People can have access to these reports at BuffaloHealthEquity.org, and in our initial report, just using state and county data and concentrating on five or six zip codes where the predominant number of African-Americans live on the east side, we found that that in terms of just looking at chronic disease, that an African-American who lives in one of those communities has a 300 percent more likelihood to have a chronic disease than a white person who lives outside of the area.
Schuyler Lawson: So we're talking about, very stark.
Reverend George Nicholas: Right, right. And it translates to about 10 to 12 lost years of life. So, we're at work, we were equipped with the data. When COVID-19, emerged, we knew that as, because of the high rates of diabetes, asthma and heart disease, which are three comorbidities that make an individual more susceptible to COVID-19, that the African-American community would be hit the hardest. Also, would you put on top of that? We know that a lot of the essential workers who work in these health care spaces, health care aides, security people, people who work in dietary and environmental services, as well as the nursing in the medical area. There is a high concentration of people from our communities that live with that, that are employed at those other level jobs. They would be coming into these environments where Covid was present and then going back into their communities, sometimes using public transportation, sometimes catch it, arrive with the uncle and them. We know that there was a real potential. So, we reached out, back in March, to the county executive and the health commissioner and some other leaders in the health care field with leaders from our community, Dr. Vasquez and others. And we said to them, listen, what's your plan? What's the plan? We know this is coming. We laid out the possible vulnerabilities of our community. At that moment, they really hadn't thought about those things in those terms. So, what we said to them was, listen, we're going to come back to you with a plan, a plan on how we're going to address this issue and we need you to resource it. We need you to support it, because these are our dollars as well. After some going back and forth and what have you, we were able to use some of the Medicaid reimbursement moneys to the district, the Millennium Collaborative Care through Erie County, being able to stand up what we call the COVID-19 response team. And what we did, Schuyler, we've got fifteen churches on the eastern west side. And we developed these Covid response call centers, and we got lists from the Board of Elections and other sources. We had our targeted area, and we hired a lot of younger people. A lot of them were home from college. Got them an iPhone, got them a laptop, got them a list. Dr. Vasquez and his team through GBUAHN had developed this tremendous I.T. system that allowed for our responders to actually make appointments for people right from their call center, what have you. And so, we literally called people in our community. And then we learned to they were there's still a percentage of people in our community that don't have a cell phone or landline. So, we engage the National Witness Project who are already doing some community engagement, community health work type stuff, and we said to them, ‘knock on these doors for us because we can't reach these people’. We want to find out one - if they had any symptoms, two - did they have access to a test, three - do they have a primary care physician, four - do they have some food or food insecurity, five - how are they doing mentally, so we ask these five questions pretty much. We were able to not only ask those questions, but to give some kind of response to attaching people to help. If you're having this some of these symptoms, get to your primary care. You don't have a primary care? Through our network, we've got GBUAHN and we've got Jericho Road. We can plug you in to a primary care physician or if you need transportation, we'll get someone to come pick you up. You need food, we engage with that. Alex, over at the African Heritage Food Co-op. Tremendous job. We said to Alex, here's a chunk of money, get what you need and then let's set up a delivery system. So, when people needed food, we were able to get it to them. We work with Best Help, if people needed some mental health stuff because people are dealing with a lot of stuff. Make that appointment for you. And then when we learned that there weren't enough testing sites within community, we were able to stand up the testing side at the Leroy Coles Library. We said to those who had access to testing, we need tests at our community health centers because the people at the Community Health Center, people at Jericho Road, the people at [inaudible] Medicine, those sites, they're already dealing with people in our community prior to Covid. So, they need to have access to the resources in order to get them some help. It wasn't easy, but we kind of put this plan together. So, here's the good news. When we started the project in March, April, and the first data started coming in. Nationally, African-Americans are dying in about two and a half to three times their population rate as it relates to Covid. Erie County African-Americans make up 14.6% of the population in Erie County. The early data was showing that about 33 percent of the fatalities were from the African-American community, which was trending pretty much at the national level. But then, as we did our work, made our calls, connected people to resources, gave people access to PPE and others, and not only us, but there were other partners in the community. So, what happened is we were able to stimulate and generate some energy that not only our project was having an impact, but it loosened other resources and other things within community where others were doing some really great work as well. As the data began to come back, we saw it trending downward to the point where in June, only 16.7% of the fatalities, in Erie County were from the black community. To make it even better, the latest data we got just this week, even in the midst of the second wave and the trending upward, that only 14.7% of the deaths are from the Black community, which was right in alignment, statistically in alignment with the population. We're one of the few cities in America that can make that claim. Why is that? Black leadership with a vision. We're already working in community around these issues, connecting with resources and systems and institutions that have an obligation to serve the Black community, if you're the county health department. Well, the last I heard, the Black community was in Erie County, and so you so you make these systems do what they are designed to do, what their mission is. Then other health care providers and institutions, insurers and others collided and say, listen, we need you to invest your resources and help us get this thing done. But also, critically following the leadership of health care professionals that were already operating with in those communities. Guys like Dr. Vasquez. Guys like Dr. Glick. Women like Dr. Lusu, and Dr. Ansari, who are already there on the front lines, so they have to be resourced and equipped so that they can do what they need to do. The results are undeniable. Data speaks for itself.
Schuyler Lawson: Yeah. I mean, it's so good. Compared to nationwide data, that's I mean, it's an anomaly. You know, the work that you described is just amazing that the coordination and just the scale of it to achieve that type of outcome, compared to your national statistics where blacks pick up a significant portion of the significant and disproportionate compared to their population, a portion of the COVID-19 deaths, that’s commendable.
Reverend George Nicholas: And shout out [inaudible] who provided great leadership on this and others with our team, Dr. Underwood, Rita Robinson, Kelly Wolfrey - they are just such a wonderful team of people who have worked tirelessly on the issues of health equity. But what we can't do is, because really what our vision with our Buffalo Center for Health Equity, the health of the African-American Health Equity Task Force, and then the university having its community research institute under our CTSI under Dr. Murphy. Another really great outcome is that, standing up that institute, and the system is embedded in the university that is focused and its mission is to look at health disparities and to research and then not only research, but to come up with remedies and engaging not only the medical school, but the other academic disciplines: School of Education, School of law, the School of Management, the School of Nursing, the School of Social Work. They are all partners with us in this work, so that when we start coming up with solutions, then we're able to draw upon the expertise that operate within these schools to come up with innovative and creative responses to some of these issues that are that are creating these health inequities. So, Dr. Tim Murphy has been fantastic, who is head of the CTSI. Dr. Margaret Grimsley, Dr. Henry Taylor, Dr. Heather Orom - they've all just been great partners with us in this work to the point right now where we were able to get through the School of Nursing, where we’re able to get a grant, where we're going to be actually looking at the impact of mental health on these communities, post-Covid. From what I understand is, the first kind of community/university collaborations to look at issues that are specifically designed to provide information, but also support for issues in our community. So, we're making some progress and we're really excited about it.
Schuyler Lawson: I'm excited about it, too. And it's great to hear that all this progress made at the community level and different types of institutional levels we're dealing with beyond every county Department of Public Health, and also to getting UB on board, which is located within the community. So, we might as well have a stake and open the ability.
Reverend George Nicholas: I mean, universities have a responsibility/ability to do problem-solving. What's the point of doing all this research and having all this knowledge if you don't take the research and knowledge to better humanity? It's so that message has been heard, and the university, an institution, has been very responsive and we're very hopeful about the future, about the work we're going to do together.
Schuyler Lawson: I have another question. What is what is the Concerned Clergy Coalition of Western New York, and how do they relate to the issues of equity that you mentioned?
Reverend George Nicholas: Reverend Pointer and myself, and a few others were the ones right after the death of Eric Garner, and we organized clergy, about 90 clergy, in the area to begin having conversations about those issues and what's happening here in Buffalo. We began to start talking about how we can provide leadership around health, economic development, criminal justice and school education, and the health piece and we've been working ever since on those on those issues. The Concerned Clergy represent about five or six different ministerial groups in the black community. They all came together under this banner of Concerned Clergy, and we're working on these social justice type issues. Doing our best to present a united front, even though we differ in some ways on issues, theologically and doctrinally, but there's agreement that we must come together to work for the betterment of the conditions of our people. We've been functioning pretty well. It's difficult because historically, there hasn't been this kind of unity amongst Black clergy. We're not as divided as people think, but we're not as unified as we should be. So, we're a work in progress. The Concerned Clergy has been functioning and certainly Reverend Pointer has been a leader in that group We've been really spending a lot of our energies around health issues. A lot of energy around education. We're trying to span out our influence in these spaces.
Schuyler Lawson: Thanks for providing that background. I have another question. Has the Concerned Clergy Coalition of Western New York played any roles in addressing the issues surrounding the pandemic?
Reverend George Nicholas: I wear a lot of hats. Yes, when I'm operating in these spaces, (Concerned Clergy) I'm representing them. Every report back, we have conversations about things. I know I can always depend upon these guys and ladies for support. The efforts around the pandemic have really been channeled through our work to the Buffalo Center for Health Equity and African-American Health Equity Task Force. Right. The Concerned Clergy are part of that work. When other churches and other groups try to do things, we will support them and resource them in that way. One of the things that we did this week, we began to start educating the community around the pending vaccine. We had a conversation, I believe it was Wednesday, with Dr. Alan Lessie, who is an epidemiologist at the university and really an expert on these issues of infectious disease. The issue with the vaccine, because of our history, we know that the data shows only about 43-44 % of black people who have been polled so far, have said that they would be willing to take the vaccine. I understand those low numbers. There's a historical context. There's a rationale behind it. Dr. Michael Eric Dyson would say that Black people are not skeptical of science, we're skeptical of scientists. We have to enhance our understanding and knowledge around issues as it relates to research. We have to have more Black folks involved in research. We have to engage in participatory research. And we have to engage more with institutions that have access to data and have conversations so that we'll operate with a greater knowledge base around this vaccine. So that's what we're trying to do. The fact is that the FDA and the CDC have put the Pfizer, Moderna, and all the companies that are developing the vaccine through a rigorous four step process that would certainly maximize the probability that when the vaccine comes into the public, that it will be safe. And in fact, I believe one of the lead scientists in the development of the vaccine was an African-American woman. So, when the vaccine emerges, the decisions that we make and whether or not we're going to take it have to be based on facts and knowledge we need to hear from. I know that Morehouse is going to play a role in the investigation and disseminating information into community about the vaccine, so we need to hear from Black doctors about this and locally, hearing for me, from Dr. Vasquez, and Dr. Underwood and people like that in community who I trust. If they say, hey, this will be something that'll be beneficial to our people and to our community, I will follow that leadership. This is a very delicate situation because we cannot be dismissive of people when they express their reservation and concern about the vaccine. We should listen to their concerns and answer any and all questions with the hope that that if the vaccine is going to be beneficial for our people, that everyone in our community does take it. We also have to be involved in the process of distribution, so what good would the vaccine be if it's gone through all four phases of approval, but yet, it’s not available to people within our communities? We have to continue to advocate and be at the table and say, OK, we're high risk, we are already struggling with a lot of issues, we got a lot of our people who are working as frontline workers in these health care facilities, so we want to make sure that people within our community have the information about the vaccine and also access to the vaccine when distribution begins.
Schuyler Lawson: Those are very important issues, and I imagine that the Task Force and the Clergy Coalition are going to play a big role in trying to have a plan for Buffalo's Black communities as far as equitable distribution, and also to make certain information campaigns to build trust and address the historic roots of the mistrust towards our scientists we have.
Reverend George Nicholas: One of the outcomes of our project is we've developed just piles of data now. We've made over a hundred thousand contacts with people and so on and so on. Each one of them is a data point. And so, we're going to be able to, as one of the outcomes of our project, be able to really make some really strong programmatic and policy recommendations about how do we can better serve the African-American community based on the data that we're collecting. We strongly believe that research will give you data, data will inform policy, and then policy will bring resources. We have to make sure that we are very aggressive in those phases, because really what's happened, Schuyler, is our people have been measured and surveyed and queried and institutions have gotten tremendous grant and funding opportunities to do that, but then once we compile the data and identify these issues, there never seems to be a follow up of policy recommendations to address that. It’s one thing to survey people and say, ‘Y'all got a lot of diabetes.' This next step is now, here are the programmatic things that we're going to put in place to address those conditions, but that has not happened at the level that we needed to happen. So that's one of the reasons why it's very important that we have this collaboration with the university and others around research. Research is critical. And we have this. One of my goals is to have 'research' no longer be a bad word in our community, as we know and I understand. We understand, though, that the importance of research, and importance of research being done right and making sure we don't take the data from the research to weaponize our people, but take the data to be a bridge, to getting resources, to change the condition of our people. And that can only happen when Black leadership is involved. That's got to be real about that, we need to insist that Black leadership is involved and we have to make sure that Black leadership is Black leadership, meaning, Black people in leadership is not Black leadership. There's a difference between there. We have to have Black folks who are in positions of influence and leadership to be unapologetic advocates for the conditions of their people. Not get tied up in the semantics of whether you should say, defund the police or not, that's the absolutely wrong conversation to have. And it's an unhelpful critique for people in leadership to critique that phrase without looking at, but without putting your energy around the issues or why people are saying that. We have to understand the nuances of how can you be an advocate for Black people. The only way you can do that is to listen to Black people, and to share their concerns in an unfiltered, unabridged way, so that we can really begin to start getting up to move. There's a generation, your generation: I have four sons and one daughter, and your generation is very clear of the directness, you know. I am grateful to see the shift - things like the unwillingness to play semantical games and to appease white institutions, but to say, listen, we have a right to be in this space and we have a right to advocate for our people, and we have a right to use the knowledge bases and the things that we've learned from these institutions to better the condition of our own people. That is a critical, critical piece that I think we have to see it, in terms of shifting in our approach in our community.
Schuyler Lawson: Very well put. And that actually leads to my final question. Is there anything else that you'd like to share with our listeners? I know you've said a lot and I'll put you on the spot, but anything else before we conclude our interview with you?
Reverend George Nicholas: I guess a message, I'm sure a lot of students listen to this, the issue around race, I think this is our season to really engage in real, meaningful conversations about it. And I'd like put it this way, to take the power of racism or to diminish the power of racism in our culture. While, as a theologian, I would be hopeful that we could eliminate racism, but also as a sociologist, I have degrees in sociology as well, understanding that I think our best hope is to be able to diminish the power of racism and the power of white supremacy and the ideology of white supremacy and its influence on institutions. To diminish that power that it has, is something which is a realistic goal. I think it happens through people engaging in transparent and honest conversations about the history and the present practice of white supremacy and systemic racism, and to engage in conversations that would define allyship in the terms that centers the needs of Black people in that allyship work and to be cautious in our conversations about intersectionality to the point where we I believe that we do that, but not at the expense of the needs of Black people. I think what has happened historically post-civil rights, I think that at times, our desire to do intersectional work and to do coalition work, has at times put the needs of Black people secondary. We have to be to be smart, cautious. Learn from our past practices and then to be innovative. To recognize that there has to be new approaches to things. I think folks of my generation have to make spaces for sunsetting some activities in organizations that may have been effective for a season. There's a new opportunity here, and I think we need to make room and spaces for the next level of leadership. But I also will caution the next level leadership to not discount the wisdom of the elders. One of the things that diminishes our strength, is when we have conversations like pushing the old folks, old guard out the way and, you know, this is our time. I think by doing such, you diminish the opportunity to glean wisdom from folks that have been on the battlefield and can maybe give some wise counsel on how to deal because the enemy is wise, and the enemy does not separate generations. The enemy passes down the wisdom of how to maintain power and control down to the next generation. That's why there's been so much success to keep this generational dominance. Those are the final things I would like to share with folks, and then just inviting people to engage. To log on to our website, BuffaloHealthEquity.org. Then when you see activities and things going on around campus, around community, around health that could be around justice, get engaged. Don't wait for somebody else to do this. This is your season, your responsibility. If your personal good conscious, and there's so much happening right now, it's a great opportunity for you to get engaged and to begin to shape the society in a way which we want to be. And it's only going to happen if we get engaged.
Schuyler Lawson: Thank you for those thoughtful parting remarks, and thanks again for taking the time to be interviewed on our podcast. We hope to have you on again to discuss future projects. For example, once the vaccine becomes available, you know how things are gonna go with the Task Force and the Coalition. We're helping out with distribution in the information campaigns. We definitely want to follow up on that. And now you add a question, is there a way for how our listeners can learn more about the Task Force and the Coalition?
Reverend George Nicholas: BuffaloHealthEquity.org, Health equity data, all the information. And if you want to send us any questions or anything like that, we have a way to respond.
Schuyler Lawson: And for our listeners, are there any volunteer opportunities?
Reverend George Nicholas: I think so. I'm not sure right now. I know that we have some students doing some academic stuff. I think one thing, too, is checking with people like Dr. Heather or Dr. Grimsley, Dr. Taylor, and Dr. Murphy, and Dr. Leslie, or your professors and Heather Abraham over at the Law School. Reach out to them and ask, are there some things that I can do, too, in terms of supporting your connection to the Task Force? We're always open. We're looking for ideas. It's what I want. We want to be a place to support and convene new ideas. I had a conversation with a young lady, they want to do some internship work. And I said to work, so that's great. So, she said, well, what will we do? I said, I want you to tell me what you want to do. I'm interested in your creative ideas, but I don't want you. We don't need you to just come run copies for us. I want to mine the intellect of young people, their ideas, as opposed to just giving up some task. Because I think that's where the power is. I would just encourage people. We will welcome ideas and thoughts. Let's see what can we come up with.
Schuyler Lawson: Okay. And again, listeners, that is BuffaloHealthEquity.org, correct
Reverend George Nicholas: Yes. BuffaloHealthEquity.org. Also, we got another website of a project we're working on called Pride in Place, Buffalo. And it's a collaboration with LISC and AARP where we're actually going to be doing some creative things that just about celebrating and loving our folks in our communities. It's going to be real artsy and really just trying to lift. What's been a big deal with this trauma, right? And we got to learn how to celebrate ourselves, celebrate what's happening in our community that's good. Celebrate the artists, the people you know, we're working with folks with like from the Wakanda Alliance. And then, there's some folks that are just doing some great things on the ground and we need to support them, and we need to resource them. If you go to Buffalo Health Equity, talk there, I think there's a link to it, but otherwise it’s called Pride in Place, Buffalo. And you'll see some exciting things and there'll be some things. We're looking for artists, we're looking for all kinds of folks in there. So that would be a place to kind of link into something.
Schuyler Lawson: Okay. Thank you very much. And again, I'm Schuyler Lawson. Thank you all for listening to another episode of Buffalo HealthCast. Take care and be well.
Outro: This has been another episode of Buffalo HealthCast. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.