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Emerging data show that African Americans and other U.S. ethnic minorities are being stricken by COVID-19 at a higher rate, and experiencing greater sickness and a higher death toll than other Americans. Some have said that COVID-19 is “ravaging” black communities. In this interactive conversation, five faculty members from the School of Public Health will discuss how racism shapes vulnerability to COVID19, why African Americans are being so heavily impacted, and why these disparities matter.

This event is sponsored by the Othering and Belonging Institute at UC Berkeley and the School of Public Health.

Denise Herd (Moderator) is a Professor in the School of Public Health and Associate Director of the Othering and Belonging Institute at UC Berkeley. Her research focuses on health inequities, social movements, the social construction of health and the social epidemiology of substance abuse issues in U.S. ethnic minority populations.

Amani Allen is an Associate Professor in the School of Public Health. Her work examines how social factors such as race, racism, and socioeconomic status determine life experiences and opportunities differently for different social groups and impacts racial inequities in mental and physical health with particular attention to cardiometabolic risk, biological aging, and chronic disease.

Jason Corburn is a Professor in the School of Public Health and Department of City & Regional Planning. His research examines the drivers of health inequalities in cities around the world, with an emphasis on community participation, citizen science, and public policy.

Cassie Marshall is an Assistant Professor in the School of Public Health. Her research focuses on the development and evaluation of person-centered interventions to promote reproductive and maternal health equity.

Mahasin Mujahid is an Associate Professor in the School of Public Health. Her research examines racial/ethnic health inequities and the structural determinants of cardiovascular risk over the life course.

Osagie Obasogie is Professor in the School of Public Health and Joint Medical Program. His research looks at the intersection of race, bioethics, and health disparities.

For a UC Berkeley News article about this event visit: https://news.berkeley.edu/2020/04/24/straight-talk-a-conversation-about…


Denise Herd: Hello. I'm Denise Herd. I'm a professor in the School of Public Health and the associate director of the Othering and Belonging Institute, the two organizations that are co-sponsoring this event. It's my pleasure to welcome you to our session, Straight Talk, a conversation about racism, health inequities and COVID-19. Before we begin, I'd like to acknowledge and thank the Ohlone people for allowing us to shelter in place and work at UC Berkeley on their beautiful land. The theme of today's session was selected to help us think more deeply about the racial inequities that have emerged in the cases and deaths from COVID-19 in the US. Statistics from all over the country show that African Americans are getting infected and dying at much higher rates of the disease than their proportion in the population. And these high rates aren't confined just to African Americans. Native Americans, Latinos in some states and neighborhoods, even right here and in our San Francisco Bay Area, are also experiencing extremely high rates of sickness and deaths from COVID. These figures are tragic and disturbing evidence of the deep racial differences in the country at a time when the media keeps telling us we're all in this together. The focus of today's session is not to dwell on more facts and figures about these disparities, but to start a conversation about structural racism as a paradigm shifting focus. We want to foster more understanding of the structural causes of these problems, and also to think more creatively about our path forward to stop the sickness and dying, promote recovery and prevent future disasters like this. Our speakers will highlight how racism shapes the social conditions that create more risk among vulnerable populations. And of equal importance, they will discuss how we need to have an anti-racist lens to design effective interventions against COVID-19 and its fundamental causes. I'm joined by an extraordinary panel of experts, all professors from the School of Public Health, and all of whom are members of the Health Disparities cluster at the Othering and Belonging Institute who will focus on this issue. First, we have with us Amani Allen. Amani is an associate professor in the School of Public Health, where she also serves as the Executive Associate Dean. Jason Corburn is a professor in the School of Public Health and in the Department of City and Regional Planning. Cassie Marshall is an assistant professor in the School of Public Health. Mahasin Mujahid is an Associate Professor of Public Health and the Chancellor's Professor of Public Health. Osagie Obasogie is a professor of bioethics in the School of Public Health and Joint Medical Program with UCSF and the Haas Distinguished Chair in health disparities. Today's format will include conversation by our panelists, followed by a Q&A with our audience on Facebook. And so now, I'm very pleased to turn the conversation over to several of our panelists, Mahasin Mujahid, Amani Allen and Osagie Obasogie, who will talk with us about how they enter this conversation and what perspectives they bring to the problem that we're here to discuss today. So thank you, Mahasin.

Mahasin Mujahid: Great. Thank you, Denise, and thank you to the organizers of this important and timely panel. So I'm gonna enter the conversation as a social epidemiologist who really genuinely believes in the power of data. Data can be a powerful tool when collected rigorously and inclusively. It can be undeniable, and it can really highlight important inequities in health, and it can also lead to or pinpoint potential solutions. So one example of this is from the Heckler Report of 1985, and this was out of the Department of Health and Human Services. And it really raised national attention about the status of minoritized populations in the United States. And because the data were undeniable, it led to the creations of the Office of Minority Health for the Centers of Disease Control and the National Institutes of Health. And it also led to, as part of our report card on how we're doing, whether or not we are working to eliminate health disparities as a part of that report card, and that's, again, because the data were undeniable. So it was in this vein that many began to call for data based on race and ethnicity in response to this COVID-19 pandemic. So we heard from representative Ayanna Pressley. We heard from senators Elizabeth Warren and Cory Booker, as well as Kamala Harris. And we really needed to have data to back up what people in the trenches were seeing, and that's the piling up of black and brown bodies across the country in hotspots like Detroit, Michigan, in Chicago, Illinois, as well as New Orleans, Louisiana. And what we got was a confirmation of our worst fears. It was data that started being reported in the beginning of April that said things like in the state of Michigan, where blacks make up 14% of the population, they made up 41% of COVID-19 deaths. Similarly, in the state of Louisiana, blacks made up 32% of the population but 70% of deaths due to COVID. And so I mentioned that these data are alarming, but they're certainly not surprising. And we have other examples of this throughout history, and we'll unpack that more throughout this panel. But equally unsurprising are the explanations that followed the results of this data. So we heard from prominent officials that the reasons why blacks are more likely to die is because they're more likely to have underlying conditions. And indeed, there's data that comes out of the Centers for Disease Control that highlights that 90% of hospitalized patients have one or more underlying conditions. And these are conditions like hypertension, which leads the pack, as well as obesity, diabetes, chronic lung disease and cardiovascular disease. So it's easy to understand the basic logic. If A equals B and B equals C, then A equals C. The reason why African Americans are dying is because they're more likely to have these conditions. Quite frankly, it helps us to sleep at night, right? It alleviates the burden and the responsibility that institutions and systems play in shaping the opportunity and resources risks across the social hierarchies that exist in the United States. So we have to do better. We have to really acknowledge the role of social determinants in shaping the distribution of resources and opportunities. But more importantly, we have to highlight the critical role that structural racism is playing, not only in this COVID-19 pandemic, but why black and brown and other other marginalized populations live sicker and die younger in the United States. So I'm gonna turn the conversation over now to Amani Allen to continue to unpack these things.

Amani Allen: Thank you, Mahasin. And again, thank you to the organizers of this panel. It's really a pleasure to be on a panel with my friends and colleagues to talk about this very important issue. So I'm entering the conversation also as a social epidemiologist who studies, specifically, why black people live sicker and die sooner than others and how racism becomes embodied. And as Mahasin said, this virus is playing out along racial lines, and this is because race is a major source of social division in this country. And it's not just about someone being mistreated in a restaurant or acting as if they're surprised at your level of intelligence, which we've all experienced time and time again. It's really about being denied the opportunity to thrive in this country, socially, economically and politically. It's about who holds voice and power in this country to decide, for example, the number of liquor stores versus grocery stores that will be allowed in certain communities, where funding for our schools comes from. It's about where toxic waste facilities will be located, who will be stopped and frisked. It's about race-based consumer marketing. So sure, people should exercise good health behaviors, but the longstanding patterns of race-based health disparities that we see in this country is not about health behaviors. Racial differences in health behaviors are simply just not big enough to account for the stark disparities that we see in health by race. In fact, for almost any outcome that we look at, we see blacks doing worse, worse than other groups, with Native Americans as a close second. And so the bottom line is that as horrible as the coronavirus is, what we are seeing in terms of the racial distribution of this virus is actually not about the virus at all. It's about racism. We saw it with Katrina. We saw it with H1N1, the Flint water crisis, and we're seeing it playing out right now with climate change in terms of who's most vulnerable. And every time we have a catastrophe and see these patterns, everyone gets upset and asks why, but to many of us, this doesn't come as a surprise. It doesn't come as a shock at all. The racial distribution of this virus is actually very predictable and is what we will likely see a year from now when we look at the residual impacts of the virus on communities of color, and not just black communities, Latinos, Asian Americans, et cetera. We're talking about jobs, access to healthcare and the residual stress, among other challenges. Now, I was reading a, I was looking at a piece written by Soraya McDonald from The Undefeated a few weeks ago. And I really think she had it right when she said the most prominent pre existing condition is race. And I would actually argue that it's racism, and that's because racism determines exposure to a lifetime of risks that result in poor health overall and poor access to a host of health-promoting resources. And this dates back to the history of slavery, to black codes during Reconstruction, Jim Crow, redlining, mass incarceration, stop and frisk. All of these experiences which have truly characterized the lives of blacks in this country with almost no relief have created a situation that has made it impossible for blacks to have the same opportunities as others. So it's opportunity. It's stress. It's socioeconomic mobility. My mother had to drink out of colored only water fountains. And so that's only one generation removed, at least from where I sit. And so, until we recognize and institute policies to correct these wrongs and even the playing field, we will continue to see these racial patterns emerge with every passing epidemic. And when we think about chronic experiences of racism over one's lifetime, we have to also talk about stress and what it does to our bodies. Stress on our bodies is like a continual fire that eventually just erodes our ability, our body's ability to operate. And eventually our bodies or the systems in our bodies give out and they're no longer able to carry out their functions properly, leaving us more susceptible to disease and death. So for example, chronic stress, including chronic experiences of racism, can erode our immune systems and our ability to fight infection. It can cause heightened inflammation in our bodies, which impacts cardiovascular health and has been associated with aa number of other chronic diseases. And so at the end of the day, yes, there are pre-existing conditions, but the question is what is the pre-existing condition that we see over and over again, regardless of what catastrophe we might happen to be dealing with at the time. So I'll stop there and turn it over to Osagie who I'm sure will have a lot more to say. Osagie?

Osagie Obasogie: Great. Thank you, Amani. So I'm entering this conversation as a legal scholar and a social scientist who studies history, theory and bioethics. And I'm interested in how racial disparities that we see in the COVID-19 case are tied to the long legacies of previous forms of racial exclusion, such as slavery, eugenics, Jim Crow, and other forms of legal and extra-legal subordination. So we have to understand how these linkages are tied together in order to truly understand what's going on and how to fix it. So we, I think one of the questions we'll talk about today during our conversation is how does acknowledging this history help us broaden our understanding of this problem. And so we really have to think about this as not only a pandemic around COVID-19 but also understand that racism itself is a pandemic. What we're seeing is, what we're seeing now is the symptom of existing structural inequities, not something that is new or unexpected. So indeed, this outcome was entirely predictable. So an inability to acknowledge this dark history and to speak truth actually makes public health as a field part of the problem. And as public health practitioners, we really have to approach this tragedy and this ongoing problem with a deep understanding of history theory, in order to make the connections that are necessary to improve people's lives.

Denise Herd: Okay, thank you so much, Amani, Osagie and Mahasin. I now wanna turn to our other two panelists to talk to us a little bit more about what's the aftermath of the kind of disparate rates we're seeing with COVID in African American and other marginalized communities.

Cassie Marshall: Thanks, Denise, and like everyone else, I'm so thrilled to be here. I enter this conversation as someone who thinks a lot about reproductive justice and healthcare delivery, specifically interventions that happen in the healthcare setting to promote equity in the space of reproductive health and maternal health. And so I became increasingly alarmed at what was happening when I started to think of the long-term impacts of COVID-19 on the populations that I care about and study. And so one example of this really has to do with maternal health. And so due to all the things that have been said before, we're already battling a crisis in maternal health in this country, and this is particularly true among black women and populations. You often hear the statistic that black women are three to four times more likely to die of pregnancy-related causes than white women in America. And this was already going on before COVID-19 and has everything to do with what was just discussed, specifically around the chronic stress that comes with living with racism and sexism in the United States. When I began to think about what COVID-19 might mean for birthing people, people currently pregnant and having to go to hospitals to give birth, I was increasingly alarmed. In New York City where, was an epidemic of COVID-19, very strict policies were put into place to deal with the epidemic and to protect healthcare workers, of course. But what ended up happening is that the policies that were being enacted were thought to, what I anticipated were going to impact the populations that we were already concerned about. So one example of this was the limitation of visitors in birthing suites. So in some cases, no visitor is allowed, so not a support person, not a husband, not a partner, and certainly not interventions that we already know can be beneficial for black woman. In some of my research in the work that I'm doing right now, we focus on the role of community doulas as interventions to provide support for black women, to help them advocate for their needs and desires in what's often a racist healthcare setting. And at this point, that was no longer being allowed. And so increasingly, it became clear that what was happening with COVID was not just going to impact COVID. It had these long-term impacts. And so many have already predicted that COVID-19 may increase the inequities and disparities we already see around maternal health due to the stress, fear and anxiety that people feel. You know, you can imagine being a pregnant, birthing person right now. And so I've been thinking about it from that lens, and also from the lens of what interventions need to be employed to address these inequities and disparities as we move forward. And Jason, I'd love for you to add to the conversation now.

Jason Corburn: Okay, thanks, everyone. And I wanna just build on what everybody has been saying. And I come to this as someone who looks at places where we live, learn, work, pray and play and how that influences health outcomes, and how community members, in particular, need to be at the center of both the science and the solutions, the policies that we need moving forward, as Denise said. So when we think about responses to this crisis, we need to think about that health starts in our communities. Disease management often starts in the clinic or the hospital, which means that we need to treat our neighborhoods, not just individuals, in this response. And we what we know is that our health and the health of our communities doesn't happen randomly, as Amani and Osagie and others have said, but it happens deliberately through policies and deliberate practices. And so in our response, we need to actually change those practices and policies in the long term. And some of those have been mentioned already, particularly things like housing, so racist housing policies like redlining, which designated black communities, starting in the '30s, as risky or red, telling banks not to issue loans to black folks, denying home ownership, resources to improve communities and wealth creation. Racism in housing was also, came in the form of white homeowner associations that use violence to keep people out of certain neighborhoods. Other housing policy called urban renewal bulldoze existing healthy black communities, and it was done often in the name of public health and hygiene. So we have to look internal to our own discipline when we think about responses today. And in that space of those healthy communities were built highways that often pollute our communities today. So this, all of these things, as folks have mentioned, contribute to those stressors of living in a segregated, racially residentially segregated neighborhood, and that may be the most severe epidemic that we're not addressing. So we're starting already with solutions that we have to look at both in this crisis, but as long-term public health, anti-racism solutions, things like moratorium on evictions, rent forgiveness, housing all the homeless. These are things we have proved we can do it in this response, so we need to think about this in the long term. Amani and others talked about those toxic stressors that continue in communities today, that system of local terror known as the war on crime and drugs, get tough on crime. It really militarized our police departments, put all of our local government resources and majority of those budgets go into policing. And the racist sentencing laws, things that are being talked about today, this has got to be part of our response to this crisis, contributing to incarceration and that stress of police terror, and the impact that's having on our bodies. But decarceration, again, is possible. It's happening. It's necessary now, and we need to move forward with keeping that at the fore of our strategies. I also look at how local governments make land use decisions about what goes where, what opportunities in what places happen. And this is, like folks have already mentioned, the opportunity to be healthy, like when a toxic industry is located and allowed to pollute in and next to black and brown communities, this is environmental racism, and we need to address that. And we know black and brown communities are more exposed to air pollution, which contributes, like folks said, to that asthma and respiratory illness, which puts you at more risk today from this virus. And that same environmental racism limits communities from having those health-promoting resources like clean drinking water, as has been mentioned, or water in the first place like in many indigenous communities. This is another form of institutional racism, these land use strategies, land use planning, also known as, it includes land use zoning. And that shapes our ability to make healthy choices, such as when jobs, housing or supermarkets are given subsidies to locate in certain places but not others. So this is a particular form of institutional racism that gets layered on many others. And what we're gonna see, I'm fearful, is that local governments are gonna be really strapped for cash in this economic crisis that's accompanying the public health crisis we're facing. And what typically happens is when local governments face financial strain, they Institute something called plan shrinkage, which is just policy speak for removing supporting, life-supporting services in black and brown communities. So these cities start closing things like fire stations and hospitals in those poor communities of color. We know this has happened before. In fact, the majority of hospitals closing today are happening in black communities. So it's this overlapping set of factors, this structural racism that we need to put at the fore of our response, so that, we need to address the multiple institutions that have allowed, like folks have said, more liquor stores than libraries, more pollution than parks, and more homelessness than hospital beds in our communities, and recognize it is not the fault of those living there, and we can't treat our way out of this challenge. Now, I wanna just also say a little bit about decision making, as Denise suggested, and how we can think today together, moving forward, and recognize that there's also racism in the decision making processes that are happening right now that we need to identify. Who has power and who's at the table in the science and health conversation and policy conversation? So that racism in our institution devalues and dehumanizes by systematically excluding certain people. So in this pandemic, the narrative is, you know, a common one, but I think also a very misleading one, for example, namely that science, you know, will ride in on its white horse and save us. This is another form of racism that we need to identify and address because it ignores in that science that the history of medicine and public health have and continue to oversample, experiment on and test on black and brown bodies, all with serious adverse health implications. So this is something we need to also put at the fore of our decision making as we move forward, that this history of exclusion helps explain why many folks don't trust the epidemiologists and the decision makers and the modelers who keep saying, you know, "We're going to follow the science, not the politics," but hiding those uncertainties and assumptions that's always embedded in our science. It doesn't make it wrong. It means we need to make it more explicit as we move forward, and it also means we have to acknowledge a new form, an existing form of expertise which comes in our communities, the assets and expertise that already exists in our communities because it improves not just the science and the decision making, but it makes it more equitable and just. So we're not hearing, for example, from those existing community experts, the community health workers who are already out there in our communities, the promotoras, the street outreach workers who are doing things like, you know, interrupting gun violence. Those folks are experts in our neighborhoods. We need to engage them in the solutions moving forward today for coronavirus, the domestic workers, frontline healthcare workers of color, the farm workers, and many, many others. We need to recognize that these experiences of racism, there's a local expertise that we need to address and engage, involve in our decision making.

Denise Herd: Okay, well, thank you so much, Cassie and Jason. Those were excellent points. And now, you know, based off of those points, I'd like for the panel now to think about, you know, what are ways that we need to move forward? How does the anti-racist lens help us move forward in addressing COVID-19? How can we think more creatively about what are the kinds of things that we need to do?

Amani Allen: So Denise, if I could just start by making a point that, I just wanna reemphasize a point that I made earlier, which is that the pattern of racial disparities that we're seeing with COVID-19 is consistent with the pattern of disparities that we see across a number of health outcomes and that we see across a number of social risks. And that is the epidemic, right? The epidemic is that once COVID is gone, the racial disparities in health are gonna still exist. And we don't wanna get lulled into a false sense of security once that's gone, until the next catastrophe happens and we see the exact same pattern emerge. And so, you know, I think Jason brought up a good point about this kind of narrative and mantra around individual responsibility and recognizing that it lives in the systems of our society, and until we actually look at those systems and question what kind of unintended, intended or unintended consequences might this policy have on this community, have on that community. My sister sent me a text this morning, and it, so we hear all this stuff all over the news kind of talking about Georgia is opening back up and all these places are opening back up. And there's been a huge outcry among the black community. Well, why are you opening up places where it's predominantly African Americans? Like, we're not gonna open up until the golf clubs open up, until, you know, all the places that are not predominantly populated by African Americans open up. So even when we think about the decisions that are being made to open up different places, who populates those places, et cetera, we need to think about those things in terms of who's going to be disproportionately impacted. So I guess my point, what I'm trying to get across is this idea of, and it's something we hear in public health all the time. Health is in all policies. And so until we look at education policy, transportation policy, food policy, all of these other kind of what many would probably not consider to be health policy, they are health policies because they have, again, whether they're intended or unintended, they have impacts on health. And we have to question whether or not the policies, practices and norms that we're putting into place have the same benefits and same harm, and levy the same harms across all communities. And I think what we see time and time again, it will be different if what we see in terms of racial differences, well, not even racial differences, if what we saw in health was randomly distributed in the population. But it's not, and it's because of the non-random distribution of health and illness in this country that we have to start to tackle not only health risks but the social risks that put certain communities at a greater health disadvantage.

Osagie Obasogie: Yeah, Amani, one of the things I've been interested in that connects with what you said is how, as more data has been released showing which populations have been vulnerable to COVID-19, such as folks who are elderly and African Americans, that has correlated with increasing calls to reopen America. So that is to say that once folks realized that the people who were being disproportionately harmed tend to be black folks and old folks, there was this kind of sensibility that kinda, again, correlated, not caused by but correlated with this kind of growing claim that we need to move past this and push forward. And what I wanna suggest is that that correlation really highlights the lingering eugenic ideology that's persisted within our society, that is that there are certain populations that simply don't matter, and that if a disease is disproportionately harming them, we can let that disease carry its course in some Darwinian fashion and let it wash these people out and we can get on with our everyday lives. And so that's why I said in my earlier comment, it's really important to make sure that we understand COVID-19 in a particular historical context so that you see that there are these kind of recurring themes and approaches to vulnerable populations that repeat themselves over time, and how that understanding can help us respond to COVID-19 and future health epidemics in a more appropriate fashion.

Denise Herd: Did anyone else have any comments on these points that have been made or examples of approaches that, you know, are coming from an anti-racist lens that can pave the way for interventions into, as Amani pointed out, the pandemic of racism, as well as this pandemic? And I do wanna emphasize, reemphasize something that Amani said, and that is we are living with epidemics. I mean, right now, for example, African Americans constitute 13% of the population and 43% of new HIV infections and of people living with HIV. So I don't know if COVID is going to go away, but are there some interventions or approaches that we can point to that might lead the way for showing us how can we deal more creatively with, you know, addressing racism itself and this very serious disease? And perhaps we can hear from Cassie or Mahasin on this thing.

Cassie Marshall: Yes, certainly. I think that is a great point. And you know, as I've mentioned, the areas that I'm thinking about really are around reproductive health and maternal health. When we saw that COVID was quickly turning into a maternal and infant health disaster, I immediately began thinking we need to think creatively and address like short term the things that can be done. So I mentioned before about birthing people having limited access to support during COVID. And so some of the things I've been thinking about are how can we quickly move to telehealth versions of support. So not just telehealth visits with healthcare providers, but telehealth midwifery care, health care, telehealth doula care. And that might, for some populations, mean providing the tablet, providing the data plan, providing those type of things that people may not have to get them through these crisis moments, right? It also might mean avoiding the hospital completely, so serving some movement to try to get birthing people out of hospitals. Are there opportunities for birth centers? Are there opportunities for home births? And the problem is that the populations that experience the greatest burden of disease often aren't able to quickly move into a home birth or quickly have access to birth centers. There may be no birth centers in their communities at all. So for me, what I was hoping for was for these creative and quick solutions that would target the people most in need. I definitely believe a one size fits all approach will not work. And we're thinking of the long-term implications of this. We need to really infuse the populations that need it with the greatest resource.

Mahasin Mujahid: And I, you know, I think I would just add on to that, that the interventions that are really going to tackle the situation that marginalized populations find themselves in may not start with the healthcare system. I mean, I think what we see throughout history is that sometimes, the worst thing for black and brown populations is to interact with the healthcare system. And we have data from audit studies that show that when blacks go to the ER and go to the hospital, they're less likely to receive pain medication. They're less likely to receive recommendations and referrals for lifesaving procedures. And so the solutions may not always lie in the healthcare system and may require us to think about the strengths and assets in our communities. I think one of the unique issues with COVID is that a lot of the ways in which we draw on community level resources and sources of support are also causing us risk right now. Our social support networks are being strained, and the long-term consequences of that are going to further exacerbate health disparities because we're not gonna have those same buffers. So we have to make sure that we are rebuilding those networks by making sure that we do things like focus on mandatory paid sick leave policies, focusing on redistributing resources so that people whose safety nets are dismantled from this pandemic have a way to refuel them. And it's gonna require, I think the hard thing for us to struggle with is that there's conversations in every public health department across the country, in every hospital system around health equity, but I think people really struggle with what it means. I think this idea that we invest equally in all people is something that people can't wrap their heads around. Let's invest equally in all of our kids. It doesn't mean that we do it, but we at least can wrap our heads around it. But instead, what we have to do is acknowledge that for some people, in some communities, we're starting 10 feet under, so we're gonna have to invest more resources into those communities. And I think that's gonna be, the challenge for us moving forward, is actually doing that.

Amani Allen: And I would add to what Mahasin is saying. Like one of the things we know from national surveys, so the National Opinion Research Council commonly does national surveys to kind of assess the attitudes of the US population. And racial attitudes, that's one type of attitude. And so people are asked, do you believe that everyone should have an equal opportunity for X, Y, or Z? And commonly, we see very kind of high frequency scores suggesting that in general, Americans believe that everyone should have equal opportunities to education, to jobs, to wage. Do away with labor and wage discrimination, et cetera. However, the follow-up question that asks, would you be willing to give up something you have so that these other groups who actually have historically not had it, it doesn't say it like that. That's the way I would say it. Would you give up something you have so that others can thrive? Then you actually see those numbers start to dwindle, right? You see them start to decline. And so ideologically, we want to all believe that we endorse kind of an egalitarian society and believe in the ideal that everyone should have an equal opportunity to thrive, you know. And people, there's still this mantra of, what do they say? Pull yourself up by your bootstraps. And Eduardo Bonilla-Silva, a prominent sociologist, and I love this line, is known for saying, "But they took my boots. "Like I don't have boots. "I don't have any boots to pull up," right? And so until we give everyone boots, we can't expect for everyone to actually be able to pull them up. And so I think this is a fundamental challenge we have in our society between ideologically, who we want to believe we are and what we're willing to do in terms of our action to really create, like Mahasin was saying, not equality types of interventions, but more targeted universalism, proportionate universalism types of interventions where we distribute resources according to need, especially among those who have been historically disenfranchised.

Denise Herd: That's a great point, Amani. And I just wondered, before we shift to taking questions from our audience, if there's any, anyone who wanted to make a very brief last comment about solutions. Jason, did you wanna make a comment?

Jason Corburn: I just wanted to echo what my colleagues have said right here that it's really important that anti-racism strategy, an anti-racist strategy is also confronting white privilege. And that's got to be historic, like Osagie and others are mentioning, and it's got to be current. And it's not a one size fits all. It's got to look at the place privileges and the population privileges that white people have and continue to have, and continue to have in our own disciplines of science and public health and medicine. So you know, one thing we can do right away, really, is look more closely internally in our own community, whether that's where we work, live and play. So, and I really agree that we, we need to take this targeted approach, what we call in urban planning urban acupuncture, really finding those important points to intervene, and it's not a one size fits all across the board.

Denise Herd: Okay. Thank you all so much. And now, I'm going to take some of the questions that we've been, that are coming in through Facebook and ask the panel to address them. One of the first question is, what can we do on the ground to address health disparities through the pandemic and beyond? Jason or, who would like to tackle that?

Jason Corburn: Well, I mean, I think there's a lot of things. Many of them were mentioned. I mean, right away, we need to be investing in, like I said, our community-based organizations that are already on the front lines. Those are also frontline workers, our community-based organizations working with youth, working with young people, working with formerly incarcerated folks, working to prevent those other epidemics we talked about, like gun violence, in our community. So there's, and this is actually happening as a response. And, for example, for contact tracing, is to deeply, deeply invest, hire people. Pay our promotoras, our community health workers, you know, a really healthy wage to be able to do the work that they do, which is build connection, build trust, and get good health information and services to folks who need it, who may be not accessing it right now. We can do that today. We can do that immediately.

Denise Herd: Okay, thanks so much. Another similar--

Cassie Marshall: Denise, Can I jump in for that one--

Denise Herd: Sure, yes.

Cassie Marshall: As well? Just one thing I was gonna add is be the voice of everything you're seeing here. I think too often, in conversations, casual conversations, when you're, you know, talking about what's going on in the popular news, or you're saying, "Oh, you know, it's coming out that, "you know, minorities are more likely to experience "complications from COVID or to get COVID," and people will use those kind of explanations. Oh, well, they have a higher proportion of chronic diseases. Oh, it's caused by this. Oh, it's caused by that. And what I would say anyone can do is start calling that out, complicate that, right? They will, there's a reason for that too. And if you go back further and further, you get to these root causes that we're discussing here. And I think the more that people can complicate that, can bring that up in their families and their friend networks, will start to really change the conversation.

Denise Herd: Well, Cassie, that's a really excellent point. I mean, and I think one of the main goals of this session was to get conversations started about structural racism, because we're not seeing it. We're not seeing it in the media. We're not seeing it necessarily amongst some of the people thinking about it in terms of health. So I think that's a really, really excellent recommendation. Some other questions that have come in are, how can we apply an intersectional lens to COVID-19 disparities?

Amani Allen: So one thing I would jump in and say about intersectionality, I mean, there are lots of different intersections that we could consider, but going back to some of what Cassie was talking about, black women in particular, I do a lot of work on black women, on African Americans in general. But when we look at kind of the intersection of race and gender, I think we see some very challenging disparities before us. We know, for example, that black women comprise the majority of the essential workforce. And so black women, just in that statistic, excuse me, just in that statistic alone, we know are at greater risk for exposure because they're out there on the front lines. And it doesn't mean that other groups aren't, but we're seeing it really highly among African American women just in terms of the opportunity for risk exposure, the opportunity for exposure because of that. And so I think we have to, you know, when we think about black women, we also can think about responsibilities for childcare and a number of other challenges that create an additional burden of stress that, again, we already know can set someone up to be more biologically susceptible to a variety of poor health outcomes, COVID just being one of many. So I think we can talk in a number of ways about the intersection of not just race and gender, but race and class, class and gender, race, class and gender and really think about the ways in which, and this gets back to Jason's point about, what did you say, urban acupuncture. It's really finding those targeted groups, because when we use these kind of population level approaches knowing that the majority of our population has not been affected, infected, I should say, the majority of our population has not been infected. And so administering interventions to the population at large may not actually be the most efficient use of resources, versus identifying the groups, those intersectional groups that are most at risk and shunting resources towards those groups that have a more effective response to COVID-19, but I would argue, to social challenges that continue to put the same groups at risk over and over again.

Denise Herd: Okay, thank you. Thank you, Amani. That was really important. Can anyone on the panel address the role of economic development and gentrification in some of the health issues that we've been talking about?

Mahasin Mujahid: Yeah, I'll start that off, and then I'll perhaps point to Jason. I think, you know, what's interesting about gentrification is I think it is sort of birthed in this idea of urban renewal and really trying to invest resources into neighborhoods and communities. And without understanding the unintended consequences, the potential unintended consequences of that, that kind of intervention that we think would be useful doesn't actually end up being, improving resources for the people who need it the most. So what we understand about gentrification is that not only is there this process of involuntary displacement, but even before that happens, there's an othering that happens in the places that you actually live. And that othering comes with a sort of toxic stress response that also increases your risk for a whole variety of health outcomes. And so when we talk about these anti-racist types of interventions, we can't rely on sort of a blanket policy or sort of a local ordinance to, on its own, consider the unintended consequences that it may have for marginalized populations. We have to anticipate it and make sure that there are precautions put into place, so for example, requiring that a certain proportion of low income individuals remain in gentrifying neighborhoods. And so it's this idea of trying to anticipate what those unintended consequences are and making sure that we address them on the front end before we see those consequences play out.

Jason Corburn: Yeah, I think that's an excellent response. And I would just add to that that gentrification and displacement, clearly a significant health impact and risk and set of stressors on folks, and often done from, by outside decision makers. We got real estate agents. We got developers. We've got planners. All these folks, investment bankers, are driving these changes. We need to shift who's at the center of decisions about land use and housing. So we need these kind of institutional shifts, and like Mahasin said, make sure that folks who are already in neighborhoods are controlling the decisions about what happens in their communities. There's no community I've ever visited that doesn't want improvements, but they want the improvements to be on their terms, and that people who exist and live there get the benefits. And that's not what we're seeing, so we need to really shift that conversation. And I think the last thing I would say is we need to take seriously public housing in this country. We need to stop vilifying that that's a bad thing, that that's only gonna lead to concentrations of poverty. There are ways and lessons from other places and other countries on how to do public housing well and inclusive, and there are pockets of communities around the country that are doing that. So that needs to be part of the conversation today about our response to COVID-19.

Amani Allen: And if I could just follow up on something Jason said and Mahasin, Mahasin, you were talking earlier about buffers, the kinds of buffers, the mainstays in low income communities and communities of color that have long been sources of health promotion in non-monetary ways. They don't have to be kind of economic injection, right? And what we tend to see with urban renewal is that the resources that bridge community and that make community life possible, the social supports, et cetera, that those disappear during times of urban renewal. And all of a sudden, we have a new cupcake shop instead of the barber shop where everybody would convene, and that was an incredible source of community, or the mom and pop bakery, or whatever it may have been, that there's this perception that because we're bringing new resources into communities, we're uplifting this community. But the problem is that when you don't have community voice, following up on what Jason said, is that the resources that are coming into communities are not necessarily the resources that these communities need or want.

Denise Herd: Yes, that's an excellent point, Amani. We have a question that's come in where people are concerned about what can we do for poor and elderly residents in Richmond, where there is no hospital. Jason earlier mentioned that hospitals have been closing at a rapid rate in African American communities. I think right here in Berkeley, there has been, have been protests about the possibility of Alta Bates closing. Does anyone have a response to this kind of question or issue?

Jason Corburn: Well, I mean, I don't have all the response, but I mean, they're exactly right. The closing of Doctors Medical Center a number of years ago really had a bad impact. That was my point before about hospitals closing around the country, even right here in the Bay Area, predominantly in communities of color. There's, you know, a very strong network of community-based organizations in West County, across the county, in the city of Richmond, and many longstanding existing community-based groups are doing great work on the ground to try outreach to elderly and communities of color. There's some work, I know, happening in North Richmond, which is kind of the unincorporated part, where there's been a big impact on the closure of affordable housing. So I would just point that person to maybe check out some of the networks that have been developed in West County. I know the RYSE organization, R-Y-S-E, has been leading a coalition of many, many partners in West County to ensure that folks who need services, like food and care, need to be checked in on, are getting those important services.

Denise Herd: Okay, thanks so much, Jason. I got questions going in a slightly different direction. What guiding questions should we ask around those, should we ask to people around us as we seek to address these more systemic issues that we've been bringing up? In other words, I think Cassie early mentioned, earlier on mentioned that part of what we can all do is to start in conversations with our family, with our co-workers, questions to help us think in a frame, a more structural frame of mind. Does anyone have suggestions about how we can take that approach better?

Amani Allen: So there's, I think there's a lot of power in the question why, and I think something as simple as that. A wise elder once told me that questions clarify thinking. And at Berkeley, I have had students come into my office, students of color, and convey concern about hearing over and over again how bad blacks are doing, how bad Latinos are doing, how bad Native Americans are doing when we look at health disparities. So identifying that disparities exist, right, which we know, without going further to ask the question why do those disparities exist. So the conversation often stops at the disparities exist, which can, in a lot of ways, naturalize and normalize the differences without interrogating the underlying reasons for those disparities. And so I think even just in simple conversations with one another, well, why is it that blacks have worse health? Why is it that there's a difference in the underlying distribution of socioeconomic position by race, right? That's not just by happenstance. There's a history in this country of the limited opportunity for wealth accumulation because of redlining, for example. There's a limited opportunity in this country when it comes to academic achievement because of the way that our schools are funded through properties taxes, which we know is a result of historical redlining and racial residential segregation. And so I think when we start to ask ourselves why, why and how, then hopefully, it'll force each of us, just as individuals, to dig deeper and really think about kind of the origins of these disparities. And I think that Cassie made a good point, which is we have to start having this conversation as a country. It's not enough that we have this conversation at the Berkeley School of Public Health, at Stanford, at the California DPH. Like, that's not enough. People need to be having these conversations around their dinner tables every evening, when they take walks. This hopefully will start to catalyze those kinds of conversations.

Denise Herd: We have a lot of questions coming in from our audience. People are interested in ways that they can help. They're interested in ways of reaching out in Berkeley and in ways that we can, on campus, help black students. So can any of you describe, and I think this is something we might be able to follow up on, but whether or not there are projects in Berkeley, for example, that people could work with, or campus-related projects that people could work with to help address what's going on with the pandemic related to race and racism?

Mahasin Mujahid: So I'll start. And I think that, you know, unfortunately, the initial sort of calls for work really focused on, you know, understanding the prevalence of COVID-19 in the population, trying to identify, you know, sort of vaccines, trying to do contact tracing, you know, sort of really to understand this at a population level. And while I think that's important, I think the next stage of that is going to really be to collect more data to understand the social patterning of not only the current COVID-19 pandemic, but the aftermath of it. And I think what we're gonna understand soon when we get the data is that, you know, the kind of stark differences that we see based on social sort of hierarchies are going to be even more pronounced. So there's going to be this post COVID or, you know, sort of era that we're entering into where, you know, as we see, unemployment is increasing. We see that, you know, that education is being sort of affected based on, you know, sort of who has access to high quality education as we shelter in place and what that's going to mean in terms of long-term consequences of that. So more and more, you are going to see studies and institutions who are funding work that's gonna unpack the social determinants of COVID-19, and so there'll be opportunities to get involved in that once those sort of studies emerge.

Denise Herd: Thanks. Were there any more thoughts from the panelists on this?

Amani Allen: One organization I'd like to highlight in the city of Berkeley in particular, since you mentioned that, Denise, is Healthy Black Families. And anyone who's interested can visit their website at healthyblackfamiliesinc.org. And I'm just reading from their mission statement, which is to educate, engage and advocate for the holistic growth and development of diverse black individuals and families. Their vision is a society that is fair, equitable and just, particularly in relation to black individuals and families. Health equity is achieved when we no longer see health disparities based on race. And the founder of Healthy Black Families is Vicki Alexander, who is the former health officer for the city of Berkeley. And they're just doing a lot to really not only educate, but to provide resources to black families in the city of Berkeley. So for those who are looking for organizations to support who are actively engaged in this work, I would just highlight Healthy Black Families as one of those organizations in the city of Berkeley.

Denise Herd: And I'd also like to invite everybody to check out the Othering and Belonging Institute's website. The institute is working very hard to gather resources. They are involved in training advocates, and they're working with a lot of people in policy and directly on the ground as a point for resources. We have been having a wonderful time with our conversation, but it's going to come to a close very quickly. I wanted to ask if the panelists, if they each wanna take 20 or 30 seconds with any final thoughts. They have to be brief because we have about three minutes left, and so we need to wrap up now.

Mahasin Mujahid: So I'll start by just saying that this is the first of a series of conversations that we're going to have. So stay tuned next week. We're going to have a panel with Nancy Krieger on May 1st from four to five p.m. So there'll be details on that posted on our School of Public Health website. I think, obviously, one conversation is not enough, but it at least was an important start of the conversation. I think if you wanna have some takeaways, you can, you know, sort of have your hashtag. We've seen them in the media, #Stopblamingblackpeoplefordying is one of them, #Whatdidyouthinkwasgonnahappen, this is not a surprise, #Weneedtodobetter. Those are a few that come to mind for me in terms of my closing remarks.

Amani Allen: 20 seconds. Anyone else? 20 seconds, Amani.

Amani Allen: I can't do 20 seconds. I'd like to say that everyone as an individual, I mean, we can just start as individuals, right? So just ask yourself where you enter this conversation. We each started with talking about how we enter the conversation. How do you enter the conversation? And how can you start to have a rippling effect in your own communities and networks by instigating these kinds of conversations, and to use the tagline of another organization, to really have courageous conversations about race and the impact of race and racism in this country, and how it impacts health disparities?

Denise Herd: Osagie, last words?

Osagie Obasogie: Yeah, I guess to follow up on what was said earlier by Mahasin and Amani, I think we all have to be okay with having uncomfortable conversations, because if we really wanna get down to the core of this problem around racial disparities and COVID-19, it's a really, really uncomfortable conversation. And once you are prepared for that, then you open yourself up to new ways of thinking about the world around us.

Denise Herd: Anyone else? Okay, well, thank you. This has been a wonderful experience. I really enjoyed coming to you with this great panel of experts, and friends and colleagues. And all of these are professors. We're all teaching classes on race and structural racism. So please check us out in the fall when we come back and teach a whole new slate of classes. Thank you all so much for being with us. And thanks so much to our Facebook audience who has also been great.